Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study.
OBJECTIVE
To find out whether intraoperative angioscopic assistance has any effect on graft outcome in patients with critical leg ischemia.


METHODS
One hundred one patients requiring a below-knee bypass were assigned to undergo in situ saphenous vein bypass with or without intraoperative angioscopic assistance; otherwise treated similarly including preoperative duplex vein mapping, intraoperative graft flow measurements, and angiography. Data on operative details, morbidity, hospital stay, and graft patency were collected prospectively and compared. All patients were followed up for 12 months.


RESULTS
The group that underwent angioscopy (A) and the control group (B) were similar in all respects, except for the number of patients enrolled in the groups (32 and 69, respectively). Angioscopy revealed incompletely destructed valves in 34 patients (range, 0 to 5; mean 1), undiagnosed vein branches in 111 patients (mean 4.3), and partly occluding thrombus in 5 patients. The number of postoperative arteriovenous fistulas with signs of failing graft and a need for angiographic or surgical reintervention were significantly higher in group B (P <.0001). The 1-year primary patency rate was significantly better in group A (P <.01), but the primary assisted and secondary patency rates did not differ between the groups.


CONCLUSIONS
Angioscopic assistance has an impact on primary graft patency, minimizes the risk for graft failure and thus reduces the need for reintervention by allowing identification of persistent saphenous vein branches, incomplete valve destruction, and partly occluding graft thrombus without adding extra operative time.
Thörne
Johan
J
Department of Surgery, Division of Vascular Surgery, University Hospital of Lund, Sweden. johan.thorne@kir.lu.se
Danielsson
Gudmundur
G
Danielsson
Peter
P
Jonung
Torbjörn
T
Norgren
Lars
L
Ribbe
Else
E
Zdanowski
Zbigniew
Z
D000368:Aged; D017546:Angioscopy; D001166:Arteriovenous Shunt, Surgical; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D014463:Ultrasonography; D014654:Vascular Patency