Vascular endoscopy-angioscopy: current indications. A review of the literature

Over the past 25 years angioscopy has been successfully applied in three areas of Vascular Surgery: The in situ vein femoro-popliteal bypass, thromboembolectomy procedures and in peripheral vascular reconstructions, in order to evaluate the quality of distal anastomoses. During the first one, angioscopy may be used to facilitate the cutting of the valve cusps, to locate the exact position of tributaries to be ligated and to evaluate the distal anastomosis. Benefits derived from its use, in this operation, include: small incisions instead of the thigh-long performed in order to find and ligate the tributaries, no retained valve cusps and shorter operative times since it is no longer necessary to perform completion angiogram or Doppler studies. During thromboembolectomy procedures angioscopy may be used to assess the arterial tree for remaining thrombi/emboli and to guide thrombectomy catheters into vessels that remain occluded despite repeated attempts to unblock them. Checking the distal anastomosis in peripheral reconstructions may be of benefit, as it may depict intimal flaps or misplaced sutures that may produce early graft failure. Angioscopy has also been experimentally used to assist percutaneous interventional procedures, or as a diagnostic modality in the place of angiography. The benefits derived from its use have to be weighed against the cost of the equipment and the time it takes the would-be angioscopist to become familiar with its use and the interpretation of the obtained images.