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Angioscopy of arm vein infrainguinal bypass grafts
P A Stonebridge1, A Miller, A Tsoukas
1Harvard-Deaconess Surgical Service, New England Deaconess Hospital, Boston, Massachusetts.
Insights
Intraoperative angioscopy improved early graft patency in arm vein infrainguinal bypass surgery. This technique detected and corrected intraluminal abnormalities, reducing graft failure compared to standard monitoring methods.
Area of Science:
- Vascular Surgery
- Medical Imaging
Background:
- Infrainguinal bypass grafts are crucial for limb salvage.
- Arm veins are an alternative conduit for bypass grafting.
- Standard monitoring methods may miss intraluminal abnormalities.
Purpose of the Study:
- To evaluate the effectiveness of intraoperative angioscopy in preparing and monitoring arm vein infrainguinal bypass grafts.
- To compare the early patency rates of grafts monitored by angioscopy versus standard methods.
Main Methods:
- A retrospective review of 56 patients undergoing 66 arm vein infrainguinal bypass grafts between 1988 and 1990.
- Grafts were monitored using continuous wave Doppler, arteriography, or intraoperative angioscopy.
- Intraluminal abnormalities detected by angioscopy were corrected intraoperatively.
Main Results:
- Intraoperative angioscopy detected and allowed correction of intraluminal abnormalities in 74% (20/27) of grafts.
- Grafts monitored by angioscopy had no 30-day occlusions, achieving a 100% primary patency rate.
- Grafts monitored by standard methods had a 30-day failure rate of 18% (7/39), with a primary patency rate of 82% (32/39).
Conclusions:
- Intraoperative angioscopy is superior to standard methods for preparing and monitoring arm vein infrainguinal bypass grafts.
- Angioscopic detection and correction of intraluminal abnormalities significantly improve early graft patency.
- This technique enhances limb salvage outcomes by reducing bypass graft failure.
Abstract:
Between January 1988 and December 1990, 56 patients underwent 66 arm vein infrainguinal bypass grafts for limb salvage. Thirty-nine grafts were intraoperatively monitored by the standard methods of continuous wave Doppler alone (30) and arteriography (9). Twenty-seven grafts were prepared and monitored by intraoperative angioscopy. No significant findings requiring intraoperative revision or correction were noted in the grafts monitored by the standard methods. However, in those grafts prepared and monitored by angioscopy, intraluminal abnormalities of the arm veins were detected and corrected in 20/27 (74%). None of the grafts prepared or monitored by angioscopy occluded within 30 days, whereas, in those grafts monitored by continuous wave Doppler and arteriography, 7/39 failed within 30 days, a primary patency rate of 32/39 (82%) (x2 with yates correction, p = 0.055). This study shows that angioscopic preparation and monitoring of arm vein bypass grafts allows the detection and correction of unsuspected intraluminal abnormalities, which appears to improve the early primary patency of arm vein infrainguinal bypass grafts.