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Endoscopic intravascular surgery removes intraluminal flaps, dissections, and thrombus
G H White1, R A White, G E Kopchok
1Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Journal of Vascular Surgery
|February 1, 1990
Summary
Angioscopy-guided instrumentation effectively removed adherent thrombus and intimal flaps after thrombectomy and angioplasty. This technique revealed intimal injuries often missed by angiography, enabling endoscopic treatment for selected patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Intraluminal instrumentation, including thrombectomy and angioplasty, is crucial for treating vascular occlusive diseases.
- Assessing intimal damage and residual complications after these procedures can be challenging with traditional methods like angiography.
Purpose of the Study:
- To evaluate the utility of angioscopy-guided instrumentation in managing complications arising from endovascular procedures.
- To assess the effectiveness of angioscopy in identifying and treating intimal injuries and residual thrombus.
Main Methods:
- Angioscopy was used to guide instrumentation in 73 patients undergoing thrombectomy, 9 with vascular trauma, and 32 during laser angioplasty/balloon dilation.
- Flexible biopsy forceps, long flexible forceps, and rotating brushes were employed for intravascular manipulation.
- Intimal defects and thrombi were assessed and treated under direct angioscopic visualization.
Main Results:
- Residual thrombus was removed in 18% of thrombectomy patients; intimal flaps were also addressed.
- Intimal defects from trauma or iatrogenic injury were managed with thrombectomy and endoscopic flap removal in most cases.
- Angioplasty revealed significant thermal damage (87%) and plaque/intimal fragmentation (81%), often underestimated by angiography; endoscopic removal of large defects was successful in three patients.
Conclusions:
- Angioscopy provides critical insights into the extent of intimal injury and mechanisms of instrumentation damage.
- Adherent thrombus and intimal flaps are common post-intervention complications.
- Endoscopic intravascular manipulation guided by angioscopy is a viable treatment for selected patients with severe intimal injuries and residual thrombus.