Intraoperative angioscopy of saphenous vein and coronary arteries

During coronary artery bypass graft operations, the saphenous vein graft and native coronary arteries in 17 patients were examined with a 1.7 mm fiberoptic catheter to determine the feasibility of the procedure and its potential for clinical application. Good to excellent visualization in 10 of 11 proximal and 10 of 10 distal coronary anastomoses was obtained promptly and consistently. Good visualization of native coronary arteries was obtained in only six of 11 vessels. Three of three coronary arteries were visualized through the completed distal anastomosis, whereas only three of eight vessels could be visualized directly through the arteriotomy site before completion of the distal anastomosis. The image quality improved with operator experience. Vessel distention by cold crystalloid solution during catheter visualization was also important for obtaining better images. Limitations of the current "state of the art" fiberoptic catheters include the large size relative to the usual dimensions of the native coronary vessels, a lack of perfusion channel, and the absence of an angulation or guiding system. Potentially, angioscopic catheters may be useful as an instructional aid during bypass operations or as a diagnostic tool in monitoring arterial status after thrombolytic intervention, balloon angioplasty, or laser therapy.