Vascular endoscopy for major vascular reconstruction: experimental and clinical studies

A new technique of vascular endoscopy employing fiberoptic endoscope and balloon catheter was devised. Experimental and clinical studies showed excellent visual field and optical quality. Our technique of vascular endoscopy has several advantages. First, the size of the balloon is large enough to obtain satisfactory visual field and can be applied to the great vessels. Second, the endoscope can be advanced or withdrawn in the balloon catheter during balloon inflation. Third, the endoscope is never in contact with blood, so thrombus formation can be prevented and complete sterilization can be achieved. Fourth, no blood is lost during the procedure because the graft is snugly tightened to the hard portion of the catheter. Vascular endoscopy is useful to observe orifices of the major aortic branches, to distinguish atheromatous plaque from thrombus, and to identify unexpected intimal tears by vascular clamps, which cannot be achieved by operative angiography. It is particularly useful for identifying the exact site of the entry or reentry in dissecting aneurysm. Although our experience was limited to intraoperative use, vascular endoscopy can be an invaluable method to examine, diagnose, and treat the patient who requires aortic, caval, or other major vascular surgery.