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Intraoperative angiography in arterial surgery
Insights
Intraoperative angiography in vascular surgery revealed unexpected issues in 39 cases. Prompt revision of these pathological angiograms significantly improved reconstruction success rates.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Vascular reconstruction surgery for aorta, iliac, femoral, and carotid arteries is complex.
- Assessing surgical success intraoperatively is crucial for long-term patency.
Purpose of the Study:
- To evaluate the utility of intraoperative angiography in assessing vascular reconstructions.
- To determine the impact of intraoperative findings on postoperative outcomes.
Main Methods:
- Intraoperative angiography was performed in 136 cases of arterial reconstruction.
- Pathological findings were identified and correlated with surgical revisions and follow-up outcomes.
- Comparison of outcomes between revised and non-revised cases with abnormal angiograms.
Main Results:
- 39 cases (28.7%) showed unexpected pathological angiograms, including non-occluding thrombosis and intimal damage.
- Immediate reexploration and revision of abnormal angiograms led to high success rates at follow-up (1-24 months).
- Non-revised reconstructions with pathological angiograms frequently failed early postoperatively; normal angiograms yielded excellent results.
Conclusions:
- Intraoperative angiography is a valuable tool for assessing vascular reconstructions during surgery.
- Prompt surgical revision based on intraoperative angiography findings improves long-term patency.
- Intraoperative angiography should be utilized more frequently in vascular surgery.
Abstract:
Intraoperative angiography was performed in 136 cases of surgical reconstruction of the aorta, iliac, femoral and carotid arteries. In 39 cases pathological angiograms were found at operation, some of them quite unsupected. The most common pathological finding was non-occluding thrombosis, but intimal lesions caused by vessel clamps and incomplete endarterectomies were not uncommon. Immediate surgical reexploration and revision resulted in a high frequency of open reconstructions at follow-up, which was performed 1--24 months postoperatively. On the other hand, nonrevised reconstructions with pathological angiograms usually failed in the early postoperative period. In cases with normal intraoperative angiograms the result at follow-up was excellent. In addition to electromagnetic flow determination, intraoperative angiography is a most valuable adjunct in the assessment of vascular surgery during operation and should be used more frequently. All pathological findings in the angiograms must be seriously considered and lead to reexploration and revision.