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Related Experiment Videos

Angioscopically directed interventions improve arm vein bypass grafts

E J Marcaccio1, A Miller, G A Tannenbaum

  • 1Harvard-Deaconess Surgical Service, New England Deaconess Hospital, Boston, MA.

Journal of Vascular Surgery
|June 1, 1993
PubMed
Summary

Intraluminal disease is common in arm veins used for bypass grafting. Angioscopy helps detect and treat these issues, improving vein quality and early graft patency.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Saphenous vein is the preferred conduit for infrainguinal bypass, but its unavailability necessitates alternative options.
  • Arm veins are frequently used as an alternative conduit when saphenous veins are inadequate.
  • Intraluminal abnormalities in arm veins can compromise graft patency.

Purpose of the Study:

  • To determine the incidence and location of intraluminal disease in arm veins for bypass.
  • To assess if angioscopy and interventions can improve arm vein conduit quality and early graft patency.
  • To describe the angioscopic technique for in situ retrograde arm vein inspection.

Main Methods:

  • Retrospective review of 109 infrainguinal arm vein bypass grafts in 104 patients.

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  • Intraoperative angioscopic vein preparation and monitoring were utilized.
  • Four arm veins with diffuse disease were excluded.

    • Main Results:

    • Intraluminal disease was found in 62.8% of arm veins, with "webs" being the most common (54%).
    • Disease prevalence varied by vein: cephalic (49.2% forearm, 35.1% arm), median cubital (33.3%), and basilic (11.7%).
    • Angioscopically directed interventions upgraded conduit quality in 66.1% of abnormal veins, leading to significantly higher primary patency (95.5% vs. 70% for inferior grafts).

    Conclusions:

    • Routine angioscopy is a sensitive method for detecting intraluminal diseases in arm veins.
    • Angioscopy-guided interventions can effectively upgrade vein conduit quality.
    • Improved conduit quality through angioscopy correlates with enhanced early graft patency in arm vein bypasses.