[Use of angioscopy in vascular surgery bypass with an in situ approach--first year experience]

Femoropopliteal and femorocrural bypass, managed by "in situ" procedure with the use of angioscope, became a standard surgical method in the treatment of occlusive process in the arteries of lower extremities in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. The capabilities of angioscopy in diagnosis and in surgery are presented, with special emphasis on bypass "in situ" procedure. Technical difficulties encountered in bypass formation and our solutions are described. From December 1993 to December 1994, eleven patients were operated. Common femoral artery was used for proximal anastomosis in four patients. Superficial femoral artery was used in five patients, and profound femoral artery was used in two patients. The third segment of popliteal artery was used for distal anastomosis in five cases. In six cases crural bypass was done. Three of them were on posterior tibial artery, two were on fibular artery and one was on anterior tibial artery. Two out of four or 50% of femoropopliteal bypasses are patent after the first year. One patient died of cardiorespiratory complications in the early postoperative period. Femorocrural bypasses are patent in five out of six patients or 83.3%. Bypass with great saphenous vein "in situ" is the procedure of choice, especially in femorocrural position.