FEMORODISTAL VENOUS BYPASS EVALUATED WITH INTRAVASCULAR ULTRASOUND

Objective: To evaluate the feasibility of intravascular ultrasound ima ging during femorodistal venous bypass procedures to assess qualitativ e and quantitative parameters of the greater saphenous vein and to det ect potential causes for (re)stenosis and/or occlusion. Methods: Intra vascular ultrasound data obtained from 15 patients were reviewed and c ompared with angiographic data. Results: Intravascular ultrasound enab led differentiation between normal and thickened vein wall. Venous sid e-branches could be located. Intact valves could be differentiated fro m valves disrupted by valve cutting. Patent anastomoses could be disti nguished from anastomoses with some degree of obstruction. Intravascul ar ultrasound imaging of the inflow and outflow tracts revealed obstru ctive lesions, not evidenced angiographically. Quantitative analysis r evealed that the median normal vein wall thickness (tunica intima and tunica media) was 0.25 mm (range 0.17-0.40 mm). The distinct vein wall thickening encountered in three patients measured 0.82, 0.95 and 1.06 mm, respectively, and was associated with narrowing in two patients. In five of 15 patients intravascular ultrasound findings altered surgi cal management. Conclusion: Intravascular ultrasound is able to assess qualitative and quantitative parameters of the venous bypass and has the potential to influence surgical management based on morphologic an d quantitative data.