INTRAOPERATIVE VASCULAR ENDOSCOPY - EARLY AND LATE RESULTS

In a prospective study, 60 consecutive cases of vascular endoscopy wer e analyzed to examine the role of angioscopy in infrainguinal vascular procedures. A total of 52 patients had 60 separate vascular endoscopy procedures performed as an adjunct to various vascular procedures; re sults of intraoperative arteriography were available in 38 of 60 cases . All patients were followed for at least 42 months. The 19 patients w ho underwent thrombectomy with angioscopy were compared with 19 age-ma tched control subjects who underwent infrainguinal thrombectomy withou t angioscopy to evaluate the influence of angioscopy on primary and se condary patency rates. Angioscopy allowed observation of 50 lesions; a ngiography failed to detect three. These findings altered surgical man agement in 24 cases (40%). Primary patency rates for the control and e xperimental thrombectomy groups were 38.8% and 6.5% at 42 months, resp ectively (p = 0.010 based on log-rank test). Secondary patency rates f or the control and experimental groups at 42 months were 63.8% and 49% , respectively (p = 0.521). The limb salvage rate was 89% at 42 months for both groups (p = 0.973). Angioscopy provides the clinician with a direct view while he or she is performing vascular procedures. Howeve r, there was no statistical improvement in secondary patency and limb salvage rates. Furthermore, the use of angioscopy during thrombectomy may increase the propensity for subsequent intervention as evidenced b y the frequency of changes in surgical management and the lower primar y patency rate.