IMPACT OF ANGIOSCOPY ON INFRAINGUINAL GRAFT PATENCY

To investigate the impact of angioscopy on infrainguinal graft patency , 50 consecutive cases with angioscopy as an adjuvant to infrainguinal arterial bypass performed during a 12-month period were reviewed (gro up I). For comparison, 42 similar cases of infrainguinal arterial reco nstruction performed during the 12 months prior to introduction of rou tine intraoperative angioscopy were also reviewed (group II). Patients were followed up for 12 months and graft patency was determined at 1, 3, 6, and 12 months. An abnormality was identified in 13 (26%) group I patients (10, angioscopy alone; 1, arteriography alone; 2, both). De fects were anastomotic abnormalities (n = 7), vein sclerosis (n = 3), retained valve eusp (n = 2), and proximal artery stenosis (n = 1). A s imilar percentage, but different types of defects, were seen in group II; 11 patients (26%) had an abnormality (anastomotic abnormality [n = 3], vein sclerosis [n = 4], retained valve eusp [n = 1], and arterial outflow stenoses [n = 3]). All significant defects were surgically ex plored and corrected. Graft patency rates in group I and II at 1, 3, 6 , and 12 months were 100% and 85% (P < 0.005), 94% and 80% (P < 0.05), 87% and 74% (P = nonsignificant [NS]), and 86.1% and 73.7% (P = NS), respectively. Intraoperative angioscopy detects anastomotic and vein g raft defects not always seen on arteriography; the repair of these def ects significantly improves early infrainguinal bypass graft patency r ates.