SAPHENOUS-VEIN ANGIOSCOPY - A VALUABLE METHOD TO DETECT UNSUSPECTED VENOUS DISEASE

Purpose: The presence of preexisting saphenous vein lesions adversely affects graft patency. Despite careful preoperative venous duplex exam ination and meticulous intraoperative evaluation, clinically significa nt saphenous vein discase may remain undetected. We evaluated angiosco py as a means to better detect these vein lesions. Methods: Ninety sap henous vein remnants, obtained at bypass surgery, were perfusion fixed for subsequent angioscopic and histologic evaluation. The specimens w ere categorized by independent examiners on the basis of the angioscop ic or light microscopic findings. Of the 90 vein remnants, 66 were nor mal by angioscopic criteria. Fifty-three (80%) of these angioscopicall y normal vein segments were normal histologically, and all 24 angiosco pically abnormal saphenous vein remnants showed disease on microscopic examination. Results: Angioscopy correctly identified sclerotic vein segments (n = 20) by irregular white plaques, whereas postphlebitic ve ins (n = 3) demonstrated multiple lumens, fibrous strands, and thicken ed opaque valve cusps on angioscopic evaluation. Absence of an angiosc opic lumen was confirmed histologically in occluded veins (n = 2). Ang ioscopy failed to identify thick-walled (n = 10) and varicose (n = 2) vein segments as abnormal; one sclerotic segment was normal angioscopi cally, thereby lowering the sensitivity of angioscopy. Conclusions: An gioscopy detected unsuspected preexisting saphenous vein disease in fi ve patients undergoing arterial reconstruction with saphenous vein. Be cause the use of angioscopy is a reliable means of prospectively asses sing the vein for most preexisting lesions, its routine use may ultima tely improve graft patency.