Routine intraoperative angioscopy in lower extremity revascularization
A. Miller, D. R. Campbell, G. W. Gibbons, F. B. Pomposelli Jr, D. V. Freeman, S. J. Jepsen, R. S. Lees, J. L. Isaacsohn, D. Purcell, M. Bolduc and al. et
Department of Surgery, New England Deaconess Hospital, Boston, Mass 02215.
The inability to see through blood remains the main obstacle to the
widespread and routine use of angioscopy. Local irrigation with a balanced
salt solution is presently the most widely used method to clear the blood.
By applying basic principles of irrigation and using a unique, dedicated,
irrigation pump, we found that routine angioscopy during lower extremity
revascularization that yields consistent high-quality studies is feasible,
clinically useful, and safe. Between May 1, 1987, and July 31, 1988, 136
intraoperative angioscopies were performed during 112 peripheral bypass
procedures, 15 thrombectomies, 2 embolectomies, and 7 miscellaneous
revascularization procedures. Mean total irrigation fluid used in the
peripheral bypasses was 398 mL (range, 0 to 1400 mL). Good visual quality
was obtained in more than 80% of angioscopies and the failure rate was only
1.8%. On the basis of the findings in 71 of the 136 angioscopies, 78
clinical or surgical decisions were made. No complications were directly
attributable to the insertion of the angioscope or use of the pump.
