New angioscopic findings in graft failure after infrainguinal bypass

A. Miller, S. J. Jepsen, P. A. Stonebridge, A. Tsoukas, G. W. Gibbons, F. B. Pomposelli Jr, D. V. Freeman, D. R. Campbell, F. J. Schoen and F. W. LoGerfo
Department of Surgery, New England Deaconess Hospital, Boston, Mass 02215.

We have previously shown that intraoperative angioscopy is a safe, useful, and effective method for monitoring infrainguinal bypass grafts. The videotaped recordings of the intraoperative angioscopy studies of 25 failed infrainguinal bypass grafts inserted between May 1987 and July 1989 and 3 failing grafts that were angioscoped during the subsequent graft salvage procedure were reviewed in a systematic fashion according to a fixed protocol, to identify any endovascular findings either initially missed or in which the relevance to graft failure had been unappreciated at the time of bypass grafting. We were able to identify new venous pathologic characteristics and highlight endoluminal features, of both a technical and nontechnical nature, which have a probable causal relationship to graft failure. However, the significance of some of the endovascular findings that were seen during infrainguinal bypass grafting has yet to be fully defined.