A comparative study of intraoperative angioscopy and completion arteriography following femorodistal bypass

B. T. Baxter, R. J. Rizzo, W. R. Flinn, C. N. Almgren, W. J. McCarthy, W. H. Pearce and J. S. Yao
Department of Surgery, Northwestern University Medical School, Chicago, Ill 60611.

A prospective comparison of the findings on standard completion arteriography with those seen using videoangioscopy was done following 49 cases of "femorodistal" bypass grafting in 47 patients. The two techniques were compared with respect to the detection of technical defects, modification of the surgical procedures, early graft patency (72 hours), and complications. Completion arteriography was specific (95%) but only moderately sensitive (67%) compared with angioscopy for detection of technical problems. Following angioscopy, significant alterations in the surgical procedure were noted in 5 (10%) of the 49 cases. Early graft failure occurred in 3 (6.1%) cases but none were identifiably due to technical problems. Four patients suffered postoperative myocardial infarctions, 2 (4.2%) of which were fatal; no patients had contrast-induced allergies or renal failure. Angioscopy was measurably more accurate for the detection of technical problems than completion arteriography, but offered little information about distal arterial anatomy that may have an impact on graft patency or the use of antithrombotic therapy.