ABSTRACT
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 (group I). For comparison, 42 similar cases of infrainguinal arterial reconstruction performed during the 12 months prior to introduction of routine 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). Defects were anastomotic abnormalities (n = 7), vein sclerosis (n = 3), retained valve cusp (n = 2), and proximal artery stenosis (n = 1). A similar 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 cusp [n = 1], and arterial outflow stenoses [n = 3]). All significant defects were surgically explored 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 = non-significant [NS]), and 86.1% and 73.7% (P = NS), respectively. Intraoperative angioscopy detects anastomotic and vein graft defects not always seen on arteriography; the repair of these defects significantly improves early infrainguinal bypass graft patency rates.
Subject(s)
Angioscopy , Arterial Occlusive Diseases/diagnosis , Blood Vessel Prosthesis , Femoral Artery/surgery , Graft Occlusion, Vascular/diagnosis , Postoperative Complications/diagnosis , Saphenous Vein/surgery , Tibial Arteries/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/surgery , Constriction, Pathologic , Female , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Graft Occlusion, Vascular/surgery , Humans , Male , Middle Aged , Monitoring, Intraoperative , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Prosthesis Failure , Radiography , Reoperation , Retrospective Studies , Saphenous Vein/diagnostic imaging , Saphenous Vein/pathology , Survival Rate , Thrombectomy , Tibial Arteries/diagnostic imaging , Tibial Arteries/pathology , Vascular Patency/physiologyABSTRACT
The influence of venous patching on luminal prostacyclin (PGI2) and thromboxane A2 (TBX) production of endarterectomized arteries was studied in a canine model. Fifteen dogs underwent bilateral common carotid endarterectomies. In each dog, one artery was closed primarily and the contralateral artery was closed by vein-patch angioplasty. At six and 12 weeks after operation, luminal prostanoid production from the venous patch, adjacent endarterectomized artery, and control artery and vein was measured by radioimmunoassay for 6-keto-prostaglandin F1 alpha and thromboxane B2. Venous patches underwent "incomplete" biochemical adaptation with decreased luminal production of PGI2 compared with control and endarterectomized arteries. Thromboxane production from venous patches was increased compared with normal vein but similar to control and endarterectomized arteries. At six weeks, PGI2 production of vein-patched arterial segments was increased compared with arteries closed primarily. These data indicate that vein-patch angioplasty favorably influences surface thrombogenicity of healing, endarterectomized arteries and support its use in reparative carotid surgery.
