Advances in Vascular Endoscopy

Abstract

In reconstructive vascular surgery several intraoperative investigations are in use to check-up and secure full blood flow restoration (angiography, ultra-sound, electro-magnetic flowmeter etc.). In the last years endoscopical lumen control, introduced 1969 in clinical praxis, could be remarkably simplified and improved. For vascular endoscopy three technical prerequisites are necessary: a) temporary interruption of blood flow using clamps or balloon catheters, b) replacement of the blood by a transparent medium via pressure controlled saline perfusion, c) availability of suitable special endoscopes. The main application of vascular endoscopy includes: a) semi-closed thromboendarterectomy (aorto-iliac or femoropopliteal), b) arterial embolectomy, c) lumen control of inserted grafts including the anastomosis and the distal run-off vessels, d) venous thrombectomy. The availability of small-calibre endoscopes (external diameter: 1.7-2.7 mm) enables the extension of lumen control to small vessel areas such as the tibial and coronary arteries. Compared with angiography vascular endoscopy offers several convincing advantages such as a more reliable three dimensional lumen control, easy performance, saving time and the avoidance of any additional X-ray exposure. Technical faults or overlooked concomitant vascular lesions can be diagnosed and corrected immediately.

Surgical Thrombectomy Followed by Intraoperative Endovascular Reconstruction for Symptomatic Ilio-femoral Venous Thrombosis

“…13,[16][17][18][19] After central venous thrombectomy using Fogarty catheters an ascending venography can be used to detect such residual stenoses. 14,15,21 We prefer wireguided thrombectomy as the endovascular procedure for residual thrombus. Adherent thrombi may also require additional catheter-guided thrombolysis.…”

“…20,21 Ascending phlebography was then performed in all patients to assess the iliac veins. 14,15 If residual venous obstruction was detected an appropriate endovascular treatment was chosen, depending on the location, morphology, and nature of the lesion. Wire-guided thrombectomy alone or in conjunction with local thrombolysis were used to manage residual thrombotic venous stenosis (TYPE II).…”

“…13 Therefore, venous thrombectomy needs to be followed by routine intraoperative angiography or alternative investigations (angioscopy or endovascular ultrasound) to detect which patients are at risk of developing recurrent occlusive thrombus. [13][14][15] Where residual obstruction is detected endovascular reconstruction (stenting, angioplasty or catheter-guided recanalisation) should be urgently considered. Few published studies report the outcome of combined surgical thrombectomy and intraoperative endovascular venous reconstruction.…”

Long-term results of semiclosed endarterectomy of the superficial femoral artery and the outcome of failed reconstructions

“…Patency can be improved by extending the intraoperative control by means of an intraoperative angiogram ~7 or by direct visual inspection by angioscopy. 18 In this study completion arteriography was not routinely performed; however, it is our opinion that intraoperative angiography should be performed to assess the quality of the arterial reconstruction.…”