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October 1990

Angioscopy for Intraoperative Management of Thromboembolectomy

Author Affiliations

From the Divisions of General (Drs Segalowitz and Grundfest) and Vascular (Drs Treiman, Wagner, Carroll, Foran, Levin, Cohen, Cossman, Gradman, Spigelman, and Shore) Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.

Arch Surg. 1990;125(10):1357-1362. doi:10.1001/archsurg.1990.01410220141020

• Our experience with angioscopy suggests that direct visualization of the arterial lumen during thromboembolectomy procedures would provide a more reliable method of assessing luminal morphologic characteristics than angiography alone. We inspected 32 grafts (seven aortobifemoral, 18 infrainguinal bypass, and seven dialysis access fistula grafts) in 32 patients. Thirty-one patients had thrombotic events and one patient had an acute embolus. Angioscopy following standard catheter thrombectomy revealed significant amounts of retained thrombus or neointima in all thrombectomies. Angioscopic information from 18 patients with an infrainguinal bypass graft led to graft revision in six cases and placement of a new graft in 10 cases. One graft limb was replaced in seven aortobifemoral grafts, and multiple repeated thrombectomies were employed to extract debris in the remaining six cases. Repeated graft thrombectomy was also beneficial in dialysis access fistulas. Angioscopy allowed us to omit the completion angiogram and led to an improved technical result. We conclude that angioscopy is useful during thromboembolectomy procedures.

(Arch Surg. 1990;125:1357-1362)