Mladinich C R, Akins E W, Weingarten K E, Hawkins I F
Department of Radiology, University of Florida College of Medicine, Gainesville 32610-0374.
Invest Radiol. 1991 Oct;26(10):874-8. doi: 10.1097/00004424-199110000-00006.
The limitations of angiography, when it is used as the sole method of vascular assessment, are increasingly apparent as vascular intervention becomes more sophisticated. Angioscopy could be an adjunctive diagnostic modality by differentiating among thrombus, dissection, and atheroma, and by monitoring the response to therapy. However, angioscopy requires a blood-free field for adequate visibility, and this may be difficult to obtain. The feasibility of carbon dioxide (CO2) and various saline delivery methods for clarifying the viewing field for percutaneous angioscopy was investigated. Angioscopy of femoral and iliac arteries on nine dogs was performed. Saline was infused by hand injection, pressure bag infusion, or mechanical power injection, and CO2 gas was injected using a special gas injector. The clarity of the viewing field was graded for each medium and method. Excellent quality antegrade femoral angioscopy was obtained with CO2. The superiority of CO2 injection in comparison with power-injected saline approached statistical significance (P = .06). Power-injected CO2 and power saline were superior to hand-injected or pressure bag-injected saline for maintaining sufficient visibility. Retrograde iliac angioscopy was possible without inflow occlusion, but required high flow rates (only possible with power-injected saline or CO2). CO2 injected under controlled circumstances holds promise as a medium to improve angioscopic visibility.
随着血管介入技术变得越来越复杂，血管造影作为唯一的血管评估方法的局限性日益明显。血管镜检查可以作为一种辅助诊断方式，用于区分血栓、夹层和动脉粥样硬化，并监测治疗反应。然而，血管镜检查需要无血视野以获得足够的可视性，而这可能很难实现。本研究探讨了二氧化碳（CO₂）和各种盐水输送方法用于改善经皮血管镜检查视野清晰度的可行性。对9只犬的股动脉和髂动脉进行了血管镜检查。通过手动注射、压力袋输注或机械动力注射来输注盐水，并使用特殊的气体注射器注入CO₂气体。对每种介质和方法的视野清晰度进行分级。使用CO₂可获得质量优异的股动脉顺行血管镜检查结果。与动力注射盐水相比，注射CO₂的优越性接近统计学意义（P = 0.06）。动力注射CO₂和动力注射盐水在维持足够的可视性方面优于手动注射或压力袋注射的盐水。在不进行血流阻断的情况下也可以进行逆行髂动脉血管镜检查，但需要高流速（仅动力注射盐水或CO₂时可行）。在可控情况下注射CO₂有望作为一种改善血管镜可视性的介质。
