Miller A, Stonebridge P A, Jepsen S J, Tsoukas A, Gibbons G W, Pomposelli F B, Freeman D V, Campbell D R, LoGerfo F W
Department of Surgery, New England Deaconess Hospital, Boston, MA 02215.
Surgery. 1991 Mar;109(3 Pt 1):286-93.
Intraoperative angioscopy provides direct, in vivo, three-dimensional visualization of the interior of the blood vessels and grafts. We have shown previously that with the application of the basic principles of irrigation and with a dedicated irrigation pump that routine intraoperative angioscopy can be performed with consistent high quality results during lower extremity revascularization. In our total experience with angioscopy as a monitoring procedure during infrainguinal bypass grafting, 259 intraoperative angioscopies, during 63 femoropopliteal and 196 distal bypass grafts, were performed from May 1, 1987, to October 31, 1989. Mean total irrigation fluid used in the study was 448 ml (range, 0 to 1400 ml) with good visual quality in more than 80% of the studies. The overall failure rate was 1.5%. No complications were directly attributable to the insertion of the angioscope or the use of the pump. Based on the angioscopic findings, 124 clinical or surgical decisions were made in 259 of the angioscopies. The incidence of graft failure in this study was 8.1% (less than 30 days) and 4.8% (greater than 30 days) with a mean follow-up of 272 days. Direct inspection of the interior of the graft and native vessels at the time of surgery has resulted in the recognition of previously unsuspected vein-graft pathology. Angioscopy as the sole monitoring procedure for infrainguinal bypass grafting is safe, effective, and reliable and may not only improve the durability of these grafts but may improve our understanding of the pathogenesis of graft failure and of the progression of the underlying atherosclerotic disease.
术中血管镜检查可提供血管和移植物内部的直接、活体三维可视化图像。我们之前已经表明，应用冲洗的基本原理并使用专用冲洗泵，在下肢血管重建术中可常规进行术中血管镜检查，并能获得一致的高质量结果。在我们将血管镜检查作为腹股沟下旁路移植术中监测手段的全部经验中，1987年5月1日至1989年10月31日期间，在63例股腘旁路移植术和196例远端旁路移植术中进行了259次术中血管镜检查。该研究中使用的平均总冲洗液量为448毫升（范围为0至1400毫升），超过80%的检查视觉质量良好。总体失败率为1.5%。没有并发症可直接归因于血管镜的插入或泵的使用。根据血管镜检查结果，在259次血管镜检查中有124次做出了临床或手术决策。本研究中移植物失败的发生率在术后不到30天为8.1%，超过30天为4.8%，平均随访272天。手术时对移植物和天然血管内部的直接检查已使人们认识到先前未被怀疑的静脉移植物病变。血管镜检查作为腹股沟下旁路移植术的唯一监测手段是安全、有效且可靠的，不仅可能提高这些移植物的耐用性，还可能增进我们对移植物失败发病机制以及潜在动脉粥样硬化疾病进展的理解。
