Intraoperative decisions based on angioscopy in peripheral vascular surgery.

We describe the technique of intraoperative angioscopy for delineation of peripheral vascular anatomy. Angioscopes with outer diameters of 0.85-2.9 mm have been used during 86 peripheral vascular procedures. Angioscopic inspections were performed during 68 femoral popliteal bypasses, four aortofemoral bypass grafts, one abdominal aortic aneurysm, two extra anatomic axillary femoral bypass grafts, and 11 other vascular procedures. We obtained useful images in 73 of 86 procedures (85%), thereby yielding 118 angioscopic inspections (53 arteries, 37 anastomoses, and 28 vein grafts). Changes in intraoperative management based on angioscopic findings included revision of five of 37 (14%) anastomoses, deletion of four of 31 (13%) completion angiograms, revision of eight of 17 (47%) in situ venous valves, and repetition of thrombectomy in six of seven (86%) cases. In 22 of 73 (30%) peripheral angioscopies, potential causes of graft occlusion were recognized. Complications from intraoperative angioscopy have included one anastomotic flap from intimal disruption that required anastomotic revision. Three small flaps, possibly resulting from angioscopic trauma, were recognized but appeared to have no clinical significance. In conclusion, intraoperative angioscopy provides visual assessment of luminal patency and anastomotic anatomy. This assessment alters intraoperative procedures in some cases and cannot be obtained by angiography.