Sales C M, Marin M L, Veith F J, Suggs W D, Panetta T F, Wengerter K R, Gordon R E
Division of Vascular Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, New York, NY 10467.
J Vasc Surg. 1993 Aug;18(2):198-204; discussion 204-6.
The presence of preexisting saphenous vein lesions adversely affects graft patency. Despite careful preoperative venous duplex examination and meticulous intraoperative evaluation, clinically significant saphenous vein disease may remain undetected. We evaluated angioscopy as a means to better detect these vein lesions.
Ninety saphenous vein remnants, obtained at bypass surgery, were perfusion fixed for subsequent angioscopic and histologic evaluation. The specimens were categorized by independent examiners on the basis of the angioscopic or light microscopic findings. Of the 90 vein remnants, 66 were normal by angioscopic criteria. Fifty-three (80%) of these angioscopically normal vein segments were normal histologically, and all 24 angioscopically abnormal saphenous vein remnants showed disease on microscopic examination.
Angioscopy correctly identified sclerotic vein segments (n = 20) by irregular white plaques, whereas postphlebitic veins (n = 3) demonstrated multiple lumens, fibrous strands, and thickened opaque valve cusps on angioscopic evaluation. Absence of an angioscopic lumen was confirmed histologically in occluded veins (n = 2). Angioscopy failed to identify thick-walled (n = 10) and varicose (n = 2) vein segments as abnormal; one sclerotic segment was normal angioscopically, thereby lowering the sensitivity of angioscopy.
Angioscopy detected unsuspected preexisting saphenous vein disease in five patients undergoing arterial reconstruction with saphenous vein. Because the use of angioscopy is a reliable means of prospectively assessing the vein for most preexisting lesions, its routine use may ultimately improve graft patency.
已有大隐静脉病变会对移植物通畅性产生不利影响。尽管术前仔细进行静脉双功超声检查并在术中进行细致评估，但临床上显著的大隐静脉疾病仍可能未被发现。我们评估了血管内镜检查作为更好地检测这些静脉病变的一种方法。
在旁路手术中获取90条大隐静脉残端，进行灌注固定以便随后进行血管内镜和组织学评估。独立检查人员根据血管内镜或光学显微镜检查结果对标本进行分类。在这90条静脉残端中，66条根据血管内镜标准为正常。其中53条（80%）血管内镜检查正常的静脉段在组织学上也是正常的，所有24条血管内镜检查异常的大隐静脉残端在显微镜检查中均显示有病变。
血管内镜通过不规则白色斑块正确识别出硬化静脉段（n = 20），而静脉炎后静脉（n = 3）在血管内镜评估中显示有多个管腔、纤维条索和增厚的不透明瓣膜尖。组织学证实闭塞静脉（n = 2）无血管内镜下管腔。血管内镜未能将厚壁（n = 10）和曲张（n = 2）静脉段识别为异常；一个硬化段在血管内镜下是正常的，从而降低了血管内镜的敏感性。
血管内镜在5例接受大隐静脉动脉重建的患者中检测到未被怀疑的已有大隐静脉疾病。由于血管内镜检查是前瞻性评估静脉是否存在大多数已有病变的可靠方法，其常规使用最终可能会提高移植物通畅性。
