Wilson Y G, Davies A H, Currie I C, McGrath C, Morgan M, Sheffield E, Baird R N, Lamont P M
Vascular Studies Unit, Bristol Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1996 Jan;11(1):12-8. doi: 10.1016/s1078-5884(96)80129-8.
Although autogenous vein is the conduit of choice for infrainguinal bypass grafting, some 20-30% of vein grafts fail during the first year postoperatively. Many of these failed veins are now known to have pre-existing pathological changes. Angioscopy enables intraoperative endoluminal visualisation of veins and can reveal anomalies, some previously unsuspected, despite preoperative Duplex ultrasound mapping and normal external appearances. The aim of this study was to compare angioscopic findings with contemporary histological appearances and with subsequent graft outcome and ultimately, to identify those endoluminal features which might be predictive for failure.
Angioscopic vein inspection was carried out using Olympus 1.4 and 2.2mm angioscopes in patients undergoing femoropopliteal/distal bypass. Severe disease in the veins of five patients led to preferential use of polytetrafluoroethylene (PTFE) for above-knee bypasses. The remaining 38 videotaped sequences were reviewed by two surgeons and scored using a scale of 0 to 3, based on frequency and distribution of angioscopically detected lesions. These included haemorrhagic mural plaques, flimsy intraluminal strands, webs/bands and mobile/adherent thrombus. Vein harvested at operation was assessed by a pathologist according to the level of pre-existing abnormality.
There were significant associations between angioscopy/histology scores and graft survival (chi 2 = 22.00; df:3; p < 0.001; chi 2 = 22.43; df:3; p < 0.001 respectively). There was a significant correlation between angioscopy and histology scores (R8 = 0.725; p < 0.001).
Angioscopy allows immediate identification of the at risk, poor quality vein graft at the time of surgery, without the delays inherent with histological preparation and assessment. Recognition of abnormalities at angioscopy may ultimately improve graft outcome by prospectively eliminating use of poor vein.
尽管自体静脉是腹股沟下旁路移植术的首选血管 conduit，但约20% - 30%的静脉移植物在术后第一年内失败。现在已知许多这些失败的静脉存在预先存在的病理变化。血管内镜能够在术中对静脉进行腔内可视化检查，并且可以揭示一些异常情况，尽管术前进行了双功超声检查且静脉外观正常，但其中一些异常情况以前并未被怀疑。本研究的目的是将血管内镜检查结果与当代组织学表现以及随后的移植物结局进行比较，并最终确定那些可能预测失败的腔内特征。
在接受股腘/远端旁路手术的患者中，使用奥林巴斯1.4毫米和2.2毫米血管内镜对静脉进行血管内镜检查。五名患者的静脉病变严重，导致优先使用聚四氟乙烯（PTFE）进行膝上旁路手术。其余38个录像序列由两名外科医生进行回顾，并根据血管内镜检测到的病变的频率和分布，使用0至3分的评分标准进行评分。这些病变包括出血性壁斑块、脆弱的腔内条索、网/带以及活动/附着的血栓。手术中获取的静脉由病理学家根据预先存在的异常程度进行评估。
血管内镜/组织学评分与移植物存活率之间存在显著关联（分别为χ2 = 22.00；自由度：3；p < 0.001；χ2 = 22.43；自由度：3；p < 0.001）。血管内镜评分与组织学评分之间存在显著相关性（R8 = 0.725；p < 0.001）。
血管内镜检查能够在手术时立即识别出有风险的、质量差的静脉移植物，而无需进行组织学制备和评估所固有的延迟。在血管内镜检查中识别异常情况最终可能通过前瞻性地避免使用质量差的静脉来改善移植物结局。
