Wilson Y G, Davies A H, Currie I C, McGrath C, Morgan M, Baird R N, Lamont P M
Vascular Studies Unit, Bristol Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1996 Aug;12(2):223-9. doi: 10.1016/s1078-5884(96)80111-0.
The diagnostic capability of angioscopy for endoluminal evaluation is established and its superiority over arteriography for completion studies has been confirmed. The therapeutic use of angioscopy in vein graft preparation is more controversial. The aim of this prospective study was to establish whether angioscopic vein preparation confers real benefits over existing techniques.
Forty-seven patients were randomised to either full angioscopic (ANG) vein preparation (23 patients) or conventional (CON) in situ grafting (19 patients). All patients underwent completion studies with arteriography and angioscopy and postoperatively, entered a Duplex graft surveillance programme.
There was a significant difference in the incidence of wound morbidity: 26% in the ANG group as against 63% in the CON group (Fisher's exact test: p = 0.043), but no significant differences with respect to duration of operation, duration of vein graft preparation, length of hospital stay and both 30 day and 12 month secondary cumulative patencies (log rank test: p > 0.5). Completion angioscopy detected eight persistent valve cusps in six patients, all missed at arteriography, but failed to detect arteriovenous fistulae.
Angioscopic preparation reduces wound morbidity and complements arteriography for detecting intraoperative defects. A large, prospective, randomised trial is now warranted to fully evaluate the potential therapeutic role of angioscopy with respect to current vascular practice.
血管镜用于腔内评估的诊断能力已得到确立，并且其在完成研究方面优于动脉造影术也已得到证实。血管镜在静脉移植物制备中的治疗用途更具争议性。这项前瞻性研究的目的是确定血管镜下静脉制备是否比现有技术具有实际优势。
47例患者被随机分为两组，一组接受完全血管镜下（ANG）静脉制备（23例患者），另一组接受传统（CON）原位移植（19例患者）。所有患者均接受动脉造影和血管镜检查以完成研究，术后进入双功超声移植监测程序。
伤口并发症发生率存在显著差异：ANG组为26%，而CON组为63%（Fisher精确检验：p = 0.043），但在手术时间、静脉移植物制备时间、住院时间以及30天和12个月的二次累积通畅率方面无显著差异（对数秩检验：p > 0.5）。完成血管镜检查在6例患者中发现了8个持续存在的瓣膜尖，这些在动脉造影时均未被发现，但未能检测到动静脉瘘。
血管镜下制备可降低伤口并发症发生率，并可补充动脉造影以检测术中缺陷。现在有必要进行一项大型、前瞻性、随机试验，以全面评估血管镜在当前血管实践中的潜在治疗作用。
