Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study.

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To find out whether intraoperative angioscopic assistance has any effect on graft outcome in patients with critical leg ischemia.Material And Methods: One hundred one patients requiring a below-knee bypass were assigned to undergo in situ saphenous vein bypass with or without intraoperative angioscopic assistance; otherwise treated similarly including preoperative duplex vein mapping, intraoperative graft flow measurements, and angiography. Data on operative details, morbidity, hospital stay, and graft patency were collected prospectively and compared. All patients were followed up for 12 months. RESULTS: The group that underwent angioscopy (A) and the control group (B) were similar in all respects, except for the number of patients enrolled in the groups (32 and 69, respectively). Angioscopy revealed incompletely destructed valves in 34 patients (range, 0 to 5; mean 1), undiagnosed vein branches in 111 patients (mean 4.3), and partly occluding thrombus in 5 patients. The number of postoperative arteriovenous fistulas with signs of failing graft and a need for angiographic or surgical reintervention were significantly higher in group B (P <.0001). The 1-year primary patency rate was significantly better in group A (P <.01), but the primary assisted and secondary patency rates did not differ between the groups. CONCLUSIONS: Angioscopic assistance has an impact on primary graft patency, minimizes the risk for graft failure and thus reduces the need for reintervention by allowing identification of persistent saphenous vein branches, incomplete valve destruction, and partly occluding graft thrombus without adding extra operative time.

Details

Authors
  • Johan Thörne
  • Gudmundur Danielsson
  • Peter Danielsson
  • Torbjörn Jonung
  • Lars Norgren
  • Else Ribbe
  • Zbigniew Zdanowski
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery

Keywords

  • Femoral Artery : surgery, Female, Human, Intraoperative Care, Ischemia : surgery, Ischemia : ultrasonography, Leg : blood supply, Male, Postoperative Complications : epidemiology, Postoperative Complications : ultrasonography, Prospective Studies, Risk Factors, Saphenous Vein : transplantation, Case-Control Studies, Surgical, Arteriovenous Shunt, Angioscopy, Aged
Original languageEnglish
Pages (from-to)759-765
JournalJournal of Vascular Surgery
Volume35
Issue number4
Publication statusPublished - 2002
Publication categoryResearch
Peer-reviewedYes

Bibliographic note

The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Surgery (Lund) (013009000), Emergency medicine/Medicine/Surgery (013240200)