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

Thörne, Johan LU ; Danielsson, Gudmundur LU ; Danielsson, Peter LU ; Jonung, Torbjörn; Norgren, Lars LU ; Ribbe, Else LU and Zdanowski, Zbigniew (2002) In Journal of Vascular Surgery 35(4). p.759-765
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... (More)
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. (Less)
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organization
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Contribution to journal
publication status
published
subject
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
in
Journal of Vascular Surgery
volume
35
issue
4
pages
759 - 765
publisher
Mosby
external identifiers
  • wos:000175366300023
  • pmid:11932676
  • scopus:0036548046
ISSN
1097-6809
DOI
10.1067/mva.2002.119240
language
English
LU publication?
yes
id
2a66facb-0aa8-4526-bcac-d28e38948716 (old id 107396)
alternative location
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11932676&dopt=Abstract
date added to LUP
2007-07-20 12:27:13
date last changed
2017-01-01 07:03:25
@article{2a66facb-0aa8-4526-bcac-d28e38948716,
  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 &lt;.0001). The 1-year primary patency rate was significantly better in group A (P &lt;.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.},
  author       = {Thörne, Johan and Danielsson, Gudmundur and Danielsson, Peter and Jonung, Torbjörn and Norgren, Lars and Ribbe, Else and Zdanowski, Zbigniew},
  issn         = {1097-6809},
  keyword      = {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},
  language     = {eng},
  number       = {4},
  pages        = {759--765},
  publisher    = {Mosby},
  series       = {Journal of Vascular Surgery},
  title        = {Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study.},
  url          = {http://dx.doi.org/10.1067/mva.2002.119240},
  volume       = {35},
  year         = {2002},
}