Advances in vascular endoscopy.

Abstract

In reconstructive vascular surgery several intraoperative investigations are in use to check-up and secure full blood flow restoration (angiography, ultra-sound, electro-magnetic flowmeter etc.). In the last years endoscopical lumen control, introduced 1969 in clinical praxis, could be remarkably simplified and improved. For vascular endoscopy three technical prerequisites are necessary: a) temporary interruption of blood flow using clamps or balloon catheters, b) replacement of the blood by a transparent medium via pressure controlled saline perfusion, c) availability of suitable special endoscopes. The main application of vascular endoscopy includes: a) semi-closed thromboendarterectomy (aorto-iliac or femoropopliteal), b) arterial embolectomy, c) lumen control of inserted grafts including the anastomosis and the distal run-off vessels, d) venous thrombectomy. The availability of small-calibre endoscopes (external diameter: 1.7-2.7 mm) enables the extension of lumen control to small vessel areas such as the tibial and coronary arteries. Compared with angiography vascular endoscopy offers several convincing advantages such as a more reliable three dimensional lumen control, easy performance, saving time and the avoidance of any additional X-ray exposure. Technical faults or overlooked concomitant vascular lesions can be diagnosed and corrected immediately.