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PubMed2004

The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery.

OBJECTIVES: To compare the effects of isoflurane and propofol on intraoperative neurophysiological monitoring (IONM) during spinal surgery. METHODS: Thirty-five patients were randomly assigned to receive isoflurane (n = 17) or propofol (n = 18) anesthesia. Somatosensory evoked potentials (SEPs) following posterior tibial nerve stimulation were recorded before induction as baselines. Isoflurane concentrations and propofol infusions were adjusted to obtain four pre-determined BIS ranges: 65-55, 55-45, 45-35 and 35-25. For each range, a stable state was maintained for at least 10 min to perform IONM. The SEP latency P40 and amplitude P40-N50, the onset latency and amplitude of transcranial motor evoked potentials (tcMEPs), and threshold intensity of triggered electromyographic activity (EMG) following pedicle screw stimulation were statistically analyzed. RESULTS: Compared with baseline values, P40 latency increased and P40-N50 amplitude decreased after anesthesia with isoflurane or propofol. Isoflurane caused a dose-dependent depression of SEPs, but propofol did not. TcMEPs were recordable and stable in all patients receiving propofol in each BIS range, but only recordable in 10 (58.8%) receiving isoflurane with BIS >55, and 3 (17.8%) with BIS <55. No difference was noted in triggered EMG. CONCLUSIONS: Isoflurane inhibited IONM more than propofol. Propofol is recommended for critical spinal surgery, particularly when motor pathway function is monitored.

Adolescent↗
PubMed2002

[Intraoperative electrophysiological monitoring of the recurrent laryngeal nerve in thyroid gland surgery--a prospective study].

INTRODUCTION: In the last few years the use of intraoperative electrophysiological monitoring of the recurrent laryngeal nerve (RLN) in thyroid gland surgery has become more and more important. PATIENTS AND METHOD: In a prospective study 223 nerves at risk in 116 patients were monitored with the Neurosign(R)100 (Fa. Magstim Ltd., UK). We used intramuscular needle electrodes inserted into the vocal muscle through the conic ligament. Practicability, complications, acceptance and predictive value of the method were documented. Recurrent nerve palsy rate and complications were compared with a control group operated upon without monitoring. RESULTS: The intraoperative delay using this method was on average 8.9 minutes. There were problems with monitoring equipment avoiding use in 6.4 %. In 2 cases (1.7 %) an accidental lesion of endotracheal tube cuff was found related to malpositioning of the needle and in 7.7 % a hematoma of the vocal cords was observed. 73.3 % of the surgeons accepted the method to identify and control the nerve integrity. False-positive and false-negative signals may occur. In cases of a final real stimulus response a regular vocal cord motility was found in 95 %. If a nerve conduction block was noted an immobility of ipsilateral vocal cord was diagnosed postoperatively in 50 %. There was no decrease in transient recurrent palsy rate using monitoring (10.7 % vs. 9.6 % without monitoring) but in permanent paralysis (1.8 % vs. 3.0 %). CONCLUSIONS: It may be concluded that intraoperative electrophysiological monitoring of the RLN is a simple and accepted method with low complications reducing the incidence of permanent RLN palsy rate. We found the monitoring especially useful for operations of recurrent goiter and carcinomas of the thyroid gland as well as for learning thyroid gland surgery.

Attitude of Health Personnel↗
PubMed1987

Transtragal, transtympanic electrode placement for intraoperative electrocochleographic monitoring.

Transtragal, transtympanic electrode placement was performed for the purpose of intraoperative electrocochleographic (ECoG) monitoring during seven suboccipital acoustic neuroma resections. The promontory, the tragus, and two external sutures stabilized the electrode during surgery. The only noted otologic sequallae of electrode placement were small circular lesions at tympanic membrane puncture sites. Satisfactory ECoG recordings were obtained in five of seven cases. Peak-to-peak N1 amplitudes were (on average) 13.4-fold larger than the corresponding amplitudes of peak I of the surface-recorded brainstem auditory evoked potential (BAEP) recordings. During acoustic neuroma resection, ECoG and BAEP recordings changed relatively independently, which suggests multiple mechanisms and/or sites of injury to the cochlea or cochlear nerve. However, once they had become manifest, none of the observed changes exhibited a tendency to return to preoperative patterns. Hearing was preserved postoperatively in only two of seven patients, one of whom could not be monitored due to technical difficulty. Transtragal, transtympanic electrode placement provided a rapid, stable, and safe method of obtaining intraoperative ECoG recordings. Although combined intraoperative monitoring of ECoG and BAEP responses appeared to provide more precise documentation of injury to the cochlea and/or cochlear nerve, it was probably not influential in preservation of hearing in this series.

Adult↗
PubMed2006

Multimodality intraoperative neurophysiologic monitoring findings during surgery for adult tethered cord syndrome: analysis of a series of 44 patients with long-term follow-up.

STUDY DESIGN: Prospective analysis of a consecutive series in which multimodality intraoperative neurophysiologic monitoring was used as an adjunct to microneurosurgery for adult tethered cord syndrome. The results of multimodality intraoperative neurophysiologic monitoring were compared with the "gold standard" (neurologic outcomes). OBJECTIVE: To assess the sensitivity, specificity, and positive and negative predictive values of multimodality intraoperative neurophysiologic monitoring in surgery for adult tethered cord syndrome. SUMMARY OF BACKGROUND DATA: Although intraoperative electrophysiologic techniques may help to minimize neural injury during spinal microneurosurgery, to our knowledge, no study has quantitatively evaluated the value of multimodality intraoperative neurophysiologic monitoring in the management of adult tethered cord syndrome. METHODS: Multimodality intraoperative neurophysiologic monitoring included posterior tibial nerve somatosensory evoked potentials (SSEPs), continuous electromyographic (EMG) monitoring of the L2 to S4 myotomes, and evoked EMG. Follow-up neurologic evaluations were performed for at least 1 year. RESULTS: A total of 44 consecutive patients, including 19 males and 25 females (aged 43 +/- 15 years), who underwent microsurgery for adult tethered cord syndrome were evaluated. After surgery, new neurologic deficits, including 1 transient and 1 permanent, developed in 2 patients. There was 1 patient who had persistent posterior tibial nerve SSEP amplitude reduction following microsurgical manipulation. In 1 patient, a transient posterior tibial nerve SSEP amplitude reduction prompted a change in microneurosurgical strategy. This patient awoke with no new postoperative neurologic deficits. For SSEPs, the sensitivity was 50% and specificity 100%. EMG bursts were recorded in 36 patients (82%). The 2 patients with postoperative neurologic worsening had EMG activity in the myotomes, where their new deficits presented. Continuous EMG had a sensitivity of 100% and a specificity of 19%. CONCLUSIONS: To our knowledge, this is the largest series to date reporting the use of multimodality intraoperative neurophysiologic monitoring in the surgical management of adult tethered cord syndrome. Posterior tibial nerve SSEPs have high specificity, but low sensitivity, for predicting new neurologic deficits. In contrast, continuous EMG showed high sensitivity and low specificity. Evoked EMG accurately identified functional neural tissue. The combined recording of SSEPs in concert with continuous and evoked EMGs may provide a useful adjunct to complex microsurgery for adult tethered cord syndrome.

Adult↗
PubMed2004

False negative findings in intraoperative SEP monitoring: analysis of 658 consecutive neurosurgical cases and review of published reports.

OBJECTIVES: To determine the sensitivity of intraoperative monitoring in neurosurgical operations using somatosensory evoked potentials and to identify reasons for false negative findings and possible settings with an increased risk for monitoring failure. METHODS: SEP monitoring of 658 neurosurgical operations was analysed. The target of monitoring was the function of a hemisphere in 251 cases, the brain stem in 198 cases, and the spinal cord in 209 cases. RESULTS: In 27 cases (4.1%), monitoring was classified as false negative. Further analysis showed that five of these patients had experienced delayed neurological damage. Among the remaining 22 false negative cases, 14 had a minor neurological deficit and eight had severe neurological damage. Overall sensitivity and negative predictive value of SEP monitoring was 79% and 96%, respectively. For the detection of severe neurological damage the corresponding figures were 91% and 98%. Sensitivity of monitoring varied depending on the target of monitoring and the type of lesion. Monitoring was less likely to detect neurological damage in surgery for infratentorial tumours with brain stem compression, small lesions of the motor cortex, and small vessel damage during aneurysm surgery. CONCLUSIONS: SEP monitoring has acceptable sensitivity for detecting neurological damage during different neurosurgical procedures. Distinct settings with an increased risk of monitoring failure can be identified. In these cases measures to enhance the sensitivity of monitoring should be considered.

Adolescent↗
PubMed2004

Intraoperative PTH monitoring in parathyroid hyperplasia requires stricter criteria for success.

BACKGROUND: Intraoperative parathyroid hormone (IOPTH) monitoring in parathyroidectomy for multigland disease is less clear than for single-gland disease. This study assesses the role of IOPTH for hyperplasia. METHODS: A prospective database revealed 45 patients with hyperplasia undergoing parathyroidectomy utilizing IOPTH from February 1999 to August 2003. RESULTS: Twenty-six females and 19 males had a mean age of 55 years. Twenty-two patients underwent total parathyroidectomy. Twenty-three patients underwent subtotal parathyroidectomy. Twenty-seven patients (60%) had a drop of IOPTH greater than 50% at 10 minutes after removal of all presumably abnormal parathyroid tissue. Nine additional patients (20%) had an IOPTH drop greater than 50%, but continued exploration revealed more abnormal tissue. Nine patients failed to decrease greater than 50%, and exploration was continued. A final IOPTH less than 35 pg/mL or a greater than 90% decrease from baseline was predictive of a successful operation in 40 patients. The 5 patients who did not meet this criteria remained hyperparathyroid. CONCLUSIONS: IOPTH identifies sporadic hyperplasia and guides completeness of resection for patients with known hyperplasia. However, more rigid criteria are required than for adenomas. Failure to achieve appropriate decreases in IOPTH should prompt further neck exploration or a search for a mediastinal gland.

Female↗
PubMed2002

Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring.

Release of tethered spinal cord by sectioning of the filum terminale carries a risk of injuring neighboring motor and sensory nerve roots involved in bowel and bladder control. Therefore, intraoperative neurophysiological monitoring techniques have been developed to prevent neurological complications postoperatively. We performed a retrospective chart review of 63 patients who had undergone tethered cord release. We excluded adult patients, those lost to follow-up and patients with either a myelomeningocele and/or lipoma. This limited our study to 25 pediatric patients, aged 4 months to 12 years, who underwent tethered cord release for either a thickened filum terminale and/or a low-lying conus. For intraoperative monitoring, we utilized electrical stimulation of the filum terminale, lumbosacral nerve roots and electromyography recordings. Ventral nerve roots were identified and their electrical thresholds obtained. The mean was 0.32 V, the mode 0.1 V and the range 0.05-1.0 V. These values were compared to electrical thresholds obtained by stimulation of the filum terminale. The mean was 26.1 V, the mode 20.0 V and the range 8-100 V. In over 70% of patients, muscle activation via the filum required 100 times the voltage needed to activate a motor root. This motor root to filum threshold of 1:100 was useful in identifying the filum. Clinical outcome showed no significant worsening with respect to bowel and bladder control or pain and motor indices. Significant bowel and bladder improvement was seen in 4 out of 25 patients, motor improvement in 9 out of 25 patients and improvement of pain in 4 out of 25 patients. Three patients developed postoperative urinary tract infections, but no cerebrospinal fluid leaks or pseudomeningoceles were encountered. These results suggest that patients with a thickened filum or low-lying conus can safely undergo tethered cord release. Intraoperative neurophysiological monitoring provides a helpful adjunct to distinguish nerve roots from the filum. A ratio, rather than an absolute number, is beneficial in distinguishing motor roots from the filum and eliminates variability due to patients' individual differences in electrical thresholds.

Child↗
PubMed1990

Intraoperative electroencephalographic monitoring during carotid surgery with routine shunting.

Fifty-nine patients undergoing sixty-four carotid reconstructions with routine intraluminal shunting had intraoperative electroencephalographic monitoring. The onset of rhythm or amplitude disturbances was demonstrated in 14 patients during exposure of the carotid artery, and in 24 patients during initial carotid clamping. Disturbances were seen in 15 patients during the period of intraluminal shunting and increased momentarily during the second clamping period. During closure of the surgical wound, all abnormalities disappeared except in one patient who ultimately developed a neurologic deficit upon awakening. Although patients who maintained normal electroencephalographic readings had higher carotid stump pressure (59 mm) than those who did not (42 mm), individual values were scattered. Intraoperative monitoring during carotid surgery with routine shunting has little usefulness.

Aged↗
PubMed2005

Intraoperative neurophysiologic monitoring: indications and techniques for common procedures in otolaryngology-head and neck surgery.

Intraoperative cranial nerve monitoring can be an effective adjunct in otolaryngology-head and neck surgery. Monitoring is not considered standard of care, despite indications of cost effectiveness and improved functional outcomes. Lessons learned performing facial nerve monitoring are applicable to upper and lower cranial motor nerves. Auditory nerve monitoring can be modified accord-ing to need for selected otologic and neurotologic surgery. Process standardization and effective communication can lead to improved patient outcomes.

Cost-Benefit Analysis↗
PubMed2002

[Cost analysis of intraoperative neurophysiological monitoring (IOM)].

INTRODUCTION: A number of studies demonstrate that a significant reduction of postoperative neurological deficits can be achieved by applying intraoperative neurophysiological monitoring (IOM) methods. A cost analysis of IOM is imperative considering the strained financial situation in the public health services. MATERIAL AND METHODS: The calculation model presented here comprises two cost components: material and personnel. The material costs comprise consumer goods and depreciation of capital goods. The computation base was 200 IOM cases per year. Consumer goods were calculated for each IOM procedure respectively. The following constellation served as a basis for calculating personnel costs: (a) a medical technician (salary level BAT Vc) for one hour per case; (b) a resident (BAT IIa) for the entire duration of the measurement, and (c) a senior resident (BAT Ia) only for supervision. RESULTS: An IOM device consisting of an 8-channel preamplifier, an electrical and acoustic stimulator and special software costs 66,467 euros on the average. With an annual depreciation of 20%, the costs are 13,293 euros per year. This amounts to 66.46 euros per case for the capital goods. For reusable materials a sum of 0.75 euro; per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euro; per case were,s a sum of 0.75 euros per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euros per case were, calculated for surgery on the peripheral nervous system. They amount to 196.40 euros per case for spinal interventions and to 347.63 euros per case for more complex spinal operations. Operations in the cerebellopontine angle and brain stem cost 376.63 euros and 397.33 euros per case respectively. IOM costs amount to 328.03 euros per case for surgical management of an intracranial aneurysm and to 537.15 euros per case for functional interventions. Expenses run up to 833.63 euros per case for operations near the motor cortex and to 117.65 euros per case for intraoperative speech monitoring. DISCUSSION: Costs for inpatient medical rehabilitation have increased considerably in recent years. In view of the financial situation, it is necessary to reduce postoperative morbidity and the costs it involves. IOM leads to a reduction of morbidity. The costs for IOM calculated here justify its routine application in view of the legal and socioeconomic consequences of surgery-related neurological deficits.

Algorithms↗
PubMed2002

Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures.

OBJECTIVES: To review our experience with iatrogenic nerve injuries and to evaluate the efficacy of intraoperative monitoring in a large consecutive series of operatively treated acetabular fractures. DESIGN: Retrospective, nonrandomized. SETTING: Level I Trauma Center, January 1, 1992 through December 31, 1998. PATIENTS/PARTICIPANTS: A total of 256 consecutive acetabular fractures were operatively treated at our institution; 140 unmonitored procedures and 112 monitored procedures were available for review. The decision to use monitoring was at the discretion of the treating surgeon. INTERVENTION: Open reduction and internal fixation of the acetabular fracture. MAIN OUTCOME MEASUREMENT: Preoperative and postoperative neurologic examinations, fracture type, use of traction, dislocation, operative approach, and complications were analyzed. Motor strength, sensation, the need for gait aids, orthoses, and extent of recovery were evaluated. RESULTS: Traumatic nerve palsies were present in eleven of 140 (7.9 percent) unmonitored and thirteen of 112 (11.6 percent) monitored fractures (p = 0.314). There were fourteen iatrogenic sciatic nerve palsies in 252 cases (5.6 percent). There were four iatrogenic sciatic palsies (2.9 percent) in the unmonitored group and ten iatrogenic palsies (8.9 percent) in the monitored group (p = 0.037). In the unmonitored group one of eighty-one Kocher-Langenbeck approaches (1.2 percent), two of fifty-two ilioinguinal (3.9 percent), and one of three extended iliofemoral approaches developed a sciatic palsy. In the monitored group six of seventy-seven Kocher-Langenbeck approaches (7.8 percent), three of twenty-five ilioinguinal (12 percent), and one of six combined approaches (16.7 percent) developed a sciatic palsy. In seven of the ten iatrogenic palsies in the monitored group, the intraoperative monitoring was normal. Seventy-six patients were monitored with somatosensory evoked potential alone, and nine had iatrogenic injuries (11.8 percent). Thirty-six patients were monitored with somatosensory evoked potential and electromyography, and one had an iatrogenic injury (2.8 percent) (p = 0.164). Clinical follow-up was available for three of the four patients with iatrogenic injuries in the unmonitored group, with a mean follow-up of twenty-seven months (range 8 to 60 months). Two patients had full motor recovery at a mean of six months, and one had no recovery at fourteen months. CONCLUSIONS: The use of intraoperative monitoring did not decrease the rate of iatrogenic sciatic palsy. Further study involving larger prospective, randomized methodology appears warranted. Sciatic nerve injury was more common in ilioinguinal approaches in both groups, likely due to reduction techniques for the posterior column performed with the hip flexed, placing the sciatic nerve under tension.

Acetabulum↗
PubMed2001

Role of intraoperative insulin monitoring in surgical management of insulinoma.

BACKGROUND AND PURPOSE: Precise localization and surgical excision is the therapeutic strategy for insulinomas. However, it is often difficult to localize the insulinomas, because of their small size. Surgeons may not localize and remove all of them together, particularly in patients with multiple insulinomas. We reviewed our experience to confirm the efficacy of blood glucose and intraoperative immunoreactive insulin (IRI) monitoring for surgical management of insulinomas. PATIENTS AND METHODS: Thirty-nine patients with insulinoma were surgically treated in our department. Perioperative blood glucose monitoring was performed in 14 patients, intraoperative quick IRI assay of the peripheral blood in 10 patients, and assay of a portal sample in 4 patients by an IMX analyzer. RESULTS: Rebound response of blood glucose to insulinoma removal was not always noted (8/14; 57%). Seven of ten patients showed a decrease of peripheral serum IRI levels within 15 minutes after removal of the insulinoma. The other two patients showed a rebound response of peripheral blood glucose or portal IRI. All the patients who had intraoperative monitoring of peripheral blood and peripheral and portal IRI had no recurrent insulinoma syndrome after surgical removal of their insulinomas. CONCLUSION: Combined monitoring of peripheral blood glucose and peripheral and portal IRI are helpful in the surgical management of insulinomas, as they can indicate that no insulinoma remains.

Adolescent↗
PubMed1992

Intraoperative electrophysiological monitoring in children.

Children, like adults, are at risk for neurological injury during a variety of surgical procedures. Intraoperative electrophysiological monitoring (IOM) provides information about the functional integrity of the nervous system during surgery. This information may determine the mechanism of injury and prevent damage by identifying nerves and detecting dysfunction at a reversible stage. Electrophysiological techniques may also help direct therapy by improving injury localization, detect the presence or absence of axonal integrity in peripheral nerve lesions, and identify rootlets with the greatest contribution to spasticity in patients undergoing selective dorsal rhizotomy (SDR). Electrophysiological techniques used are modified from those employed in the diagnostic laboratory. The first portion of this article reviews IOM experience at the Mayo Clinic in patients under 18 years of age from 1985 to 1991. The types of procedures monitored, the monitoring modalities used, technical problems unique to children, and neurological outcome are discussed. Subsequently presented are the application and techniques of electrophysiological monitoring during SDR as currently practiced at the University of Kentucky and other medical centers.

Brain Stem↗
PubMed1996

Intraoperative electrophysiologic monitoring of ocular motor nerves under conditions of partial neuromuscular blockade during skull base surgery.

The feasibility and usefulness of intraoperative electromyographic monitoring of the oculomotor nerve (CN III), trochlear nerve (CN IV), and abducens nerve (CN IV) were evaluated under conditions of partial neuromuscular blockade in 21 patients undergoing skill base surgery. Intracranial electrical stimulation of each nerve was performed, and compound muscle action potentials (CMAPs) were reconded from the inferior or superior rectus muscle, the superior oblique muscle, and the lateral rectus muscle for monitoring of CN III, IV, and VI, respectively. Partial neuromuscular blockade was achieved by controlled infusion of vecuronium titrated to eliminate about 90% of the twitch response of the abductor pollicis brevis to electrical stimulation of the median nerve. A total of 30 cranial nerves were stimulated intraoperatively. Of these, 29 were successfully monitored (19 CN III, 6 CN IV, 4 CN VI). A relationship was found between intraoperative findings of cranial nerve monitoring, such as disappearance of response and increase in latency and stimulus threshold during manipulation of a lesion, and the presence of postoperative nerve deficits. We conclude that intraoperative electromyographic monitoring of ocular motor nerves is feasible during partial neuromuscular blockade, and that partial neuromuscular blockade does not affect the relationship between findings of intraoperative monitoring and postoperative nerve function.

Journal Article↗
PubMed2002

Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery.

BACKGROUND: Postoperative paraplegia is one of the most dreaded complications after descending thoracic and thoracoabdominal aneurysm surgery. In this study, intraoperative monitoring was applied during resection of descending thoracic and thoracoabdominal aneurysms to detect spinal cord ischemia and help prevent paraplegia. METHODS: Fifty-six patients (descending thoracic, 25; thoracoabdominal, 31) were monitored intraoperatively with both motor- (MEP) and somatosensory- (SSEP) evoked potentials. MEPs were elicited with transcranial electrical stimulation and recorded from the spinal epidural space (D wave) or peripheral muscles (myogenic MEP). SSEPs were obtained with median and tibial nerve stimulation. RESULTS: A total of 16 patients (28.6%) showed MEP evidence of spinal cord ischemia, only 4 of whom had delayed congruent SSEP changes. In 13 patients (23.2%), ischemic changes in MEPs were reversed by reimplanting segmental arteries or increasing blood flow or blood pressure. None of these 13 patients suffered acute paraplegia regardless of the status of SSEP at the end of the procedure, but 1 of them developed delayed postoperative paraplegia after multisystem failure. Three patients (5.4%) who had persistent loss of MEPs despite of recovery of SSEPs awoke paraplegic. CONCLUSIONS: The results demonstrate that compared with SSEP, MEP, especially myogenic MEP, is more sensitive and specific in detection of spinal cord ischemia, and that intraoperative monitoring can indeed help prevent paraplegia.

Adult↗
PubMed1999

Intraoperative microdoppler monitoring for spinal dural arteriovenous fistulae.

BACKGROUND: One of the most important goals in the surgical treatment of spinal dural arteriovenous fistulae is complete interruption of the flow in the fistula. To confirm complete interruption, we use intraoperative microdoppler monitoring. METHODS: Three patients with spinal dural arteriovenous fistulae with perimedullary venous drainage underwent surgical treatment using microdoppler monitoring. All of them suffered from congestive myelopathy before treatment. Microdoppler monitoring was performed on the perimedullary draining vein to detect the arterial spectrum before and after the interruption of the arteriovenous shunt. RESULTS: In all patients, an arterial spectrum was detected on the dorsal perimedullary vein. Sequential monitoring demonstrated the effects of each surgical procedure, which included epidural coagulation of the fistulae or intradural ligation of the retrogradely draining radiculomedullary veins. After complete interruption of the fistula, the arterial spectrum disappeared completely. In a patient with duplicated dural arteriovenous fistulae, the direction of the flow of the second arteriovenous shunt could be demonstrated by microdoppler monitoring combined with temporary clipping. This is especially useful in a complex case with duplicated fistulae. In all patients, postoperative angiography demonstrated complete disappearance of the arteriovenous fistulae. The patients all showed remarkable improvement with no therapeutic morbidity. CONCLUSION: Intraoperative microdoppler monitoring is an easily available and useful technique to safely confirm complete obliteration of spinal dural arteriovenous fistulae.

Adult↗
PubMed1991

Angioscopy of arm vein infrainguinal bypass grafts.

Between January 1988 and December 1990, 56 patients underwent 66 arm vein infrainguinal bypass grafts for limb salvage. Thirty-nine grafts were intraoperatively monitored by the standard methods of continuous wave Doppler alone (30) and arteriography (9). Twenty-seven grafts were prepared and monitored by intraoperative angioscopy. No significant findings requiring intraoperative revision or correction were noted in the grafts monitored by the standard methods. However, in those grafts prepared and monitored by angioscopy, intraluminal abnormalities of the arm veins were detected and corrected in 20/27 (74%). None of the grafts prepared or monitored by angioscopy occluded within 30 days, whereas, in those grafts monitored by continuous wave Doppler and arteriography, 7/39 failed within 30 days, a primary patency rate of 32/39 (82%) (x2 with yates correction, p = 0.055). This study shows that angioscopic preparation and monitoring of arm vein bypass grafts allows the detection and correction of unsuspected intraluminal abnormalities, which appears to improve the early primary patency of arm vein infrainguinal bypass grafts.

Aged↗