Vascular endoscopy: Useful tool or interesting toy

A prospective protocol was designed to evaluate the efficacy and practicality of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy. The optical resolution of the Hopkins Optical System was superior to the fiberoptic units. Vascular endoscopy required 5 minutes or less in 53 cases, between 5 to 10 minutes in 29 cases, and more than 10 minutes in nine. There were no infections. The single complication was a 1 cm linear tear in the intima of an internal iliac artery. Positive findings were noted in 60 endoscopic studies, for an incidence of 66%. These consisted of intimal shreds in 47, elevated or irregular intimal flaps in 25, clot in five, and stenosis in three. In 26 cases the endoscopic findings were considered to be significant enough to possibly affect the ultimate outcome of the reconstruction.