The current status of angioscopy and laser angioplasty

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Presentation transcript:

The current status of angioscopy and laser angioplasty Warren S. Grundfest, M.D., Frank Litvack, M.D., Ann Hickey, M.D., Lynne Doyle, M.D., David Glick, M.D., Myles Lee, M.D., Aurelio Chaux, M.D., Richard Treiman, M.D., Louis Cohen, M.D., Robert Foran, M.D., Philip Levin, M.D., David Cosman, M.D., Robert Carroll, M.D., Leon Morgenstern, M.D., James S. Forrester, M.D. Journal of Vascular Surgery Volume 5, Issue 4, Pages 667-673 (April 1987) DOI: 10.1016/0741-5214(87)90251-5 Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 This angioscopic image was obtained from left anterior descending artery of a patient with stable triple-vessel disease. Intimal surface is smooth although vessel is tortuous. An atheroma causing significant occlusion of lumen can be seen at left. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 This is the typical appearance of an angioscopic image of a normal sutured anastomosis. Suture line of 5-0 Prolene can be seen as a series of regular lines radiating around oval anastomoses. Both proximal and distal lumens are widely patent. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 This angioscopic view of a polytetrafluoroethylene graft to the suprageniculate popliteal artery reveals an almost totally occluded distal lumen. The more proximal aspect has incorporated a large ulcerated atheroma into the suture line. This information permitted the surgeon to revise the anastomoses. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Retained saphenous vein valves after valvulotomy can be seen as gossamer obstructions as shown by this angioscopic image. Occasionally only one leaflet is left intact; however, in this example both valve leaflets were not disrupted. Angioscopy permitted the surgeon to localize the valve and assess the results of the repeat valvulotomy. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 This figure illustrates typical appearance of recent thrombus causing partial obstruction of the vessel lumen. This image is obtained from a patient with 4 days of unstable rest angina. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 This angioscopic image was obtained from left anterior descending artery of a patient with accelerated angina. Angiography showed only a smooth 50% stenosis. Angioscopically we found a circumferentially ulcerated irregular lesion with subintimal hemorrhage. Cellular debris has accumulated on the surface of this lesion. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 This figure illustrates acute effects of laser ablation on a segment of cadaveric human atherosclerotic aorta. Right panel, This was produced after irradiation of the specimen with 5 watts for 2 seconds over a 0.5 mm area from an argon ion laser. Middle panel, A section from aorta was irradiated with 30 watts for 2 seconds over a 0.6 mm area from an Nd:YAG laser. Left panel, This was obtained after irradiation of aortic segment with 30 mJ/mm2 at 40 nsec from a 308 nm excimer laser. The argon and Nd:YAG irradiated specimens reveal broad irregular carbonized craters with coagulation deep to the crater margins. Loss of tissue architecture and vacuole formation are prominent. In contrast, excimer ablation produced an incision that conformed precisely to the beam configuration with no evidence of carbonization. Thermal injury is minimal and tissue architecture is preserved. Journal of Vascular Surgery 1987 5, 667-673DOI: (10.1016/0741-5214(87)90251-5) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions