Role of vascular endoscopy in aortoiliac and femoropopliteal thromboendarterectomy.

Over the last few years the technique of thromboendarterectomy in the aortoiliac and femoropopliteal position has experienced a renaissance. Nearly 15 years ago thromboendarterectomy was found to have an increased early occlusion rate, especially in the femoropopliteal position (8-10%), and a high late complication of myointimal hyperplasia with subsequent stenosis. Bypass procedures were preferred to thromboendarterectomy because of these reasons. A prospective study was started in Lippstadt after good results of a retrospective study from the University of Ulm (1970-1990), in which angioscopy was used as a means of intraoperative assessment during thromboendarterectomy, were reported. Some 24 aortoiliac, 11 ileofemoral and 26 femoropopliteal semiclosed thromboendarterectomies were admitted to the study. Several technical problems including intimal flaps and incomplete obliteration were detected and treated immediately under direct visualization through the angioscope. During a mean follow-up of 10 months only one patient developed an ileofemoral occlusion. No deep infection or mortality was recorded. Angioscopy reduces the early postoperative occlusion rate after thromboendarterectomy.