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.