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Clinical Case Reports Oct 2023Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is...
KEY CLINICAL MESSAGE
Contrast defects in veins are often diagnosed as benign thrombi, but depending on the patient's background it is necessary to differentiate between tumor thrombi. It is difficult to differentiate between these using contrast-enhanced CT alone, but with angioscopy it is easy to visually distinguish between a benign and tumor thrombi.
ABSTRACT
Contrast-enhanced computer tomography (CT) performed on a male patient being treated for de-differentiated chondrosarcoma revealed contrast defects in the pulmonary artery and right femoral vein, and a diagnosis of pulmonary artery thromboembolism and venous thromboembolism was made, and oral anticoagulant therapy was started. However, a follow-up CT showed that the contrast defect had extended to the inferior vena cava. Observation using an angioscope revealed that it was not a benign thrombi but a tumor.
PubMed: 37780915
DOI: 10.1002/ccr3.7975 -
Annals of Cardiothoracic Surgery Nov 2021
PubMed: 34926185
DOI: 10.21037/acs-2021-taes-21 -
Journal of Vascular Surgery Aug 1999Nosocomial transmission of viral hepatitis and retrovirus infection has been reported. The expected risk is greatest for the hepatitis B virus (HBV). The duck HBV (DHBV)...
PURPOSE
Nosocomial transmission of viral hepatitis and retrovirus infection has been reported. The expected risk is greatest for the hepatitis B virus (HBV). The duck HBV (DHBV) has similar biologic and structural characteristics to HBV and has been adopted as a suitable model for disinfectant testing.
METHODS
Angioscopic examination of the external jugular vein was performed on DHBV-infected ducks. After use, the instrument was air dried for 3 minutes. Samples were obtained by flushing the channel with 5 mL of phosphate buffered saline solution. The samples were collected immediately after drying (control), after flushing with 5 mL of water, after glutaraldehyde disinfection for 5, 10, and 20 minutes, and after ethylene oxide gas sterilization. Angioscopes were either precleaned or uncleaned before disinfection/sterilization. Residual infectivity was assessed with inoculation of samples into the peritoneal cavity of day-old ducks (n = 231).
RESULTS
DNA analysis results of liver samples showed that all 38 control ducks became infected. The frequency of DHBV infection was reduced to 93% (14 of 15) by flushing the angioscope with 5 mL of sterile water. No transmission occurred after the use of any of the properly precleaned and disinfected/sterilized angioscopes. However, after the use of the uncleaned angioscopes, the transmission rate was 90% (9 of 10) and 70% (7 of 10) after 5 and 10 minutes of contact time, respectively, in 2% glutaraldehyde. Even after the recommended 20 minutes of contact time, there was still 6% (2 of 35) transmission. After ethylene oxide sterilization, two of the recipient ducklings (2 of 35) were infected with DHBV.
CONCLUSION
There was no disease transmission after reuse of disposable angioscopes adequately cleaned before disinfection or sterilization. However, if the angioscopes are inadequately cleaned, DHBV can survive despite glutaraldehyde disinfection or ethylene oxide sterilization. This contrasts with previous in vitro and in vivo data with solid surgical instruments. It is postulated that the presence of a narrow lumen or residual protein shielding within the lumen may compromise effective inactivation of hepadnaviruses on angioscopes, with the potential risk for patient-to-patient transmission.
Topics: Angioscopes; Angioscopy; Animals; Cross Infection; DNA, Viral; Disease Models, Animal; Disinfection; Ducks; Hepatitis B Virus, Duck; Jugular Veins; Liver; Sterilization
PubMed: 10436447
DOI: 10.1016/s0741-5214(99)70138-2 -
The Surgical Clinics of North America Aug 1992Endoscopy of the vascular system has evolved over recent years from an experimental procedure to a sophisticated diagnostic and therapeutic technique for surgical or... (Review)
Review
Endoscopy of the vascular system has evolved over recent years from an experimental procedure to a sophisticated diagnostic and therapeutic technique for surgical or percutaneous interventions of the peripheral vascular system. Particularly in procedures involving remote instrumentation of arteries, the angioscope provides a method of controlled guidance and a monitor of the effects of the various instruments on the vessel wall and allows immediate assessment of results. Angioscopic examination reveals the extent of intimal injury after angioplasty, in situ vein preparation, trauma, and thrombectomy and gives insights into the mechanisms and effects of endovascular devices.
Topics: Aged; Blood Vessels; Endoscopes; Endoscopy; Female; Humans; Male; Middle Aged; Monitoring, Intraoperative; Vascular Diseases
PubMed: 1496439
DOI: 10.1016/s0039-6109(16)45778-6 -
Operative Neurosurgery (Hagerstown, Md.) Feb 2017Angioscopy - or endovascular endoscopy - is a catheter-based technique employing a flexible fiberoptic angioscope to directly visualize arterial lumen. Poor resolution...
BACKGROUND
Angioscopy - or endovascular endoscopy - is a catheter-based technique employing a flexible fiberoptic angioscope to directly visualize arterial lumen. Poor resolution and excessive stiffness of pre-existent angioscopes limited their use clinically. Recent advances resulted in novel fused optical fiber bundle angioscopes with improved flexibility and imaging resolution. Use of these devices in endovascular neurosurgery is still largely unexplored.
OBJECTIVE
To evaluate image quality and feasibility of optical angioscopes for diagnostic and interventional neuro-angioscopy in carotid arteries of human cadavers.
METHODS
A 5-F optical angioscope was used in human cadaveric carotid arteries to inspect integrity of arterial walls, identify atherosclerotic plaques and associated lesions prone to thrombogenicity, place intravascular occlusion coils, and deploy endovascular stents with real-time visualization.
RESULTS
Angioscopy provided key information about endoluminal anatomy such as presence and characteristics of atherosclerotic plaques and thrombogenic lesions not detected by conventional diagnostic methods. Direct real-time visualization of vascular lumen during endovascular interventions provided information on spatial distribution of coils, coil loop herniation, and apposition of stent cells against carotid artery wall complementary to angiography.
CONCLUSIONS
Fused optical fiber bundle angioscopes provide good-quality endoluminal images in human carotid arteries. Their use can feasibly assist in navigation of extracranial carotid arteries to inspect integrity of the arterial wall and identify atherosclerotic plaques and associated lesions vulnerable to thrombogenicity, allow placement of intravascular occlusion coils, and assess apposition of stents to vessel wall. Further in Vivo validation needs to be conducted along with additional research to improve image quality, flexibility, and size of angioscopes.
Topics: Angiography, Digital Subtraction; Angioscopy; Cadaver; Carotid Arteries; Carotid Artery Diseases; Female; Fiber Optic Technology; Humans; Male
PubMed: 28931265
DOI: 10.1093/ons/opw002 -
Texas Heart Institute Journal 1995Coronary angioscopy will not replace angiography as the gold standard for imaging atherosclerotic coronary arteries. However, there may well be a clinical niche for a... (Review)
Review
Coronary angioscopy will not replace angiography as the gold standard for imaging atherosclerotic coronary arteries. However, there may well be a clinical niche for a technology that gives accurate information regarding a specific lesion, if that information can be used to improve the acute or chronic outcome of an interventional procedure. Our experience demonstrates that angioscopy indeed provides this information. Using angioscopy, we now have access to information regarding arterial wall disease that heretofore has been available only at necropsy. In addition, whereas angiography has provided only a 2-dimensional, gray-scale image of the coronary vessels, angioscopy offers a full-color, 3-dimensional perspective of the intracoronary surface morphology. These important lesion-specific details, not reliably available from angiography alone, may ultimately be used to improve patient outcome and to assess risk.
Topics: Angioplasty, Balloon, Coronary; Angioscopes; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Endothelium, Vascular; Equipment Design; Graft Occlusion, Vascular; Humans; Myocardial Infarction; Recurrence
PubMed: 7787466
DOI: No ID Found -
Journal of Vascular Surgery. Venous and... Jan 2023Venous stenting is increasingly used to manage femoro-ilio-caval venous outflow obstruction/stenosis due to post-thrombotic syndrome. Although the safety, efficacy, and...
BACKGROUND
Venous stenting is increasingly used to manage femoro-ilio-caval venous outflow obstruction/stenosis due to post-thrombotic syndrome. Although the safety, efficacy, and long-term patency of venous stents have been reported, re-interventions due to stent occlusion and in-stent restenosis (ISR) have also been reported. The mechanism of ISR and the in-stent neointimal growth after venous stenting remains unclear. We performed angioscopy to evaluate intraluminal details after venous stenting, allowing real-time direct visualization of the vessel lumen.
METHODS
Ten angioscopic procedures in four patients with post-thrombotic syndrome were performed. All evaluated vessels were stented iliac veins, and their native pathology was chronic post-thrombotic occlusion. Nine procedures in three patients underwent serial evaluation of the neointimal changes after stent implantation to study the natural time course of neointimal proliferation/coverage over the stent. The serial follow-up angioscopic evaluations were performed at the end of the venous stent deployment procedure, and at 6 months, 12 months, and 24 months. One procedure was performed 1 month after the stent implantation to evaluate ISR, which was observed at the first month of routine stent surveillance. A 5.7F angioscope was used to visualize the target veins. Continuous irrigation was used to displace blood and clear the visual field.
RESULTS
At 6 months after stent implantation, stent struts were covered by a thin neointima in two of the three patients. The struts were partially covered in one patient, but there was little neointimal growth overall. Neointimal coverage increased over time, and at 12 months stent struts in 2 patients were almost completely covered. There was no significant change between the 12 and 24 months after stent implantation. In the ISR case, angioscopy demonstrated an overgrown thickened neointima, and the stent struts were fully embedded and invisible in the entire stented area. No thrombus and no webs or trabeculae were found in the area evaluated as an ISR lesion.
CONCLUSIONS
At 6 months after stent placement, the stent struts were almost covered by a neointima. The stent struts were completely covered 1 year after stent implantation. Neointimal coverage was unchanged from the 1-year follow-up to the 2-year follow-up, suggesting that neointimal proliferation proceeded gradually with subsequent neointimal remodeling up to 1 year. The cause of ISR might be the overgrown thickened neointima rather than the formation of thrombosis.
Topics: Humans; Angioscopy; Neointima; Drug-Eluting Stents; Angioscopes; Stents
PubMed: 35931362
DOI: 10.1016/j.jvsv.2022.05.017 -
Circulation Journal : Official Journal... Mar 2010Although the concept of vulnerable plaque has become common, it is still impossible to predict effectively the onset of acute coronary syndrome (ACS). Thin-cap... (Review)
Review
Although the concept of vulnerable plaque has become common, it is still impossible to predict effectively the onset of acute coronary syndrome (ACS). Thin-cap fibroatheroma (TCFA) is regarded as vulnerable from pathological studies and various diagnostic tools have tried to detect TCFA clinically but failed to predict ACS. Because there are so many silent plaque ruptures detected, it is supposed that many vulnerable plaques might have ruptured but not caused ACS. Some factor(s) other than the rupture of vulnerable plaque is required for the onset of ACS. "Vulnerable blood" may be one of them. The thrombogenic potential of blood (ie, vulnerable blood) may play an important and determinant role in the onset of ACS, the process of which will be discussed from the angioscopic point of view.
Topics: Acute Coronary Syndrome; Angioscopy; Coronary Thrombosis; Coronary Vessels; Humans; Rupture, Spontaneous
PubMed: 20118566
DOI: 10.1253/circj.cj-09-0795 -
Heart (British Cardiac Society) Feb 2008Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large... (Review)
Review
Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair. Some European countries (eg, Belgium) have taken the results of these trials to rationalise the number of hospitals able to do endovascular repair. The devices continue to improve and although most require open surgical access at present, in future percutaneous access will become the norm. This article reviews the current state of endoluminal aortic aneurysm repair in the infrarenal aorta.
Topics: Angioscopes; Angioscopy; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Equipment Design; Humans; Randomized Controlled Trials as Topic; Stents; Surgical Wound Dehiscence; Treatment Outcome; Vascular Surgical Procedures
PubMed: 18195126
DOI: 10.1136/hrt.2007.121061 -
Neurosurgery Sep 1999To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel...
OBJECTIVE
To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex.
METHODS
A carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated proximal to the aneurysm to block proximal blood flow and allow endoluminal visualization. A flexible angioscope connected to a video monitoring system and to a high-intensity light source was then advanced within the catheter lumen and positioned immediately distal to the catheter tip. The aneurysm neck was clipped, and the clip was repositioned several times along the neck, with or without distal parent vessel compromise. Each time, the endovascular image on the monitor was interpreted by an observer blinded to the position of the clip. Clip position and image interpretation were communicated independently to a third person, who analyzed the correlation between them.
RESULTS
Angioscopy allowed clear visualization of the extent of aneurysm neck occlusion (complete, incomplete, residual "dog ear") after clip application, as well as the presence or absence of distal parent vessel compromise. Aneurysm neck configuration, size, presence of thrombus, and suture line definition were depicted. Critical structures external to the aneurysm-parent vessel complex were transilluminated by the high-intensity lamp.
CONCLUSION
Although acknowledged as the treatment of choice for intracranial aneurysms, surgical exclusion can be accompanied by significant morbidity related to perforator occlusion, parent artery compromise, and/or persistent residual aneurysm. The availability of a device allowing visualization of an aneurysm from an endoluminal perspective theoretically could reduce the incidence of these complications. Angioscopy has the potential to become a useful adjunct during intracranial aneurysm clipping because it provides real-time endoluminal viewing of the aneurysm-distal parent vessel complex, which is sometimes obscured to the surgeon.
Topics: Angioscopy; Animals; Carotid Artery Diseases; Dogs; Intracranial Aneurysm; Video-Assisted Surgery
PubMed: 10493380
DOI: 10.1097/00006123-199909000-00032