Keeping an ‘eye’ on type A dissections

Abstract

We readwith interest the how-to-do-it article ‘Angioscopy — a valuable tool in guiding hybrid stent grafting and decision making during type A aortic dissection surgery’ by Tsagakis and colleagues, and the conference discussion with Professor von Segesser [1]. Currently, each form of endoscope for the purpose of angioscopy during circulatory arrest for type A dissection repair has its pros and cons. The bronchoscope has a good length, is thin,flexibleandeasy tomanipulate.However, there are potential issues about its sterility, and its illumination and image quality are relatively inferior. Themodified gastroscope has a biplanar, flexible, distal section for optimal positioning. In addition, it has a suction irrigation system, which allows for in situwashingwithout the need to remove it. Nevertheless, it is a bulkier device with a thicker scope [2]. In our experience, the choice of angioscope for inspection of and open-stent deployment for the arch and descending aorta is the flexible-tip 5-mm EndoEYE (Olympus America Inc.) endoscope. The device is a new-generation highdefinition video endoscope with a miniaturized chargecoupled device (CDD) chip at the tip of the scope, which provides the very best picture quality and superior lighting. It is also thin and lightweight, as well as being fully autoclavable. The disadvantage is its limited scope flexibility, which may not allow it to visualize the distal aorta. Hybrid procedures for aortic dissection repair are increasing in popularity. There remain many shortcomings in the available endoscopes for the purpose of angioscopy. The future device should be a surgeon-friendly scope that is specifically designed for the task of intra-operative aortic exploration.