The Use of Angioscopy in Vascular Access Surgery: Shedding New Light

Abstract

Introduction: Angioscopy is a well-recognised surgical technique used in luminal assessment of native vessels and grafts. It allows direct visualisation of the lumen and its internal surface. It is increasingly being utilised in coronary arteries, lower limb vessels and vascular grafts. However, its role in vascular access for haemodialysis is still uncertain. Methods: Operative notes of angioscopies for dysfunctional AV fistula in a district general hospital were analysed. A Pubmed search was also performed from inception to September 2018 for English-language studies on the use of angioscopy and vascular access for haemodialysis. Outcomes such as identification of luminal abnormalities and additional surgical intervention needed were extracted and analysed. Results: A total of 13 angioscopies for AV fistula were performed from January 2001 to September 2018. Abnormalities identified include the presence of thrombus and irregular surface of the intima. Retrieval of thrombus using a fogarty catheter or biopsy forceps via the operating port of the angioscope under direct vision was also performed. Only 4 retrospective observational studies met the inclusion criteria. A total of 131 patients were included in the eligible studies with 185 angioscopies performed. 97 angioscopies were performed during revision of grafts and 88 in primary grafts. Fibrescopes with outer diameter ranging from 0.8mm to 2.8mm and 300W xenon light source were used. Indications for angioscopies include assessment of suitability of native vessels in primary procedure and identifying site of stenosis and occlusion, and retained thrombus in revision procedures. 94 (97%) revision angioscopies successfully identified abnormalities i.e. thrombus or stenosis, which led to additional surgical intervention including repeated thrombectomies and angioplasties. Conclusion: Angioscopy is a valuable technique in the assessment and management of vascular access for haemodialysis which allows direct visualisation on the luminal surface of the graft or native vessels. It also allows retrieval of thrombus under direct vision. The limited available data on this subject provides opportunity for further studies. Disclosure: Nothing to disclose