CHAPTER 34 Angioscopically Assisted Thromboembolectomy

lnrroduced In 19fi3, the balloon em bolectomy carhertr hal> proved to be ~ n im porranc contribution fO rhe deveJopmt"nt of endovascular devices to assIst in the treatmen t of peripheral vascular ocdusi~e disease (l,2). Ie has al~o provided a template for the deslgn of orher, more speuabzed curgicaJ prncedures for removJIlg thrombus were tnwghr with complica­ tions that resulted in high patient mortality :md 1110(­ hid it)'. USIng the embolectomy catheter to remove ac ute peripheral emboli has impro\'ed surgical outcome and conseq uently patiem survival. Independent studies con ­ ducted by Tawes er a l. (3), Ellior ct al. (4 ), Abbott e( al. L5), and Camhria an d Ahbott (6) have shown limb sa l­ vage ra tes of 85% to 95% with a ttendant !l1 ortil lity cares reduced to '10% to 20<>1<> Going beyond [he basic em boltcromy pro(;edure, new catbeter-based technologIes, developed from a m()r~ lIl-depth knmvledge and understanding of (he niology of tht, va,cular occlusive disease process, have em erg.:d to addrc)) the variou~ progressive 5law:s of disease. In so doing, the less invasive, endovascubr field has evolved to indude man)' n~w moda hties WhO:il' primary applicmion is not to physically remove th romboem bolic materia l but to pr()\'ide assistance in 1) diagnosis, 2 ) facil itation of the therapemie endovascu la r su rgical proa d ure, and 3) postoperative eva luation of rhe resultanf efficacy of [he surgical intervention. These modalities include angllr scopy [hat allo\vs a 360 endoscopic VIsualization of ves­ sel lumen, and th e more n:ccntlr introduced intral uminal Doppler ultrasonic imaging, which provides an echo im<1ge of rhe inrima and su rround ing li ~sue structures. The followmg will describe applications suited to anglOscnpy and will specifically address the adva ntage~ and disadvantages associated with the llse of angioscopy \tl thromboembol ectomy.