Angioscopy

Today, according to the World Health Organization, about 30% of the causes of death in the world are caused by vascular diseases. Timely detection of possible deviations in the work of the vascular system gives high chances for their successful treatment without serious consequences. And monitoring the effectiveness of the treatment, including surgical interventions, is very important.

Therapists, cardiologists, phlebologists, cardiovascular surgeons – all these specialists recognize the importance of high-precision modern methods for examining the state of blood vessels in the human body. Thanks to the achievements of technical progress applied in the field of medicine, it became possible to study and observe various vascular anomalies, diseases, as well as the results of the prescribed treatment, performed operations on the vessels. One of the ways to study the vascular system from the inside is angioscopy. It is mainly used in vascular surgery.

What is angioscopy, how did the procedure appear

The angioscopy procedure is a method of intravital examination of the state of the vessels from the inside, when a device called an “angioscope” is inserted into the vessel itself. The device is a special endoscopic tube, usually no more than 2 millimeters thick, at the end of which there are light-sensitive optical devices.

The tube is equipped with a video camera, and the doctor has the opportunity to directly examine and examine the internal state of the vessels, the presence of constrictions, plaques or other disorders in them, according to the picture that is displayed on the monitor.

For the first time, an attempt to conduct a targeted examination of blood vessels in the human body using a special tube was made at the beginning of the 20th century by the French surgeon Alexis Carrel. Although the process of developing endoscope devices had already begun at that time, the equipment for carrying out procedures of such high accuracy, of course, did not yet exist, so this examination technique did not gain popularity. She became interested after 1946, when cardiac surgeon Russell Brock managed, using a special endoscope, to examine the valves of the heart, introducing it through the carotid artery and aorta into the patient’s body. After that, in the 60s, experimental procedures were carried out to study the inner surface of the vessels using various technologies and endoscopic devices.

As a result, since the 1970s, the production of fibroangiocardioscopes began, with the help of which examinations of the internal surface and cavity of blood vessels are carried out. Modern optical devices, combined with computer technology, make it possible to obtain a high-precision picture of the internal state of veins and arteries in almost any part of the human body.

There is an informal division of angioscopy into phleboscopy and arterioscopy, depending on whether veins or arteries are studied, respectively. The procedure is carried out only if general or local anesthesia is applied to the patient – this depends on the size of the vessel under study. In general, despite the high efficiency and accuracy of this method, it is used less frequently than, for example, angiography or vascular ultrasound, since the equipment for its implementation is very expensive and rarely available in most medical institutions. In addition, the procedure itself is considered difficult for the doctor and for the patient, and requires some effort to carry it out.

What is the procedure for?

To date, the main scope of the procedure is surgery. Often, angioscopy is performed immediately after the operation, in order to assess the effectiveness of surgical intervention:

• to determine whether the intima is completely removed during intima thrombectomy;
• to establish the state of the superimposed vascular anastomosis (connecting element);
• to study the presence of blood clots;
• for taking material during angiobiopsy;
• to study the state of the valve apparatus of the veins;
• to determine the state of the intima in the distal part of the vessel, which is switched off from the blood circulation process.

In addition, angioscopy allows you to identify the presence of such abnormalities, pathologies and diseases:

• atherosclerosis;
• thrombosis and thromboembolism;
• aneurysms;
• inflammatory or neoplastic processes.

This procedure is not available in every medical institution, since the equipment for its implementation is expensive. Basically, it is available in large diagnostic and treatment centers, vascular departments of hospitals that specialize specifically in vascular operations.

Contraindications for angioscopy

Despite the obvious value of the data obtained through angioscopy, in some cases such a procedure can harm the health of the patient, and then the doctor decides on the possibility of conducting other research methods. Among the contraindications:

• insufficiently large diameter of the vessel (the diameter of the angioscope should be less than the diameter of the vessel cavity);
• severe atherosclerosis of the vessel;
• significant violations of the anatomy of the vessel (branching, kinks or compression);
• the inability to maintain the sterility of the wound that will be inflicted during the operation.

Absolute sterility of the device is a mandatory requirement for surgical intervention. To achieve it, the endoscope is treated with ethylene oxide, 0,5% chlorhexidine solution or formaldehyde vapor. The working part of the endoscope is immersed in a sterilizing solution or subjected to steam treatment for 10-15 minutes.

How to prepare for the procedure

Doctors usually do not recommend any special preparations for the procedure. In the case of taking drugs that affect the state of the vascular walls, it is necessary to consult a doctor about the possibility of temporarily canceling them before angioscopy is performed.

If it is planned to introduce the patient into a state of general anesthesia for angioscopy, the preparation is similar to that which precedes any operations under general anesthesia: on the day of the procedure, you can not eat, the patient is preliminarily consulted by the anesthetist, sedatives may be administered to him before immersing him in medical sleep.

Before conducting this vascular study, it is necessary to pass a general blood and urine test.

How is angioscopy performed?

In fact, the procedure is a surgical intervention. Inspection of the vessel occurs under the condition of stopped blood flow in it. A transparent sterile liquid is introduced into the examined vessel, which replaces the blood in it.

To perform such an operation, the presence of several specialists is required:

• a surgeon who “exposes” the vessel, blocks the blood flow in it, inserts an angioscope through the angiotomy opening, and makes sure that it does not damage the walls of the vessel;
• an endoscopist who directly performs the examination, giving instructions to the surgeon on how to guide the endoscope;
• an assistant who is responsible for supplying fluid through the system into the lumen of the vessel.

If the operation is performed under general anesthesia, an anesthesiologist also takes part in it.

Of course, the success of the study and how harmless it will be for the patient depend on how well-coordinated and polished the teamwork of these three people is. A mandatory requirement is the strict observance of sterility by all participants in the operation.

After local anesthesia, or by introducing the patient into a state of medical sleep, the surgeon opens the vessel. The cessation of blood flow occurs through the imposition of special elastic clamps or bandaging. A sterile saline solution is fed into the vessel through the endoscope tube to improve visibility and prevent blood from entering the cavity of the vessel under study.

Under the condition of completely inhibited blood flow in the vessel, it is allowed to use the endoscope as an instrumental channel through which scissors, forceps and other instruments can be inserted into the cavity, it is possible to perform an intimal biopsy, remove the part of the intima remaining after intimthrombectomy, remove plaque or thrombotic masses. Carrying out phleboscopy under such conditions, the doctor can cut the valves or fibrous septa, which are often the cause of phlebothrombosis.

After conducting a study and other necessary actions, blood flow is restored in the vessel: for this, a vascular suture or prosthetic material is first used, after which the clamps are removed.

Possible complications after the procedure

The most serious risks of this operation are associated with non-compliance with the rules of complete sterility: because of this, local purulent inflammation, septicopyemia and sepsis may occur.

The most common complication after angioscopy is damage to the vessel walls by the endoscope. In some cases, it may be necessary to carry out prosthetics or replace part of the wall. If the procedure lasts too long, a large amount of fluid may be injected at the site of the procedure, resulting in thrombosis of small vessels and even soft tissue edema.

Studying the results of angioscopy

In a healthy state, the vessel should have a normal lumen, into which the endoscope tube should pass freely (of course, provided that it has a smaller diameter than the vessel under study). The vascular wall normally looks like a smooth and even surface, on the inner shell of which there are no atherosclerotic plaques, protrusions, pathological expansions and narrowings. All ramifications of the vessel should appear on the monitor as dark dots.

The inner shell of the vessel – the intima – should not be damaged, its surface normally looks even, shiny and smooth.

Angioscopy is a method of studying the vascular system of the human body, which has not yet been fully improved. With its help, you can explore, for example, the state of the vessels of the upper and lower extremities, the brain. This operation is a complex intervention and requires a team of doctors to coordinate and coordinate work, accuracy, and accuracy.

Carrying out this category of research is impossible without the availability of special high-precision equipment – an angioscope. Such devices are expensive, which is why they can only be found in large specialized centers.