In Reply to: Re: Case 0400_02-- Angioscopy Following Mechanical Thrombectomy of Hemodialysis Grafts posted by Frank Lynch on April 12, 2000 at 22:24:07:
The results of my study using angioscopy to evaluate the performance of different mechanical thrombectomy devices will be published in the September issue of JVIR.
I agree with all of the comments....in response to Dr. Grant, I can't get my video player to work either!!! Why can't I view these video clips...I wonder what is wrong?
For me, the angioscope continues to be a good research tool. I have now performed nearly 50 angioscopy procedures and have learned alot about the performance of the different thrombectomy devices. Most recently, I have used angioscopy to evaluate the new Helix catheter (Microvena) and the Xpeedior catheter (Possis).
The single most important lesson I have learned is that the angiographic appearance of a graft (or blood vessel) does not correlate with angioscopic observations. Angiography provides a rather "opaque" view of the endovascular enviroment, the details are only visualized using more direct methods (angioscopy or endoluminal ultrasound).
Angioscopy is alot of fun; residents, fellows, and visitors love to watch over my shoulder during angioscopic examinations. But, as a day-to-day clinical tool, it is not commonly useful. Again, I use it primarily as a research tool. But, I ocassionally use it to evaluate perplexing clinical situations. For example, to evaluate graft-to-graft anastomoses to determine if the stenosis is due to intimal hyperplasia or an aberrant suture line.
This is a topic for a very long discussion but personally, I doubt that the method of thrombus removal is directly related to long-term patency. I feel that long-term patency is dependent upon the successful treatment of the underlying problem which caused the thrombosis to occur. This theory is suggested by the published data. In my experience using angioscopy, some devices work MUCH better than other devices. Yet, the published long-term patency rates for these thrombectomy devices, even for the lousy devices, are similar. This suggests, to me, that the method of thrombus removal is not directly related to the method by which the thrombus is removed.
I gotta keep trying to get these video clips to run on my computer.