Combined Use of Angioscopy and Intravascular Ultrasonography for Diagnosis and Evaluation of Surgical Repair of Aortic Disease

Angioscopy (AS) and intravascular ultrasonography (IVUS) enable pathological diagnosis of vascular interior and visualization of vascular wall architecture, respectively, and therefore these techniques in combination may give us much information on vascular disease. But, these techniques in combination have been rarely used for diagnosis and evaluation of surgical repair of large vessels. Systematic review on the combined use of AS and IVUS for vascular disease, except those of the coronary arteries, has rarely been published in the literature, so we have described developmental history of AS, and AS and IVUS images of aortic disease before and after surgical therapy that were obtained mostly in our laboratory. Usually, AS system is composed of a 4.5F fiberscope and 9F balloon guide catheter and IVUS system is composed of a 9F, 12 or 20 MHz, 20 CPS probe. They are introduced into the aorta for diagnosis of aortic aneurysm and evaluation of their surgical repair in patients. Recent important findings are as follows: (1) Entry and re-entry of dissecting aortic aneurysm were easily identified by IVUS and entry was frequently found by AS in yellow plaques. Thrombus formation was found by AS in the aortic arch graft, suggesting the necessity of anticoagulant therapy after repair for prevention of cerebral embolism. (2) Disrupted plaques and thrombi were observed by IVUS in the aneurysm, which were frequently not detectable by computed tomography or aortography, in patients with saccular abdominal aortic aneurysm. Fresh and old thrombus in mixture were frequently observed by AS, suggesting recurrent thrombus formation. Incomplete neo-endothelial coverage of the Y-graft even 6 months after grafting and detached threads at the sutured portion were found by AS but not by IVUS. Pseudoaneurysm at the sutured portion was confirmed by AS and IVUS in combination. AS and IVUS in combination give us much information on structural and pathological changes and evaluation of surgical repair of aortic disease.