How many angioscopies were performed in the United States in 2003 (or
2002 if figures are not available for 2003)?

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Clarification of Question by silvershadow-ga on 26 Mar 2004 08:01 PST

Pleased include source so I can read further.

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Clarification of Question by silvershadow-ga on 29 Mar 2004 08:43 PST

To commenter alkali:

Yes, I did mean coronoary angioscopies. Thanks so much for your information.

ANGIOSCOPY IS NOT A ROUTINELY DONE PROCEDURE.
However, Intravascular Ultrasound (IVUS)is the next best investigation
to Angioscopy. More about Angioscopy :
The inability to see through blood remains the main obstacle to the
widespread and routine use of angioscopy. Local irrigation with a
balanced salt solution is presently the most widely used method to
clear the blood. By applying basic principles of irrigation and using
a unique, dedicated, irrigation pump, we found that routine angioscopy
during lower extremity revascularization that yields consistent
high-quality studies is feasible, clinically useful, and safe. Between
May 1, 1987, and July 31, 1988, 136 intraoperative angioscopies were
performed during 112 peripheral bypass procedures, 15 thrombectomies,
2 embolectomies, and 7 miscellaneous revascularization procedures.
Mean total irrigation fluid used in the peripheral bypasses was 398 mL
(range, 0 to 1400 mL). Good visual quality was obtained in more than
80% of angioscopies and the failure rate was only 1.8%. On the basis
of the findings in 71 of the 136 angioscopies, 78 clinical or surgical
decisions were made. No complications were directly attributable to
the insertion of the angioscope or use of the pump.

For further reading go to 'Archives of Surgery', Vol.124, No.5, May 1989.

Angioscopy is a generic term meaning "to visualize the interior of a
blood vessel", from the Greek "angeios" (vessel) and "scope" (look).

Angioscopy encompasses any technology that allows the interior of a
blood vessel to be seen, either directly (with a small camera or fiber
optic system) or on a roentgenogram (x-ray). Consequently, it would
probably be impossible to find out the number of angioscopies
performed - health care records are probably not routinely aggregated
for simple and common procedures.

Coronary angioscopy, on the other hand, is an angioscopy involving the
coronary arteries, the blood vessels supplying the heart. This is a
much bigger deal, and therefore performed in a more easily countable
number of places, usually tertiary care centres.

Did you mean coronary angioscopy in particular?

Alan Kali

Silvershadow,

Since you mean coronary angioscopy, rather than general angioscopy
(for example, the kind of angioscopy performed on the saphenous vein
to examine its suitability for grafting during a coronary artery
bypass procedure), I have a couple of thoughts on how to find the
information you are looking for. For simplicity, I'll assume you mean
plain ordinary coronary angioscopy rather than the more complicated
radiologic (x-ray) variations.

The first thing I did was to search the medical literature at
http://pubmedcentral.nih.gov/ and
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi. In the latter case, I
specified "Review Articles", since these kind of articles are an
overview and are more likely to give numbers about overall procedures
performed worldwide or by country. As far as I can tell, there aren't
any. I also searched without the "Review" flag, with no success.

I think the reason may be that coronary angioscopy, or PTCA (or just
PCA) for percutaneous (through the skin) transluminal (down the hole
in the middle of the blood vessel) coronary angioscopy has been mainly
a diagnostic (finding out what is wrong and how best to fix it) rather
than therapeutic (doing something about it) procedure. That may be
changing, however, since new angioscopes (the tools used for
performing angioscopy) are being made with valvulotomes (tome = cut)
to clean out the saphenous vein when it is being used as a graft. A
direct visualization coronary artery "roto-rooter" cannot be far
behind.

More to the point though, PCA has not become part of the mainstream
approach to the diagnosis and treatment of coronary artery disease.
PCA is used for finding out what type of clots are present, rather
than how many, where they are and how severe they are. Consequently,
not every patient, or even most patients, undergoes this procedure.
The clinical situation must warrant it.

The medical profession tends to collect and publish more numbers about
groups under study than overall figures, and tends to focus on the
outcome of mainstream rather than peripheral branches of the
diagnostic and therapeutic tree. If someone has collected and
published the overall numbers for coronary angioscopy, it will
probably be a sideline to the main event, which is how effective the
technique is under various circumstances.

In Canada right now almost every procedure of this type would be
performed under the provincial government health insurance plans, and
the respective provincial ministries of health would almost certainly
have the numbers you are looking for. The Ontario Ministry of Health
(http://www.health.gov.on.ca/) has a billing code for Fluorescein
Angioscopy (it is G853), but that is a procedure performed on the eye,
and not what you are looking for. It may be that coronary angioscopy
is too new to have a billing code, or else it is not being done in
Ontario. You could try other provinces of Canada or other countries
with socialized medicine for this information. They probably wouldn't
mind sharing the aggregate data.

In the U.S. it is more difficult, since most coronary angioscopies
will be done under private health insurance. I have no idea how to get
that information, and it would probably have to come from more than
one source. Perhaps there is a government agency that could help.

I thought of another idea. Why not contact Edwards Lifesciences, a
division of Baxter Healthcare in Irvine, California? They are the
maker of most of the scopes used in PCA procedures in the U.S. They
sell the tools, so they should know how much the tools are used. Even
better, some types of angioscopes are disposable, single-use
instruments, so once you have their annual sales figures, you should
know more or less exactly how many procedures were performed, allowing
for wastage, loss and inventory.

You can contact Edwards Lifesciences at communications@edwards.com, or
use their handy feedback form at:

http://www.edwards.com/ContactUs.aspx?returnUrl=%2fMedicalProfessionals%2fFindProducts%2fProductList.aspx%3fItemId%3d6C437DFD-96FE-4F8D-8C7C-8EEAFDC8D86D&transfer=

Hope this helps.

Alan Kali