We evaluated the usefulness of angioscopy for the diagnosis of deep venous thrombosis (DVT) in the selected patients. Seven patients (age 37–76 years old, mean 62.1 years, 2 males, 5 females) were studied. Lesions: I.V.C. [2] Rt.C.I.V. [1] Lt.C.I.V. [4] Thrombus: acute [3] acute on chronic [1], chronic [3]. Compressibility was evaluated by B-mode ultrasonography. Color Doppler flow image is obtained by milking of the leg. Table 12.1 shows the profile of all 7 patients. Angioscopy was performed at 1 week to 2 years after the onset of DVT. In 3 patients who underwent angioscopy at 1 or 2 weeks after the onset, angioscopy demonstrated red thrombus in two of them (Fig. 12.3) and white one in 1 (Fig. 12.4). In these patients, thrombolysis therapy using urokinase was performed, and thrombus disappeared in the patients with red thrombus.

Diagnosis of acute pulmonary embolism (PE) is commonly done by contrast CT, angiography, or MRI, but these methods can only provide indirect imaging of thrombus. On the other hand, angioscopy can provide direct visualization of pulmonary thrombus. We performed angioscopy in 32 patients [13]. There were 6 patients of less than 1 week after onset, 7 of 1–4 weeks, 8 of 1–3 months, 6 of more than 3 months, and 4 with recurrent PTE. A 1.4 mm angioscope with 9 F guiding catheter was used. In the patients within 1week from onset, there were 1 patient with red thrombus and 3 with white thrombus. In those from 1 week to 1 month after onset, there were 1 red and 2 white. In those of more than 1 month after onset, all patients had yellow or red yellow thrombus. Angiography could diagnose pulmonary thromboembolism in 11 of 16 patients with globular thrombus and 1 of 5 with mural thrombus. In a few cases, we performed thrombolysis with urokinase (Fig. 12.5). Therefore, mural small thrombus visualized by angioscopy cannot be detected by angiography. Angioscopy may provide a final diagnosis of PE in patients suspected for PE.