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Amaurosis Fugax: A Clinical Comparison• Amaurosis fugax (transient monocular blindness) is a symptom of retinal ischemia just as contralateral hemiparesis and sensory loss are symptoms of cerebral ischemia. These symptoms are produced by atherosclerotic stenosis of the carotid vessels at the ipsilateral carotid bifurcation and emboli from these areas causing focal, repetitive, retinal ischemia.A study of 31 endarterectomy patients was undertaken to see if eight patients with amaurosis fugax (25%) could be differentiated from 22 patients with transient cerebral ischemia. The patients with amaurosis fugax were found to be younger. They all had 75% or greater stenosis of the internal carotid artery at the bifurcation on the symptomatic side. They all had unilateral visual symptoms and these symptoms were relieved by surgery. The patients with amaurosis fugax were devoid of cardiac disease, while 45% of the cerebral ischemic patients had documented myocardial disease.Amaurosis fugax (transient monocular blindness) in the setting of clinically significant atheroslerosis of the carotid vessels is an indication for carotid endarterectomy.

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The purpose of this study is to evaluate the angioscopic method of preparation of the saphenous vein for in situ grafting as compared with the standard open vein preparation. Nineteen consecutive cases performed after adoption of a semiclosed angioscopic technique were compared with 20 consecutive cases performed with the conventional technique of vein preparation. Wound complications occurred less frequently in the angioscopy group (37% vs 78%, p=0.02). By univariate analysis, wound healing problems were associated with low preoperative ankle-brachial index (p=0.07), tissue loss (p=0.05), and use of a long, continuous leg incision (p=0.01). Logistic regression analysis identified low preoperative ankle-brachial index (p=0.03), diabetes (p=0.05), and a long, continuous leg incision (p=0.06) as independent predictors of wound compli cations. Patients with wound complications had significantly longer hospital stays (9 ±8 vs 4 ±3 days, p<0.01). This initial experience suggests that angioscopic preparation of the saphenous vein results in fewer wound complications and should result in shorter hospital stays compared to conventional methods of vein preparation. The long-term effect of angioscopically assisted vein preparation remains to be determined.