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Arteriovenous crossing sheathotomy for branch retinal vein occlusion

 
Guidance issued
 
Number: IPG72

Summary

The Interventional Procedures Advisory Committee (IPAC) has considered this procedure and NICE has issued a consultation document about its safety and efficacy. Consultation has now ended. IPAC will consider the consultation comments and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.

The consultation period for this procedure closed on the 21st December 2009.

If you wish to be updated to any developments with this procedure, you can express an interest here.

Description

Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease after diabetic retinopathy. It results from a blockage of the part of the circulation that drains blood from the retina.

Symptoms of BRVO include peripheral visual loss, distortion of vision, or 'blind spots'. In some cases spontaneous improvement in vision can occur as the macular oedema (which follows acute occlusion of the vein) resolves.

BRVO typically occurs at arteriovenous crossings, where the artery and vein share a common adventitial sheath. Arteriovenous crossing sheathotomy is commonly used as an adjuvant to pars plana vitrectomy.

In arteriovenous sheathotomy, the overlying artery is separated from the vein with a microvitreoretinal blade. A pars plana vitrectomy is first performed (surgical removal of the vitreous). An incision is then made in the adventitial sheath adjacent to the arteriovenous crossing, and is extended along the membrane that holds the blood vessels in position to the point where they cross. At this point, the blade is used to separate adhesions holding the artery to the vein. The artery is then lifted away from the vein.

Cutting the sheath around the vessels and physically separating them where they cross should improve blood flow through the vein.

OPCS code:

Details

Arrangement:
Special
Topic area:
Cardiovascular
Eye
Surgical procedures
Specialty:
Ophthalmology
Specialist advice has been sought from:
  • Royal College of Ophthalmology
Date notified to NICE:
05 May 2003
Provisional consultation date:
Autumn 2009
Guidance issue date:
28 July 2004

Contact details:

Project manager (for general enquiries or comments)
(for general enquiries or comments)
Technical lead
(for procedure specific enquiries or comments)
Steven Barnes
ip@nice.org.uk
Contact Address:

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA

Links: