title: Angioscopically directed valvulotomy: a new valvulotome and technique.
abstract: Despite a large experience with "blind" retrograde valvulotomy in in situ vein bypass grafting, the incidence of residual competent valves remains high, and valvulotome-induced injury is common. In this study we describe a new valvulotome and technique of angioscopically directed valvulotomy and review the video tape recordings of 85 completion angioscopies of in situ femorodistal bypasses. Fifty-three vein grafts were prepared with the blind retrograde valvulotomy technique and 32 vein grafts with the new valvulotome and angioscopy. The use of the new valvulotome and technique is compared with that of the standard blind retrograde valvulotomy technique, and the normal endoluminal anatomy and incidence of primary disease in saphenous vein grafts was noted. The incidence of valvulotome-induced injury was 5/32 (15.6%) and 45/53 (85%) in vein grafts prepared with angioscopically directed valvulotomy and blind retrograde valvulotomy, respectively. Residual competent valves were found in 10/53 (18.9%) in blind retrograde valvulotomy and 0/25 of angioscopically directed valvulotomy vein grafts (p = 0.0114). In 22/53 vein grafts unsuspected primary disease was detected. Angioscopically directed valvulotomy with the new valvulotome and technique is feasible, reliable, and safe. It avoids residual competent valves, minimizes valvulotome-induced injury, and allows the detection and correction of unappreciated primary vein graft abnormalities. The new valvulotome and technique is a first step in the complete endoluminal preparation of the in situ vein graft.
authors.affiliation: Harvard-Deaconess Surgical Service, Division of Vascular Surgery, New England Deaconess Hospital, Boston, MA.
authors.forename: A
authors.initials: A
authors.lastname: Miller
authors.forename: P A
authors.initials: PA
authors.lastname: Stonebridge
authors.forename: A I
authors.initials: AI
authors.lastname: Tsoukas
authors.forename: C J
authors.initials: CJ
authors.lastname: Kwolek
authors.forename: C M
authors.initials: CM
authors.lastname: Brophy
authors.forename: G W
authors.initials: GW
authors.lastname: Gibbons
authors.forename: D V
authors.initials: DV
authors.lastname: Freeman
authors.forename: F B
authors.initials: FB
authors.lastname: Pomposelli
authors.forename: D R
authors.initials: DR
authors.lastname: Campbell
authors.forename: F W
authors.initials: FW
authors.lastname: LoGerfo
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis; D004724:Endoscopy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D012501:Saphenous Vein / Q000293:injuries / Q000637:transplantation*; D013525:Surgical Instruments; D007507:Therapeutic Irrigation / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*; D014743:Videotape Recording