Angioscopic evaluation of valvular disruption during in situ saphenous vein bypass.
Several valvulotomes are currently available to achieve valvular disruption; however, studies comparing the efficacy of these endoluminal instruments are lacking. This prospective study evaluates the efficacy and safety of the three most commonly employed valve cutters: the Hall, LeMaitre, and Mills valvulotomes. A total of 30 in situ greater saphenous vein bypass grafts were included in this investigation. Valvular disruption was attempted with either the LeMaitre (11 cases), Hall (12 cases), or Mills (7 cases) valvulotomes. Subsequently, angioscopy was employed to assess the completeness of valvulotomy and to identify vein wall injury. Incomplete disruption of one or more valve complexes was identified in 2 of 12 (17%) grafts in the Hall group, 10 of 11 (91%) grafts in the LeMaitre group, and 0 of 7 grafts in the Mills group (p < 0.01). Intact valve cusps were noted in 2 of 36 (5.5%) valves, 31 of 42 (74%) valves, and 0 of 38 valves after valvulotomy with the Hall, LeMaitre, and Mills instruments, respectively (p < 0.01). A total of three valvulotome-related injuries occurred; two injuries were noted in conjunction with the Hall instrument, one was associated with the Mills valvulotome, and no injuries were detected after use of the LeMaitre instrument (p = 0.33). These data demonstrated a significantly increased incidence of retained valve cusps when the LeMaitre valvulotome was used. No significant difference in the rate of vein wall injury was noted in the three groups. Thus this study suggests that the LeMaitre instrument is not as effective as either the Hall or Mills valvulotomes for achieving valvular disruption.
Parent
F N
FN
Department of Surgery, Eastern Virginia Medical School, Norfolk.
Gandhi
R H
RH
Wheeler
J R
JR
Gregory
R T
RT
Snyder
S O
SO
Gayle
R G
RG
Masuda
E M
EM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy; D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*