Valvulotomy of non-reversed saphenous vein bypass grafts: a randomised, blinded, angioscopy-controlled study.

Abstract

to compare the result of vein valve disruption with two different valvulotomes during non-reversed saphenous vein bypass. a randomised, blinded clinical study. twenty patients undergoing femorodistal non-reversed saphenous vein arterial bypass were randomised into two equal groups. Valve leaflet disruption was performed either with a standard size plastic valvulotome or with a metal valvulotome with an exchangeable cutting head. Valvulotomy was done after full exposure of the vein and completion of the proximal anastomosis. The result was evaluated by a surgeon blinded to the valvulotome used, using angioscopy. a total of 219 valve cusps were inspected with angioscopy. There were 83 completely lysed cusps (69%) by plastic and 76 (78%) by metallic valvulotomes (p=0.14). Of all the incompletely lysed cusps 12 (29%) occurred in the most proximal valve pocket treated with valvulotomy. no significant difference in performance between the investigated valvulotomes was found. Incomplete valvulotomy occurred mainly in the proximal part of the vein and was obviously caused by a size mismatch between the diameter of vein and the valvulotome. Construction of a valvulotome with a variable diameter cutting head is therefore recommended.