A New Endoscopic Valvulotome for In Situ Bypass Surgery

Summary

A new adjustable endoscopic valvulotome is described in this article. The scientific basis of its development has been discussed in detail by highlighting the historical background and technical problems associated with valvulotomy since the inception of in situ bypass surgery. A concise description of the mechanical properties and physical design of the instrument is disclosed and graphically demonstrated by accompanying illustrations and photographs.

The valvulotome has been used in 12 patients for arterial reconstruction of 14 limbs performed over a period of 1 year and 8 months. The indications for surgery were limb-threatening ischemia (78.5%) and disabling claudication (21.5%). Arterial reconstruction was performed from femoral to distal runoff vessel of either anterior or posterior tibial arteries in 78.5% of the patients. The remaining number of patients had either femoral to above-knee popliteal or below-knee popliteal bypass grafts. Limb salvage rate was 100%; primary patency of these grafts was 85.7%; and cumulative patency rate was 92.8%. The average graft velocity at the distal end of the graft at a 6-month interval was 73.4 cm/sec without significant change compared to earlier postoperative values.