Angioscopy-guided semiclosed technique for in situ bypass with a novel flushing valvulotome: early results

To allow and facilitate endoluminal vein preparation under angioscopic guidance for in situ bypass grafting, a Mill's valvulotome was equipped with a flushing channel. The advantages of the novel valvulotome are obvious: it allows perfect angioscopic view within a saphenous vein that still contained blood by adjusting the jet of lactated Ringer's solution directly to the lens of the angioscope; it permits the use of very small angioscopes without integrated flushing channels, preventing endothelial damage. The described technique was tested in 27 peripheral reconstructions in 26 patients. The secondary cumulative patency rate within a follow-up time of 4 to 30 months (mean, 14 months) was 89%. The described technique substantially facilitates in situ bypass grafting and minimizes early and late complications and further improves surgical outcome.