In situ grafting made easy. Modification of a technique

In situ bypass grafting has come of age following a period of disenchantment. It has become, in some centers, the operation of choice for bypasses to the tibial and peroneal vessels. Two fundamentally different techniques for this procedure have evolved. The first, following the method of Hall, uses a retrograde valvulotome passed from the distal saphenous vein to the proximal vein; on withdrawal, it severs the valves. A second approach, that of Leather, uses microscissors and a right-angle valvulotome, along with a disposable valve stripper, to disrupt the valves. Proponents exist for both approaches. In 1983 we reported our protocol for in situ grafting using the Hall technique. A number of modifications have since been made to expedite the technique. We describe and provide illustrations of these modifications.