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Angioscopic evaluation of valvular disruption during in situ saphenous vein bypass
F N Parent1, R H Gandhi, J R Wheeler
1Department of Surgery, Eastern Virginia Medical School, Norfolk.
Insights
The LeMaitre valvulotome is less effective for disrupting vein valves compared to the Hall and Mills instruments. This study found the LeMaitre device left more intact valve cusps, indicating incomplete valvular disruption.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Surgical Instrumentation
Background:
- Valvular disruption is crucial for the patency of vein bypass grafts.
- Existing valvulotomes lack comparative efficacy data.
- Prospective evaluation of commonly used valvulotomes is needed.
Purpose of the Study:
- To compare the efficacy and safety of the Hall, LeMaitre, and Mills valvulotomes for valvular disruption.
- To assess the completeness of valvulotomy and identify vein wall injury using angioscopy.
Main Methods:
- Prospective study of 30 in situ greater saphenous vein bypass grafts.
- Valvular disruption attempted with Hall (12), LeMaitre (11), or Mills (7) valvulotomes.
- Angioscopy used to evaluate disruption completeness and vein wall injury.
Main Results:
- The Mills valvulotome achieved complete disruption in all cases (0% incomplete).
- The Hall valvulotome had 17% incomplete disruption; LeMaitre had 91% (p < 0.01).
- No significant difference in vein wall injury rates among the three instruments (p = 0.33).
Conclusions:
- The LeMaitre valvulotome is significantly less effective for complete valvular disruption than Hall or Mills.
- Mills and Hall valvulotomes demonstrate superior efficacy in achieving valvular disruption.
- No instrument showed a significant advantage in preventing vein wall injury.
Abstract:
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.