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Preliminary Experience with a Self-Centering, Expandable Valvulotome for in Situ Vein Reconstruction

A self-centering, expandable valvulotome was employed to establish femoral distal in situ vein reconstructions in 41 patients. The focus of the early follow-up was to assess graft patency and the incidence of incomplete valve closure. Residual arteriovenous fistulas, clearly unrelated to the methodology of valvulotomy, were also noted. Early patency was achieved in all 41. Missed valves occurred in two instances, requiring open direct valve excision in one case and use of a Mills valvulotome in the other. One vein was injured but successfully repaired. The authors conclude that excellent patency results with complete valve cutting can be achieved in the majority of cases for in situ reconstruction in the lower extremity with a new self-centering, expandable valvulotome. The role of angioscopy is uncertain and requires further study.