Valve Disruption for In Situ Vein Bypass: Use of a New Technique

Abstract

Following its introduction in 1960, the in situ bypass technique has gradually gained acceptance among vascular surgeons. This can be explained, in part, by the lack of a reliable method for rendering vein valves incompetent. Several instruments developed by Skagseth and Hall, Leather and Karmody, and others have been used. Although most are relatively easy to use, one common drawback is the difficulty in controlling rotation of the cutting blade. This is due to insufficient torsional rigidity of the shaft and the lack of a blade plane indicator. Edwards, in 1936, described the consistent orientation of vein valves, whose margins are always parallel to the overlying skin surface. This knowledge facilitates complete midline incision of the valve cusps, provided that the surgeon is able to control the cutting blade. With this fact in mind, we have developed a new set of instruments. They feature satisfactory torsional rigidity, as well as blade plane indicators at the handle. For the endoscopist, the blade plane is made visible by a mark at the tip of each instrument. Precision-manufactured of stainless steel and welded with laser technology, the instruments are suitable for multiple use, which we consider an advantage from an economic, as well as an ecological viewpoint.