Instrumental evolution of the valve incision method of in situ saphenous vein bypass Robert P. Leather, M.D., Dhiraj M. Shah, M.D., John D. Corson, M.D.,

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Presentation transcript:

Instrumental evolution of the valve incision method of in situ saphenous vein bypass Robert P. Leather, M.D., Dhiraj M. Shah, M.D., John D. Corson, M.D., Allastair M. Karmody, M.D. Journal of Vascular Surgery Volume 1, Issue 1, Pages 113-123 (January 1984) DOI: 10.1016/0741-5214(84)90191-5 Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 1 Concept of valve incision. Blunted scissors are advanced to depths of valve sinus with leaflets in functionally closed position and valve leaflets cut. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 2 Microvascular scissors originally used for valve incision. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 3 Modified Mills' valvulotomes. Top: Original tip. Bottom: Current tip (shorter and safer). Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 4 Valve incision with valve cutter (American V. Mueller). Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 5 Pressure-control system with pneumatic transfusion cuff (not shown) over compliant plastic bag containing 500 ml blood or 2500 units of intravenous fluid with heparin and 120 mg papaverine hydrochloride and appropriate tubing. A No. 8 French catheter is attached to cutter (insert) to provide a pressure gradient at valve site. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 6 Scissors now used. Top: With reversed handle. Bottom: Sweet pituitary scissors. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 7 A, Preoperative phlebogram showing a perforating vein (arrow). B, Operative completion angiogram (same vein) showing, in addition, a double system (present but not visible on this print of preoperative phlebogram without additional light). Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 8 Valve incision with valvulotome. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 9 Sites of distal anastomoses in 407 in situ saphenous vein arterial bypasses for limb-threatening ischemia. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 10 In situ bypass patency by life-table analysis of procedures performed for limb salvage shown with a comparable series (23) typifying the results for reversed saphenous vein grafts. A, One hundred sixty-two femoropopliteal bypasses. B, Two hundred forty-five infrapopliteal bypasses. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions

Fig. 11 Bypass patency by life-table analysis adjusted for preoperative selection of patients for operation and presence of a suitable vein for use at time of operation. Journal of Vascular Surgery 1984 1, 113-123DOI: (10.1016/0741-5214(84)90191-5) Copyright © 1984 Mosby, Inc. Terms and Conditions