Angioscopically directed valvulotomy: A new valvulotome and technique

Slides:

Advertisements

Similar presentations

The role of arteriovenous shunts in the pathogenesis of varicose veins Howard C. Baron, M.D., Sebastiano Cassaro, M.D. Journal of Vascular Surgery Volume.

Advertisements

The effect of inguinal lymphatic manipulation on regional lymph flow patterns Jeffrey R. Rubin, MD, Lisa B. Eberlin, MD Journal of Vascular Surgery Volume.

A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease Ramon Berguer, MD, PhD, Mark D. Morasch,

John Large, F.R.C.S. (Edin.) Journal of Vascular Surgery

Aortic injury occurring after minor trauma in ankylosing spondylitis

Heparin-coated catheters and heparin-induced thrombocytopenia

Peter Gloviczki, MD, Peter C. Pairolero, MD, Barbara J

Ultrasound measurement of the luminal diameter of the abdominal aorta and iliac arteries in patients without vascular disease Ole Martin Pedersen, MD,

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.,

Lloyd M. Taylor, M.D., Edward S. Phinney, M.D., John M. Porter, M.D.

Effect of a femoral arteriovenous fistula on lower extremity venous hemodynamics after femorocaval reconstruction Sunil S. Menawat, MD, Peter Gloviczki,

Technique for obtaining proximal intraluminal control when arteries are inaccessible or unclampable because of disease or calcification Frank J. Veith,

Mycotic axillary artery aneurysm

A new valvulotome for in situ bypass grafts

Aortic injury occurring after minor trauma in ankylosing spondylitis

The effect of valvulotomy on the flow rate through the saphenous vein graft: Clinical implications Albert K. Chin, MD, David N. Mayer, BA, Robert K.

Ambulatory venous pressure revisited

Miniincisional ligation of incompetent perforating veins of the legs

Malcolm O. Perry, MD, Richard Kempczinski, MD

Erik E. Swensson, M. D. , Vallee L. Willman, M. D. , Gary J

Interposition grafting for reoperation on the common femoral artery

Return to well-being and function after infrainguinal revascularization Gary W. Gibbons, MD, Anne M. Burgess, RN, Edward Guadagnoli, PhD, Frank B. Pomposelli,

Heparin-coated catheters and heparin-induced thrombocytopenia

Milton M. Slocum, MD, John G. Adams, MD, Rosemary Teel, MT, Donald P

Bruce D. Misare, MD, Frank B. Pomposelli, MD, Gary W

Dorsalis pedis arterial bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus Frank B. Pomposelli, MD, Edward J. Marcaccio,

Joseph P. Archie, PhD, MD Journal of Vascular Surgery

Reduction of hospital resources utilization in vascular surgery: A four-year experience Sean P. Roddy, MD, Thomas F. O'Donnell, MD, Mark D. Iafrati, MD,

Objective tinnitus resulting from internal carotid artery stenosis

Refinements in the ultrasonic detection of popliteal vein reflux

The history of the in situ saphenous vein bypass

Regarding "Flush saphenofemoral ligation and multiple stab phlebectomy preserve a useful greater saphenous vein four years after surgery" Germano Lucertini,

Femoral vein valvuloplasty: Intraoperative angioscopic evaluation and hemodynamic improvement Harold J. Welch, MD, Robert L. McLaughlin, RVT, Thomas.

Geoffrey H. White, M. D. , Rodney A. White, M. D. , George E

Calvin B. Ernst, MD Journal of Vascular Surgery

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices Mitsuo Sugiura,

Miltos K. Lazarides, MD, Spyros N

Cardiovascular surgery—The rocket and its stars: Presidential address

The fate of the donor artery in extraanatomic revascularization

Angioscopically directed interventions improve arm vein bypass grafts

Ambulatory venous pressure revisited

Research and research funding in vascular surgery

Peripheral vascular bypass in juvenile-onset diabetes mellitus: Are aggressive revascularization attempts justified? Christopher J. Kwolek, MD, Frank.

Regarding “Venous ulcers and the superficial venous system”

A simple technique to protect subcutaneous vein grafts

Septic embolism complicating infective endocarditis

Angioscopy-guided semiclosed technique for in situ bypass with a novel flushing valvulotome: Early results Peter Stierli, MD, Peter Aeberhard, MD Journal.

Ioannis Prionidis, MD, Tom F. Browne Journal of Vascular Surgery

Should patient age be a consideration in carotid endarterectomy?

Acute aortic occlusion – Factors that influence outcome

The effects of endothelial injury on smooth muscle cell proliferation

Monitoring vascular surgical performance

Salvage of exposed arteriovenous hemodialysis fistulas

Michael J. Worsey, MBBS, William J. Sharp, MD, John D

Angioscopy guided semiclosed technique for in situ bypass

Homologous veins as an arterial substitute: Long-term results

D. Emerick Szilagyi, MD—An appreciation

Presidential address: The second-generation vascular surgeon

George D. Lilly 1906–1988 Journal of Vascular Surgery

Gary A. Tannenbaum, MD, Frank B. Pomposelli, MD, Edward J

Relationship of venous reflux to the site of venous valvular incompetence: Implications for venous reconstructive surgery Natalia A. Gooley, M.D., David.

James A. DeWeese, MD Journal of Vascular Surgery

Steven H. Silverman, MD a,b, Chris J. Mladinich, DVM a, Irvin F

Scott A. Berceli, MD, PhD, Allen K. Chan, MD, Frank B

Innominate artery trauma: A thirty-year experience

Popliteal entrapment syndrome: A report of tibial nerve entrapment

John Large, F.R.C.S. (Edin.) Journal of Vascular Surgery

Proximal vein thrombosis secondary to hemodialysis catheterization complicated by arteriovenous fistula Joseph J. Piotrowski, M.D., Robert B. Rutherford,

Lessons learned in adopting the in situ saphenous vein bypass

Cornelius A. Sullivan, MD, Michael J. Rohrer, MD, Bruce S. Cutler, MD

Presentation transcript:

Angioscopically directed valvulotomy: A new valvulotome and technique Arnold Miller, MBChB, Peter A. Stonebridge, MBChB, Athanasios I. Tsoukas, MD, Chris J. Kwolek, MD, Colleen M. Brophy, MD, Gary W. Gibbons, MD, Dorothy V. Freeman, MD, Frank B. Pomposelli, MD, David R. Campbell, MD, Frank W. LoGerfo, MD Journal of Vascular Surgery Volume 13, Issue 6, Pages 813-821 (June 1991) DOI: 10.1016/0741-5214(91)90046-W Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Angioscopically directed valvulotomy. A, The saphenous vein is completely exposed and the tributaries ligated. The patient is heparinized and the vein transected at both ends. The vein is gently distended with papaverine-saline solution, and the first proximal valve excised with scissors. B, The valvulotome with the introducer in place is passed through the vein from the distal end to protrude through the proximal end of the vein. The introducer is replaced with the appropriately sized valvulotome. C, The valvulotome is withdrawn under constant angioscopic direction steering past the tributary orifices and accurately cutting each valve leaflet. D, The valvulotome (described in text). Journal of Vascular Surgery 1991 13, 813-821DOI: (10.1016/0741-5214(91)90046-W) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Alternative methods of irrigation (see text). A, Irrigation through a Mark's needle inserted through a tributary at the proximal end of the vein. B, Irrigation through a Mark's needle inserted through a tributary at the distal end of the vein. C, Irrigation sheath (7F to 9F) with hemostatic valve allows for passage of angioscope and proximal irrigation. D, Irrigation catheter (16-gauge) for distal irrigation held in place together with the valvulotome. E, Collateral irrigation catheter (16-gauge) lying alongside the angioscope for proximal irrigation. F, Tourniquet technique for unexposed vein (see text). The tourniquet is only applied at the time of angioscopically directed valvulotomy. Journal of Vascular Surgery 1991 13, 813-821DOI: (10.1016/0741-5214(91)90046-W) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Note the close relationships of the tributary and the protruding shoulder of the valve sinus to the valve leaflet. B, A valve with a single leaflet. C, An “empty” sinus. D, Supravalvular valvulotome-induced injury in association with a cut valve. Journal of Vascular Surgery 1991 13, 813-821DOI: (10.1016/0741-5214(91)90046-W) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions