1. 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 (June 1991)
DOI: / (91)90046-W
Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2. 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 C, The valvulotome is withdrawn under constant angioscopic direction steering past the tributary orifices and accurately cutting each valve leaflet.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  , DOI: ( / (91)90046-W)
Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3. 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  , DOI: ( / (91)90046-W)
Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4. 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  , DOI: ( / (91)90046-W)
Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions