Minimally invasive in situ bypass

Since the report of a successful femoropopliteal in situ saphenous vein byp ass in 1962, surgeons have attempted to make this bypass a less invasive op eration and simplify the two principal technical components of the operatio n: (1) rendering the saphenous vein valves incompetent and (2) occluding th e venous side branches. To accomplish this bypass, however, a long incision that is the length of the leg over the course of the saphenous vein is oft en necessary, which can be fraught with hazard, especially in patients with diabetes in whom wound complications can be devastating. An angioscopicall y assisted technique that allows the surgeon to perform valvulotomy and occ lude venous side branches from within the saphenous vein-a minimally invasi ve in situ vein bypass-has been developed. This article discusses preclinic al, fluoroscopic clinical, and angioscopic clinical studies of minimally in vasive in situ bypass.