Valvulotomy of non-reversed saphenous vein bypass grafts: a randomised, blinded, angioscopy-controlled study

Objectives: to compare the result of vein valve disruption with two differe nt valvulotomes during non-reversed saphenous vein bypass. Design: a randomised, blinded clinical study. Materials and methods: twenty patients undergoing femorodistal non-reversed saphenous vein arterial bypass were randomised into two equal groups. Valv e leafier disruption tons performed either with a standard size plastic val vulotome or with a metal valvulotome with an exchangeable cutting head. Val vulotomy was done after full exposure of the vein and completion of the pro ximal anastomosis. The result was evaluated by a surgeon blinded to the val vulotome used, using angioscopy. Results: a total of 219 valve cusps were inspected with angioscopy. There w ere 83 completely lysed cusps (69%) by plastic and 76 (78%) by metallic val vulotomes (p=0.14). Of all the incompletely lysed cusps 22 (29%) occurred i n the most proximal valve pocket treated with valvulotomy. Conclusions: no significant difference in performance between the investiga ted valvulotomes was found. Incomplete valvulotomy occurred mainly in rile proximal part of the vein and was obviously caused by a size mismatch betwe en the diameter of vein and the valvulotome. Construction of a valvulotome with a variable diameter cutting head is therefore recommended.