The in situ saphenous vein arterial bypass by valve incision

Publisher Summary This chapter discusses the in situ saphenous vein arterial bypass by valve incision. The provision of a normal functioning endothelium that will retain a nonthrombogenic surface even in low flow situations is the theoretical ideal in vascular surgical conduits. Smooth tapering and matching of the sizes of the conduit at both the ends of the arterial bypass has definite and obvious hemodynamic flow advantages. After the most proximal valves have been incised, the venous anatomy determines the subsequent techniques for valve incision. It is found that when the saphenous vein is greater than 4 mm with a single trunk in its thigh portion, a detachable intraluminal valve cutter is used that divides the cusps up to the level of the knee without the necessity of surgical exposure of the vein. A small incision is made posterior to the previously marked vein below the level of the knee joint. The vein is examined for suitability at this point because it is, in general, at its narrowest there. Once arterial pressure has been established at the knee level, the valvulotome is used for all subsequent valve incisions.