In situ femorodistal bypass: novel technique for angioscope-assisted intraluminal side-branch occlusion and valvulotomy. A preliminary report.

To allow and facilitate complete endoluminal vein preparation under angioscopic guidance for in situ femorodistal bypass grafting, a novel instrument was constructed. In experiments in cadavers we developed the occluder valvulotome, consisting of a modified Mills' valvulotome containing a laterally-ending working channel, a retrograde cutting blade and an advanceable Teflon tube within the working channel. Using this instrument in combination with commercially available wire coils, we successfully performed five femorocrural in situ reconstructions with endoluminal valvulotomy and embolization of a total of ten thigh tributaries. The technique allows angioscope-assisted valvulotomy and simultaneous endoluminal tributary occlusion, making long skin incisions and extensive vein dissection obsolete.