Valvulotomy

Valvulotomy is a vascular surgical procedure in which the valves within a vein are incised or disrupted to create a continuous, uncleaved lumen suitable for arterial flow. It is most frequently performed to enable autologous veins to serve as arterial conduits in bypass surgery, where intact vein valves would impede forward flow.

Indications include use of the great saphenous vein or other autologous veins as conduits in coronary artery bypass grafting or peripheral arterial bypass. Valves located along the graft can become a barrier to high-pressure arterial flow; disrupting or removing these valves helps ensure a uniformly patent lumen.

Technique involves harvesting the vein, then introducing a valvulotome or similar intraluminal instrument and advancing it along the graft to sever the valve leaflets from within. The aim is to render the valves ineffective while preserving the overall endothelium of the vein. In some cases, the vein may be prepared or oriented to minimize residual valve obstruction.

Outcomes and risks depend on technique and patient factors. Valvulotomy can improve graft patency when valve planes would otherwise limit flow, but it carries risks such as intimal injury, thrombosis, graft stenosis, bleeding, or infection. Contemporary bypass practice may favor alternative vein preparation methods or synthetic conduits, depending on clinical context and surgeon preference.