Perforation of a vein valve leaflet: a mechanism for incomplete valve incision during in situ bypass.

The modified Mills retrograde valvulotome has been our preferred instrument for valve incision for in situ saphenous vein bypass. In one case during completion angioscopy the valvulotome was identified to have perforated a posterior valve leaflet and left the leaflet intact. This intact leaflet was identified and incised under direct vision. Valve leaflet perforation by the valvulotome tip is proposed as one possible mechanism for incomplete valve lysis.