Percutaneous autologous venous valve transplantation: Short-term feasibility study in an ovine model

Dusan Pavcnik, Qiang (Michael) Yin, Barry Uchida, Won Kyu Park, Hanno Hoppe, Man Duck Kim, Frederick Keller, Josef Rosch

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Limited experience with bioprosthetic venous valve percutaneously inserted into femoral veins in 15 patients has been promising in short-term results only to show disappointing long-term results. Percutaneous autogenous venous valve (PAVV) transplantation was explored in an ovine model as a possible alternative treatment. Methods: PAVV consisted of a vein segment containing a valve that was attached to a stent template. The stent templates (n = 9) were designed and hand made in our research laboratory. They consist of two stainless steel square stents 13 or 15 mm in diameter to fit the ovine jugular veins (JV), which ranges from 10 to 15 mm in diameter. A valve-containing segment of JV was harvested and attached with sutures and barbs inside the stent template (n = 9). The valve devices were then manually folded and front loaded inside the 4 cm chamber of the 13F delivery sheath and delivered into the contralateral JV by femoral vein approach. Transplanted PAVVs were studied by immediate and 3 months venograms. Animals were euthanized at 3 months, and jugular veins harvested to perform angioscopic evaluations in vitro. Results: PAVV transplantation was successful in all nine animals. Good valve function with no reflux was observed on immediate and 3 months venograms in eight valves. The transplanted maximal JV diameter ranged from 10.2 mm to 15.4 mm (mean 13.1 ± 1.5 mm). Venoscopic examination revealed intact, flexible, nonthickened valve leaflets in eight specimens. One PAVV exhibited normal function of one leaflet only; the other cusp was accidentally cut during the transplantation procedure. All transplanted autologous valves were free of thrombus and incorporated into the vein wall of the host vessel. Conclusion: This study demonstrated that autogenous valve transplants remained patent and competent without long-term anticoagulation for up to 3 months. The percutaneous autogenous venous valve may provide in future minimally invasive treatment for patients with chronic deep venous insufficiency, but long-term studies need to be done to document its continued patency and function.

Original languageEnglish (US)
Pages (from-to)338-345
Number of pages8
JournalJournal of Vascular Surgery
Volume46
Issue number2
DOIs
StatePublished - Aug 2007

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Venous Valves
Feasibility Studies
Jugular Veins
Sheep
Transplantation
Stents
Femoral Vein
Veins
Venous Insufficiency
Stainless Steel
Sutures
Thrombosis
Hand
Transplants
Equipment and Supplies
Therapeutics
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Percutaneous autologous venous valve transplantation : Short-term feasibility study in an ovine model. / Pavcnik, Dusan; Yin, Qiang (Michael); Uchida, Barry; Park, Won Kyu; Hoppe, Hanno; Kim, Man Duck; Keller, Frederick; Rosch, Josef.

In: Journal of Vascular Surgery, Vol. 46, No. 2, 08.2007, p. 338-345.

Research output: Contribution to journalArticle

Pavcnik, Dusan ; Yin, Qiang (Michael) ; Uchida, Barry ; Park, Won Kyu ; Hoppe, Hanno ; Kim, Man Duck ; Keller, Frederick ; Rosch, Josef. / Percutaneous autologous venous valve transplantation : Short-term feasibility study in an ovine model. In: Journal of Vascular Surgery. 2007 ; Vol. 46, No. 2. pp. 338-345.
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abstract = "Background: Limited experience with bioprosthetic venous valve percutaneously inserted into femoral veins in 15 patients has been promising in short-term results only to show disappointing long-term results. Percutaneous autogenous venous valve (PAVV) transplantation was explored in an ovine model as a possible alternative treatment. Methods: PAVV consisted of a vein segment containing a valve that was attached to a stent template. The stent templates (n = 9) were designed and hand made in our research laboratory. They consist of two stainless steel square stents 13 or 15 mm in diameter to fit the ovine jugular veins (JV), which ranges from 10 to 15 mm in diameter. A valve-containing segment of JV was harvested and attached with sutures and barbs inside the stent template (n = 9). The valve devices were then manually folded and front loaded inside the 4 cm chamber of the 13F delivery sheath and delivered into the contralateral JV by femoral vein approach. Transplanted PAVVs were studied by immediate and 3 months venograms. Animals were euthanized at 3 months, and jugular veins harvested to perform angioscopic evaluations in vitro. Results: PAVV transplantation was successful in all nine animals. Good valve function with no reflux was observed on immediate and 3 months venograms in eight valves. The transplanted maximal JV diameter ranged from 10.2 mm to 15.4 mm (mean 13.1 ± 1.5 mm). Venoscopic examination revealed intact, flexible, nonthickened valve leaflets in eight specimens. One PAVV exhibited normal function of one leaflet only; the other cusp was accidentally cut during the transplantation procedure. All transplanted autologous valves were free of thrombus and incorporated into the vein wall of the host vessel. Conclusion: This study demonstrated that autogenous valve transplants remained patent and competent without long-term anticoagulation for up to 3 months. The percutaneous autogenous venous valve may provide in future minimally invasive treatment for patients with chronic deep venous insufficiency, but long-term studies need to be done to document its continued patency and function.",
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