Martijn L. Dijkstra2, Walid Mohabbat3, Rodney J. Lane1, Michael Cuzzilla2
1Vascular Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; 2Dalcross Private Hospital, Sydney, NSW, Australia; 3Macquarie University Private Hospital, Sydney, NSW, Australia.
OBJECTIVES: Defective venous valves are central to chronic venous insufficiency. A simple method of endovenous valve transfer to replace normal competent valves for defective ones would appear to be a beneficial concept. An essential pre-requisite was the development of an venous valve transfer stent with associated deliver system.
METHODS: The internal jugular veins of sheep 45-55kgs were used (n=16). A segment of vein with valve were stented externally to a specially designed stent. The stent was introduced remotely into a contralateral internal jugular venotomy. Harvesting occurred acutely (n=1) and at 1, 3 and 6 months post-operatively (n=5 per group). In vivo competence testing macroscopic, microscopic and scanning electron microscopic (SEM) examinations were performed. 4 humans (all male, mean age 52) were treated (6 valves), brachial to femoro-popliteal segment. All had chronic ulcers and exhausted all treatments. Suitability for valve transfer was assessed using ultrasound and venography.
RESULTS: At harvest there was no evidence of thrombosis, tilting, endoleak or migration in any of the specimens. There was improvement in competence with macroscopic, microscopic and SEM findings. In the human cases 2 ulcers had healed, one progressed and one remained unchanged (FU 2yrs). There was one type I venous endoleak.
CONCLUSIONS: Endovenous valve transfer is a simple surgical technique with near perfect results in sheep. Very specific stent design facilitates harvesting, improves competence and avoids complications. Further Human studies are in progress.
AUTHOR DISCLOSURES: M. Cuzzilla, Nothing to disclose; M. L. Dijkstra, Nothing to disclose; R. J. Lane, Nothing to disclose; W. Mohabbat, Nothing to disclose.
Posted April 2012