Endovenous valve transfer for chronic deep venous insufficiency

The influence of age on valve disease in patients with varicose veins analysed by transmission electron microscopy and stereology

Abstract. Background: The aim of this study was to investigate the influence of age on the ultrastructure of venous valve morphology in patients with C2 classified chronic venous disorders according to the CEAP classification. Patients and methods: The study population consisted of 16 consecutive patients with varicose veins (C2). The mean age was 49.8 years (30–66). The (pre-) terminal valve including the vessel wall was harvested within the proximal 2 centimetres of the great saphenous vein. The mean thickness (volume-to-surface ratio = V/S ratio) of elastin, collagen, endothelium and of the entire valve was determined. A blinded morphologist performed the examination by transmission electron microscopy and stereology. Analyses by Pearson’s product moment correlation, Kendall’s tau and Spearman’s rank correlation were performed to investigate whether there is a correlation between age and the ultrastructural morphology. Results: Stereological analysis of the valves demonstrated a mean V/S ratio (signifying a thickness estimation) for elastin of 0.87 μm3/μm2, for collagen of 18.0 μm3/μm2, for endothelium of 0.65 μm3/μm2, and for the entire valve of 25.2 μm³/μm². Statistical analyses showed no statistically significant correlation between age and the ultrastructural morphology in this patient group. Conclusions: The ultrastructural morphology of the venous valves in chronic venous disorders may not depend on age in patients presenting with C2 disease. This conclusion may or may not apply to all C classes as we investigated a homogenous group of patients with C2 limbs.

Thinking Outside the Heart: Use of Engineered Cardiac Tissue for the Treatment of Chronic Deep Venous Insufficiency

This article considers the use of autologous stem cell-derived cardiomyocytes as a novel means to aid venous return. The approach consists of creating external cuffs of engineered heart tissue around vein segments with incompetent or poorly competent valves. The engineered heart tissue cuff prevents distention of the impaired vein segments and aids unidirectional flow by its rhythmic contractions. There appear to be no fundamental limitations to this approach as feasibility of all of the individual components has already been shown. Here, we underline the clinical need for novel ways to treat chronic deep venous insufficiency, review previous research that enabled this approach, consider potential designs of engineered heart tissue cuffs, and outline its advantages and future challenges.