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Nadasy GL, Patai BB, Molnar AA, Hetthessy JR, Tokes AM, Varady Z, Dornyei G. Vicious Circle With Venous Hypertension, Irregular Flow, Pathological Venous Wall Remodeling, and Valve Destruction in Chronic Venous Disease: A Review. Angiology 2024:33197241256680. [PMID: 38839285 DOI: 10.1177/00033197241256680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Substantial advances occurred in phlebological practice in the last two decades. With the use of modern diagnostic equipment, the patients' venous hemodynamics can be examined in detail in everyday practice. Application of venous segments for arterial bypasses motivated studies on the effect of hemodynamic load on the venous wall. New animal models have been developed to study hemodynamic effects on the venous system. In vivo and in vitro studies revealed cellular phase transitions of venous endothelial, smooth muscle, and fibroblastic cells and changes in connective tissue composition, under hemodynamic load and at different locations of the chronically diseased venous system. This review is an attempt to integrate our knowledge from epidemiology, paleoanthropology and anthropology, clinical and experimental hemodynamic studies, histology, cell physiology, cell pathology, and molecular biology on the complex pathomechanism of this frequent disease. Our conclusion is that the disease is initiated by limited genetic adaptation of mankind not to bipedalism but to bipedalism in the unmoving standing or sitting position. In the course of the disease several pathologic vicious circles emerge, sustained venous hypertension inducing cellular phase transitions, chronic wall inflammation, apoptosis of cells, pathologic dilation, and valvular damage which, in turn, further aggravate the venous hypertension.
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Affiliation(s)
- Gyorgy L Nadasy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | | | - Andrea A Molnar
- Department of Cardiology, Semmelweis University, Budapest, Hungary
| | | | - Anna-Maria Tokes
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gabriella Dornyei
- Department of Morphology and Physiology, Health Science Faculty, Semmelweis University, Budapest, Hungary
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Sun C, Zheng W, Wang S, Wu Y. Embolization of a duplicated femoral vein for treatment of lower extremity deep venous insufficiency: A case report. Vascular 2024; 32:694-697. [PMID: 36696562 DOI: 10.1177/17085381231154434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Lower extremity deep venous insufficiency (DVI) occurs secondary to structural or functional abnormalities of deep venous valves in the affected extremities. The effectiveness of surgical treatment for improvement of the hemodynamic status in these patients remains controversial in clinical practice. METHOD In this case report, we describe a patient who presented with severe right lower extremity edema and liposclerosis and underwent venography, which suggested a variation in the number of femoral veins. The valve within the duplicated femoral vein was significantly incompetent; however, the valve of the main trunk of the femoral vein showed normal function. We performed embolization of the duplicated femoral vein. RESULTS The patient tolerated the procedure well without recurrent symptoms. CONCLUSIONS Individualized assessment based on venography findings is useful to establish the therapeutic approach in patients with DVI.
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Affiliation(s)
- Chun Sun
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Zheng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingfeng Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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González-Pérez F, Acosta S, Rütten S, Emonts C, Kopp A, Henke HW, Bruners P, Gries T, Rodríguez-Cabello JC, Jockenhoevel S, Fernández-Colino A. Biohybrid elastin-like venous valve with potential for in situ tissue engineering. Front Bioeng Biotechnol 2022; 10:988533. [PMID: 36213079 PMCID: PMC9532864 DOI: 10.3389/fbioe.2022.988533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Chronic venous insufficiency (CVI) is a leading vascular disease whose clinical manifestations include varicose veins, edemas, venous ulcers, and venous hypertension, among others. Therapies targeting this medical issue are scarce, and so far, no single venous valve prosthesis is clinically available. Herein, we have designed a bi-leaflet transcatheter venous valve that consists of (i) elastin-like recombinamers, (ii) a textile mesh reinforcement, and (iii) a bioabsorbable magnesium stent structure. Mechanical characterization of the resulting biohybrid elastin-like venous valves (EVV) showed an anisotropic behavior equivalent to the native bovine saphenous vein valves and mechanical strength suitable for vascular implantation. The EVV also featured minimal hemolysis and platelet adhesion, besides actively supporting endothelialization in vitro, thus setting the basis for its application as an in situ tissue engineering implant. In addition, the hydrodynamic testing in a pulsatile bioreactor demonstrated excellent hemodynamic valve performance, with minimal regurgitation (<10%) and pressure drop (<5 mmHg). No stagnation points were detected and an in vitro simulated transcatheter delivery showed the ability of the venous valve to withstand the implantation procedure. These results present a promising concept of a biohybrid transcatheter venous valve as an off-the-shelf implant, with great potential to provide clinical solutions for CVI treatment.
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Affiliation(s)
- Fernando González-Pérez
- Bioforge Lab (Group for Advanced Materials and Nanobiotechnology), CIBER-BBN, Edificio LUCIA, Universidad de Valladolid, Valladolid, Spain
| | - Sergio Acosta
- Department of Biohybrid and Medical Textiles (BioTex), AME–Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Stephan Rütten
- Electron Microscopy Facility, Uniklinik RWTH Aachen, Aachen, Germany
| | - Caroline Emonts
- Institut für Textiltechnik Aachen (ITA), RWTH Aachen University, Aachen, Germany
| | | | | | - Philipp Bruners
- Klinik für Diagnostische and Interventionelle Radiologie, Universitätsklinikum Aachen, Aachen, Germany
| | - Thomas Gries
- Institut für Textiltechnik Aachen (ITA), RWTH Aachen University, Aachen, Germany
| | - J. Carlos Rodríguez-Cabello
- Bioforge Lab (Group for Advanced Materials and Nanobiotechnology), CIBER-BBN, Edificio LUCIA, Universidad de Valladolid, Valladolid, Spain
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex), AME–Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
- AMIBM-Aachen-Maastricht-Institute for Biobased Materials, Maastricht University, Maastricht, Netherlands
- *Correspondence: Stefan Jockenhoevel, ; Alicia Fernández-Colino,
| | - Alicia Fernández-Colino
- Department of Biohybrid and Medical Textiles (BioTex), AME–Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
- *Correspondence: Stefan Jockenhoevel, ; Alicia Fernández-Colino,
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Fernández-Colino A, Jockenhoevel S. Advances in Engineering Venous Valves: The Pursuit of a Definite Solution for Chronic Venous Disease. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:253-265. [PMID: 32967586 DOI: 10.1089/ten.teb.2020.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Native venous valves enable proper return of blood to the heart. Under pathological conditions (e.g., chronic venous insufficiency), venous valves malfunction and fail to prevent backward flow. Clinically, this can result in painful swelling, varicose veins, edema, and skin ulcerations leading to a chronic wound situation. Surgical correction of venous valves has proven to drastically reduce these symptoms. However, the absence of intact leaflets in many patients limits the applicability of this strategy. In this context, the development of venous valve replacements represents an appealing approach. Despite acceptable results in animal models, no venous valve has succeeded in clinical trials, and so far no single prosthetic venous valve is commercially available. This calls for advanced materials and fabrication approaches to develop clinically relevant venous valves able to restore natural flow conditions in the venous circulation. In this study, we critically discuss the approaches attempted in the last years, and we highlight the potential of tissue engineering to offer new avenues for valve fabrication. Impact statement Venous valves prosthesis offer the potential to restore normal venous flow, and to improve the prospect of patients that suffer from chronic venous disease. Current venous valve replacements are associated with poor outcomes. A deeper understanding of the approaches attempted so far is essential to establish the next steps toward valve development, and importantly, tissue engineering constitutes a unique toolbox to advance in this quest.
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Affiliation(s)
- Alicia Fernández-Colino
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany.,AMIBM-Aachen-Maastricht-Institute for Biobased Materials, Maastricht University, Geleen, Netherlands
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Zervides C, Mahdi H, Staub RA, Jouni H. Prosthetic venous valves: Short history and advancements from 2012 to 2020. Phlebology 2020; 36:174-183. [PMID: 33021138 DOI: 10.1177/0268355520962451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic Venous Disease is estimated at 83.6% of the global population. Patients experience pain, discomfort and severe complications with few effective therapies being available. Current strategies for the treatment of malfunctioning venous valves are invasive with a high recurrence rate. A prosthetic venous valve replacement is imminent, possibly providing better outcomes and improved general quality of life. In this review, prosthetic venous valves history is presented and assesses the advantages and disadvantages of developed venous valves. Articles that discussed potential designs of prosthetic venous valves were examined. A systematic search produced thirty-five papers fitting the inclusion criteria. Our understanding of the ideal abilities required in prosthetic valves has evolved. Developed valves are reported for regurgitation, migration and leakage. Issues have been resolved, but we are still away from the ideal valve. Improvements within the last eight years provided information on the importance of sinuses and prosthetic to venous wall-size mismatch.
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Affiliation(s)
| | - Habib Mahdi
- University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Hassan Jouni
- University of Nicosia Medical School, Nicosia, Cyprus
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Kuznetsov S, Pankow M, Peters K, Huang HYS. A structural-based computational model of tendon-bone insertion tissues. Math Biosci 2020; 327:108411. [PMID: 32623027 DOI: 10.1016/j.mbs.2020.108411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
Tendon-to-bone insertion provides a gradual transition from soft tendon to hard bone tissue, functioning to alleviate stress concentrations at the junction of these tissues. Such macroscopic mechanical properties are achieved due to the internal structure in which collagen fibers and mineralization levels are key ingredients. We develop a structural-based model of tendon-to-bone insertion incorporating such details as fiber preferred orientation, fiber directional dispersion, mineralization level, and their inhomogeneous spatial distribution. A python script is developed to alter the tapered tendon-bone transition zone and to provide spatial grading of material properties, which may be rather complex as experiments suggest. A simple linear interpolation between tendon and bone material properties is first used to describe the graded property within the insertion region. Stress distributions are obtained and compared for spatially graded and various piece-wise materials properties. It is observed that spatial grading results in more smooth stress distributions and significantly reduces maximum stresses. The geometry of the tissue model is optimized by minimizing the peak stress to mimic in-vivo tissue remodeling. The in-silico elastic models constructed in this work are verified and modified by comparing to our in-situ biaxial mechanical testing results, thereby serving as translational tools for accurately predicting the material behavior of the tendon-to-bone insertions. This model will be useful for understanding how tendon-to-bone insertion develops during tissue remodeling, as well as for developing orthopedic implants.
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Affiliation(s)
| | - Mark Pankow
- North Carolina State University, United States of America
| | - Kara Peters
- North Carolina State University, United States of America
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Tissue Level Mechanical Properties and Extracellular Matrix Investigation of the Bovine Jugular Venous Valve Tissue. Bioengineering (Basel) 2019; 6:bioengineering6020045. [PMID: 31091689 PMCID: PMC6630446 DOI: 10.3390/bioengineering6020045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022] Open
Abstract
Jugular venous valve incompetence has no long-term remedy and symptoms of transient global amnesia and/or intracranial hypertension continue to discomfort patients. During this study, we interrogate the synergy of the collagen and elastin microstructure that compose the bi-layer extracellular matrix (ECM) of the jugular venous valve. In this study, we investigate the jugular venous valve and relate it to tissue-level mechanical properties, fibril orientation and fibril composition to improve fundamental knowledge of the jugular venous valves toward the development of bioprosthetic venous valve replacements. Steps include: (1) multi loading biaxial mechanical tests; (2) isolation of the elastin microstructure; (3) imaging of the elastin microstructure; and (4) imaging of the collagen microstructure, including an experimental analysis of crimp. Results from this study show that, during a 3:1 loading ratio (circumferential direction: 900 mN and radial direction: 300 mN), elastin may have the ability to contribute to the circumferential mechanical properties at low strains, for example, shifting the inflection point toward lower strains in comparison to other loading ratios. After isolating the elastin microstructure, light microscopy revealed that the overall elastin orients in the radial direction while forming a crosslinked mesh. Collagen fibers were found undulated, aligning in parallel with neighboring fibers and orienting in the circumferential direction with an interquartile range of -10.38° to 7.58° from the circumferential axis (n = 20). Collagen crimp wavelength and amplitude was found to be 38.46 ± 8.06 µm and 4.51 ± 1.65 µm, respectively (n = 87). Analyzing collagen crimp shows that crimp permits about 12% true strain circumferentially, while straightening of the overall fibers accounts for more. To the best of the authors' knowledge, this is the first study of the jugular venous valve linking the composition and orientation of the ECM to its mechanical properties and this study will aid in forming a structure-based constitutive model.
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Liu X, Liu L. Effect of valve lesion on venous valve cycle: A modified immersed finite element modeling. PLoS One 2019; 14:e0213012. [PMID: 30830909 PMCID: PMC6398833 DOI: 10.1371/journal.pone.0213012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/13/2019] [Indexed: 01/21/2023] Open
Abstract
The present study aimed to understand the effect of venous valve lesion on the valve cycle. A modified immersed finite element method was used to model the blood–tissue interactions in the pathological vein. The contact process between leaflets or between leaflet and sinus was evaluated using an adhesive contact method. The venous valve modeling was validated by comparing the results of the healthy valve with those of experiments and other simulations. Four valve lesions induced by the abnormal elasticity variation were considered for the unhealthy valve: fibrosis, atrophy, incomplete fibrosis, and incomplete atrophy. The opening orifice area was inversely proportional to the structural stiffness of the valve, while the transvalvular flow velocity was proportional to the structural stiffness of the valve. The stiffening of the fibrotic leaflet led to a decrease in the orifice area and a stronger jet. The leaflet and blood wall shear stress (WSS) in fibrosis was the highest. The softening of the atrophic leaflet resulted in overly soft behavior. The venous incompetence and reflux were observed in atrophy. Also, the atrophic leaflet in incomplete atrophy exhibited weak resistance to the hemodynamic action, and the valve was reluctant to be closed owing to the large rotation of the healthy leaflet. Low blood WSS and maximum leaflet WSS existed in all the cases. A less biologically favorable condition was found especially in the fibrotic leaflet, involving a higher mechanical cost. This study provided an insight into the venous valve lesion, which might help understand the valve mechanism of the diseased vein. These findings will be more useful when the biology is also understood. Thus, more biological studies are needed.
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Affiliation(s)
- Xiang Liu
- School of Science, Wuhan University of Technology, Wuhan, China
- Hubei Key Laboratory of Theory and Application of Advanced Materials Mechanics, Wuhan University of Technology, Wuhan, China
| | - Lisheng Liu
- Hubei Key Laboratory of Theory and Application of Advanced Materials Mechanics, Wuhan University of Technology, Wuhan, China
- State Key Laboratory of Advanced Technology of Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
- * E-mail:
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