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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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2
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Chen HY, Tien WS, Chambers SD, Dabiri D, Kassab GS. Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies. Eur J Vasc Endovasc Surg 2019; 58:112-119. [PMID: 31133446 DOI: 10.1016/j.ejvs.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND Valve incompetence is a progressive disease of the venous system that may eventually lead to venous hypertension, pain, and ulcers. There is a need for a venous valve prosthesis to replace incompetent valves. Computational and experimental investigations on venous valve design and associated haemodynamics will undoubtedly advance prosthesis design and treatments. Here, the objective is to investigate the effect of venous valve on the fluid and solid mechanics. The hypothesis is that there exists a valve geometry that maximises leaflet shear stress (LSS) but minimises leaflet intramural stress (LIS; i.e., minimise stress ratio = LIS/LSS). METHODS To address the hypothesis, fully dynamic fluid-structure interaction (FSI) models were developed. The entire cycle of valve opening and closure was simulated. The flow validation experiments were conducted using a stented venous valve prosthesis and a pulse duplicator flow loop. RESULTS Agreement between the output of FSI simulations and output of pulse duplicator was confirmed. The maximum flow rates were within 6% difference, and the total flow during the cycle was within 10% difference. The simulated high stress ratio region at the leaflet base (five times the leaflet average) predicted the disease location of the vast majority of explanted venous valves reported in clinical literature. The study found that the reduced valve height and leaflet dome shape resulted in optimal performance to provide the lowest stress ratio. CONCLUSION This study proposes an effective design of venous prostheses and elaborates on the correlations of venous valve with clinical observations.
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Affiliation(s)
- Henry Y Chen
- California Medical Innovations Institute, San Diego, CA, USA
| | - Wei-Shin Tien
- Department of Biomedical Engineering, University of Washington, Seattle, WA, USA
| | | | - Dana Dabiri
- Department of Biomedical Engineering, University of Washington, Seattle, WA, USA
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Boersma D, Vink A, Moll FL, de Borst GJ. Proof-of-Concept Evaluation of the SailValve Self-Expanding Deep Venous Valve System in a Porcine Model. J Endovasc Ther 2017; 24:440-446. [DOI: 10.1177/1526602817700120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the SailValve, a new self-expanding deep venous valve concept based on a single polytetrafluoroethylene cusp floating up and down in the bloodstream like a sail, acting as a flow regulator and allowing minimal reflux to reduce thrombogenicity. Methods: Both iliac veins of 5 pigs were implanted with SailValve devices; the first animal was an acute pilot experiment to show the feasibility of accurately positioning the SailValve via a femoral access. The other 4 animals were followed for 2 weeks (n=2) or 4 weeks (n=2) under a chronic implantation protocol. Patency and valve function were evaluated directly in all animals using ascending and descending phlebography after device placement and at termination in the chronic implant animals. For reasons of clinical relevance, a regimen of clopidogrel and calcium carbasalate was administered. Histological analysis was performed according to a predefined protocol by an independent pathologist. Results: Deployment was technically feasible in all 10 iliac veins, and all were patent directly after placement. No perioperative or postoperative complications occurred. Ascending phlebograms in the follow-up animals confirmed the patency of all valves after 2 or 4 weeks. Descending phlebograms showed full function in 5 of 8 valves. Limited reflux was seen in 1 valve (4-week group), and the function in the remaining 2 valves (2-week group) was insufficient because of malpositioning. No macroscopic thrombosis was noted on histology. Histology in the follow-up groups revealed a progressive inflammatory reaction to the valves. Conclusion: This animal study shows the potential of the SailValve concept with sufficient valve function after adequate positioning and no (thrombogenic) occlusions after short-term follow-up. Future research is essential to optimize valve material and long-term patency.
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Affiliation(s)
- Doeke Boersma
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Centre, Utrecht, the Netherlands
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
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Tien WH, Zhao X, Chen HY, Berwick ZC, Krieger JF, Chambers S, Dabiri D, Kassab GS. Role of vessel-to-prosthesis size mismatch in venous valve performance. J Vasc Surg Venous Lymphat Disord 2017; 5:105-113.e1. [DOI: 10.1016/j.jvsv.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
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5
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Yamaki T. Post-thrombotic syndrome – Recent aspects of prevention, diagnosis and clinical management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rvm.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Glynn JJ, Jones CM, Anderson DEJ, Pavcnik D, Hinds MT. In vivo assessment of two endothelialization approaches on bioprosthetic valves for the treatment of chronic deep venous insufficiency. J Biomed Mater Res B Appl Biomater 2015; 104:1610-1621. [PMID: 26316151 DOI: 10.1002/jbm.b.33507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 12/28/2022]
Abstract
Chronic deep venous insufficiency is a debilitating disease with limited therapeutic interventions. A bioprosthetic venous valve could not only replace a diseased valve, but has the potential to fully integrate into the patient with a minimally invasive procedure. Previous work with valves constructed from small intestinal submucosa (SIS) showed improvements in patients' symptoms in clinical studies; however, substantial thickening of the implanted valve leaflets also occurred. As endothelial cells are key regulators of vascular homeostasis, their presence on the SIS valves may reduce the observed thickening. This work tested an off-the-shelf approach to capture circulating endothelial cells in vivo using biotinylated antikinase insert domain receptor antibodies in a suspended leaflet ovine model. The antibodies on SIS were oriented to promote cell capture and showed positive binding to endothelial cells in vitro; however, no differences were observed in leaflet thickness in vivo between antibody-modified and unmodified SIS. In an alternative approach, valves were pre-seeded with autologous endothelial cells and tested in vivo. Nearly all the implanted pre-seeded valves were patent and functioning; however, no statistical difference was observed in valve thickness with cell pre-seeding. Additional cell capture schemes or surface modifications should be examined to find an optimal method for encouraging SIS valve endothelialization to improve long-term valve function in vivo. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1610-1621, 2016.
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Affiliation(s)
- Jeremy J Glynn
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, 97239
| | - Casey M Jones
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, 97239.,Department of Chemistry, Lewis & Clark College, Portland, Oregon, 97219
| | - Deirdre E J Anderson
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, 97239
| | - Dusan Pavcnik
- Dotter Interventional Institute, Oregon Health & Science University, Portland, Oregon, 97239
| | - Monica T Hinds
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, 97239. .,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, 97239. .,Department of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, 97006.
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7
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Weber B, Robert J, Ksiazek A, Wyss Y, Frese L, Slamecka J, Kehl D, Modregger P, Peter S, Stampanoni M, Proulx S, Falk V, Hoerstrup SP. Living-engineered valves for transcatheter venous valve repair. Tissue Eng Part C Methods 2014; 20:451-63. [PMID: 24156382 PMCID: PMC4026099 DOI: 10.1089/ten.tec.2013.0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/07/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno- and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. METHODS Tri- and bicuspid venous valves (n=27) based on polyglycolic acid-poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bone-marrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n=18) and experimentally delivered (n=7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. RESULTS The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. CONCLUSIONS Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of currently used non-autologous replacement materials and may open new therapeutic concepts for the treatment of CVI in the future.
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Affiliation(s)
- Benedikt Weber
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
| | - Jérôme Robert
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Institute for Clinical Chemistry, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
| | - Agnieszka Ksiazek
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Yves Wyss
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Laura Frese
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Jaroslav Slamecka
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Debora Kehl
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Modregger
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- School of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Silvia Peter
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Marco Stampanoni
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Steven Proulx
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Volkmar Falk
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Simon P. Hoerstrup
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
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8
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Shen MR, Xiong SH, Yuan JM, Liu Z, Zhang YZ, Dang RS, Yang XQ, Zhang X, Zhang CS. Biocompatibility evaluation of tissue-engineered valved venous conduit by reseeding autologous bone marrow-derived endothelial progenitor cells and multipotent adult progenitor cells into heterogeneous decellularized venous matrix. J Tissue Eng Regen Med 2014; 10:982-988. [DOI: 10.1002/term.1877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/11/2013] [Accepted: 01/09/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Man-ru Shen
- Department of Anatomy; Second Military Medical University
- Department of Gastroenterology; Qingpu District Central Hospital; Shanghai China
| | - Shao-hu Xiong
- Department of Anatomy; Second Military Medical University
| | - Jian-ming Yuan
- Department of Anatomy; Second Military Medical University
| | - Zhen Liu
- Department of Anatomy; Second Military Medical University
| | | | - Rui-shan Dang
- Department of Anatomy; Second Military Medical University
| | - Xiang-qun Yang
- Department of Anatomy; Second Military Medical University
| | - Xi Zhang
- Department of Anatomy; Second Military Medical University
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9
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Sarvazyan N. Thinking Outside the Heart: Use of Engineered Cardiac Tissue for the Treatment of Chronic Deep Venous Insufficiency. J Cardiovasc Pharmacol Ther 2014; 19:394-401. [PMID: 24500906 DOI: 10.1177/1074248413520343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Narine Sarvazyan
- Pharmacology and Physiology Department, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
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10
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Yuan JM, Xiong SH, Liu Z, Wen Y, Dang RS, Shen MR, Zhang YZ, Zhang X, Yang XQ, Zhang CS. Functional analysisin vivoof engineered valved venous conduit with decellularized matrix and two bone marrow-derived progenitors in sheep. J Tissue Eng Regen Med 2013; 10:554-63. [DOI: 10.1002/term.1748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/24/2012] [Accepted: 03/14/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Jian-Ming Yuan
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Shao-Hu Xiong
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Zhen Liu
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Yu Wen
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Rui-Shan Dang
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Man-Ru Shen
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Yong-Zhen Zhang
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Xi Zhang
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Xiang-Qun Yang
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
| | - Chuan-Sen Zhang
- Department of Anatomy; Second Military Medical University; Shanghai People's Republic of China
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11
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Phillips MN, Dijkstra ML, Khin NY, Lane RJ. Endovenous valve transfer for chronic deep venous insufficiency. Eur J Vasc Endovasc Surg 2013; 46:360-5. [PMID: 23809841 DOI: 10.1016/j.ejvs.2013.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aims of the study were to test the safety and efficacy of a custom-made endovenous valve transfer stent, and delivery system in animals and humans. METHODS The internal jugular veins of 16 sheep, weighing 45-55 kg, were used. A segment of vein with venous valve was enclosed circumferentially with a barbed stent. This segment from the internal jugular vein was introduced and deployed remotely into the contralateral internal jugular vein. Harvesting occurred acutely (one sheep) and at 1, 3, and 6 months postoperatively (five sheep per group). Operative competence testing, histological and scanning electron microscopic (SEM) examinations were performed. Four males with recalcitrant ulcers (mean age of 22 years) had axillary veins transferred from the popliteal vein and were followed for a mean of 3.8 years. RESULTS At harvest, all the transferred valves were competent, with no evidence of thrombosis, tilting, endoleak, or migration with normal macroscopic and SEM findings. Although only 50% of the ulcers completely healed in humans, the remainder were improved, with all valves being competent and patent. CONCLUSIONS Endovenous valve transfer with a custom-made circumferential stent produces near perfect results in sheep and encouraging results in a small pilot study.
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Affiliation(s)
- M N Phillips
- Royal North Shore Hospital, Department of Vascular Surgery, Sydney, NSW, Australia
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12
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de Borst GJ, Moll FL. Percutaneous venous valve designs for treatment of deep venous insufficiency. J Endovasc Ther 2012; 19:291-302. [PMID: 22545897 DOI: 10.1583/11-3766r.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
At present, no widely accepted surgical options exist for treating chronic deep venous insufficiency (CDVI). Experimental efforts to improve catheter-based management for CDVI have shown disappointing results, hindering application of these techniques in the clinical arena. A review of the literature focusing on technical aspects of valve stent design was conducted. Eight experimental studies were scrutinized to derive data on (1) stent design and configuration; (2) valve design, composition, and configuration; (3) delivery system; (4) functional outcome; and (5) histology to provide a basis for the design of a new prosthetic venous valve. The analysis of available experimental data found that all prosthetic valve designs currently under development/testing rely on some type of a stent to act as a carrier or frame for valve attachment. Most valve models reviewed were for the most part implanted safely and accurately, with good short-term patency and competency. The most commonly reported adverse event was thrombosis, which limited durability. It is assumed that valve configuration determines long-term results after repair. Hence, the newly proposed valve design consisted of 2 stent rings without barbs to fix the valve in the host vein. Because a little reflux might actually benefit the patency of the valve, the valve cusp in the new design forms a billowing "sail" that does not completely open or close, which also prevents the valve cusp from sticking to the wall. This technology remains of great interest to the interventionist and all physicians who are involved in the care for patients with advanced chronic venous disease. Valve design remains a challenge, but promising new valve substitutes such as the one outlined here are under evaluation.
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Affiliation(s)
- Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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13
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Jones CM, Hinds MT, Pavcnik D. Retention of an autologous endothelial layer on a bioprosthetic valve for the treatment of chronic deep venous insufficiency. J Vasc Interv Radiol 2012; 23:697-703. [PMID: 22410542 PMCID: PMC3336010 DOI: 10.1016/j.jvir.2012.01.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/06/2012] [Accepted: 01/10/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Percutaneous transcatheter implantation of porcine small intestinal submucosa (SIS) bioprosthetic valves has been reported as a treatment for chronic deep venous insufficiency (CDVI). Endothelial progenitor outgrowth cells (EOCs), isolated from whole ovine blood, were evaluated as a source of in vitro autologous seeding for SIS endothelialization. Retention of the EOC monolayer was evaluated to test the feasibility of delivering an endothelialized SIS valve. MATERIALS AND METHODS Twenty bioprosthetic venous valves were constructed from SIS sutured onto collapsible square stent frames and were seeded with ovine EOCs in vitro. Retention of the endothelial monolayer through valve loading and delivery (three valves), in vitro flow (three valves), and ex vivo flow (four valves) was evaluated with immunofluorescent staining and histologic analysis compared with paired unmanipulated control valves. In the ex vivo shunt loop, venous blood was pulled from an implanted dialysis catheter, through the valve, and returned to the sheep. RESULTS Immunofluorescent staining of EOCs on the valves after in vitro seeding revealed a confluent monolayer (95.6% ± 2.3% confluent) on each side of the valve. When examined by immunofluorescent staining, the endothelial monolayer remained intact after loading and delivery (97.1% ± 1.7%) and when subjected to flow in the in vitro loop (96.0% ± 3.0%). Histologic analysis of the valves subjected to the ex vivo shunt loop revealed retention of the endothelial monolayer. CONCLUSIONS Endothelial monolayers seeded on SIS were retained under loading and delivery, in vitro flow, and ex vivo flow. EOCs are a promising cell source for autologous endothelialization of bioprosthetic valves for the treatment of CDVI.
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Affiliation(s)
- Casey M Jones
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L342, Portland, OR 97239, USA
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14
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Zervides C, Giannoukas AD. Historical Overview of Venous Valve Prostheses for the Treatment of Deep Venous Valve Insufficiency. J Endovasc Ther 2012; 19:281-90. [DOI: 10.1583/11-3594mr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Pavcnik D, Uchida B, Kaufman J, Hinds M, Keller FS, Rösch J. Percutaneous management of chronic deep venous reflux: review of experimental work and early clinical experience with bioprosthetic valve. Vasc Med 2008; 13:75-84. [PMID: 18372443 DOI: 10.1177/1358863x07083474] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lower extremity chronic deep venous insufficiency (CDVI) is common and remains a major health problem worldwide. Selected patients benefited from direct deep vein valve surgical repair or valve transplantation. A major limitation of this approach is that most of the patients are not candidates for these procedures due to obstructions or residual thrombus throughout the vein. The past 15 years have witnessed experimental efforts at catheter-based management of CDVI. This review describes the initial designs and experimental evolution of a mechanical and bioprosthetic venous valve that can be implanted by using a transcatheter technique. These valves consisted of single, double, or triple cusp leaflets made of synthetic or biological materials attached to a carrier or frame. All described devices for percutaneous transcatheter valve placement rely on some form of a vascular stent for valve attachment.
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Affiliation(s)
- Dusan Pavcnik
- Dotter Interventional Institute, Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
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Scheerlinck JPY, Snibson KJ, Bowles VM, Sutton P. Biomedical applications of sheep models: from asthma to vaccines. Trends Biotechnol 2008; 26:259-66. [PMID: 18353472 DOI: 10.1016/j.tibtech.2008.02.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 02/04/2008] [Accepted: 02/05/2008] [Indexed: 01/27/2023]
Abstract
Although rodent models are very popular for scientific studies, it is becoming more evident that large animal models can provide unique opportunities for biomedical research. Sheep are docile in nature and large in size, which facilitates surgical manipulation, and their physiology is similar to humans. As a result, for decades they have been chosen for several models and continue to be used to study an ever-increasing array of applications. Despite this, their full potential has not been exploited. Here, we review the use of sheep as an animal model for human vaccine development, asthma pathogenesis and treatment, the study of neonatal development, and the optimization of drug delivery and surgical techniques.
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Affiliation(s)
- Jean-Pierre Y Scheerlinck
- Centre for Animal Biotechnology, School of Veterinary Science, University of Melbourne, Victoria, Australia
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