Mapping the future: Organizational, clinical, and research priorities in venous disease

Venous disease patient registries available in the United States

Patient registries are beneficial in that they allow the collection of prospective data focused on a specific medical issue. These registries give providers a "real-world" view of patient outcomes. Many medical disciplines have a long history of developing and using patient registries; the first patient registry for chronic venous disease in the United States was launched in 2011, fairly recently in comparison. Registries included in this review were identified by surveying members of major academic societies that focus on the care of chronic venous disease and by searching MEDLINE and Embase databases using Ovid interface. Medical directors of four of the five databases available in the United States completed a standard questionnaire, and the answers served as the basis for this review. This review is not a comparison of registries; it does, however, describe the common and unique features of four venous registries currently available in the United States with the purpose of increasing awareness of and fostering participation in these registries.

Effects of electrocautery to provoke endovascular thermal injury

PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

The design, development, and evaluation of a prototypic, prosthetic venous valve

Background

Chronic venous insufficiency is a serious disease for which there is no clearly successful surgical treatment. Availability of a proven prosthetic vein valve could provide such an option by reducing venous reflux while permitting normal antegrade flow.

Methods

A new prosthetic vein valve design has been developed which mimics the function of a natural valve by ensuring complete closure of the leaflets with minimal obstruction for antegrade flow. A 2:1 mock-up of the device was tested to evaluate its ability to prevent regurgitation and several key modifications were made. A subsequently re-designed 1:1 prototype was then built in 4 slightly different size configurations and then each tested under physiologic conditions of pulsatile flow in both supine and standing positions.

Results

Each of the configurations showed acceptable amounts of antegrade resistance and effective orifice area and showed low values of regurgitation and % reflux with two of the prototype configurations (flange lengths of 2.5 mm and 3.75 mm) having corresponding values of <2.5 mmHg-min/L, >97%, 11 mL, and 36%, respectively. These values are particularly striking when compared to the corresponding regurgitation and % reflux values of 60 mL and 205%, respectively, when no device is present.

Conclusion

The results of this study show that this prototype vein valve design is capable of providing significant relief of reflux under realistic conditions without inducing any increase in antegrade flow resistance and warrants further testing with in vivo models.