Growth and remodeling of canine common iliac vein in response to venous reflux and hypertension

Venous thromboembolism swine model with reflux-induced venous hypertension

Objective

This study describes a novel swine model of venous thromboembolism (VTE) with reflux-induced venous hypertension.

Methods

Six pigs underwent disruption of the tricuspid chordae tendineae to create reflux and venous hypertension in the femoral vein. The vein was traumatized 2 to 3 weeks later by repeated withdrawal of a slightly overinflated occlusion balloon across the lumen, followed by balloon occlusion of the outflow. A small amount of thrombin was injected into the traumatized vein segment immediately after outflow occlusion. Thrombosis of the traumatized vein evolved into an organized thrombus seven weeks later. The histological features of the harvested post-thrombotic femoral vein were studied with hematoxylin and eosin and Trichrome stains.

Results

In all six pigs, initial disruption of the chordae tendineae was successfully performed to create tricuspid reflux and venous hypertension. After two-stage sequential procedures, a thrombus formed in the target femoral vein segment. Histology of the harvested thrombotic vein showed features of an organizing thrombus with collagen formation and fibrosis.

Conclusions

The novel swine VTE model may serve as a platform for developing and testing human-sized therapeutic procedures and devices in translational venous research.

Clinical Relevance

This study describes a swine model of VTE created by incorporating all three elements of Virchow's triad. The model uniquely incorporates reflux-induced venous hypertension, which may be used in studying venous insufficiency and VTE in those with systemic venous hypertension. Likewise, this model may serve as a platform for development and evaluation of diagnostic imaging or therapeutic procedures and devices in subjects with systemic venous hypertension.

Novel venous balloon for compliance measurement and stent sizing in a post-thrombotic swine model

Objective: Real-time accurate venous lesion characterization is needed during endovenous interventions for stent deployment. The goal of this study is to validate a novel device for venoplasty sizing and compliance measurements. Methods: A compliance measuring sizing balloon (CMSB) uses real-time electrical conductance measurements based on Ohm's Law to measure the venous size and compliance in conjunction with pressure measurement. The sizing accuracy and repeatability of the CMSB system were performed with phantoms on the bench and in a swine model with an induced post thrombotic (PT) stenosis in the common femoral vein of swine. Results: The accuracy and repeatability of the CMSB system were validated with phantom bench studies of known dimensions in the range of venous diameters. In 9 swine (6 experimental and 3 control animals), the luminal cross-sectional areas (CSA) increased heterogeneously along the PT stenosis when the CMSB system was inflated by stepwise pressures. The PT stenosis showed lower compliance compared to the non-PT vein segments (5 mm2 vs. 10 mm2 and 13 mm2 at a pressure change of 40 cm H2O). Compliance had no statistical difference between venous hypertension (VHT) and Control. Compliance at PT stenosis, however, was significantly smaller than that at Control and VHT (p < 0.05, ANOVA). Conclusion: The CMSB system provides accurate, repeatable, real-time measurements of CSA and compliance for assessment of venous lesions to guide interventions. These findings provide the impetus for future first-in-human studies.

Venous Compliance in Great Saphenous Vein Incompetence: Pre- and Post-interventional Changes

Objective

Methods

Results

Conclusions

•

Venous compliance reflects the mechanical properties of the vessel wall.

•

Calf venous compliance is reduced in patients with great saphenous vein insufficiency.

•

Venous reflux parameters markedly improve after surgical intervention.

•

Venous compliance is further reduced in the post-operative state.

Iliac Veins Are More Compressible Than Iliac Arteries: A New Method of Testing

Incompressibility implies that a tissue preserves its volume regardless of the loading conditions. Although this assumption is well-established in arterial wall mechanics, it is assumed to apply for the venous wall without validation. The objective of this study is to test whether the incompressibility assumption holds for the venous wall. To investigate the vascular wall volume under different loading conditions, inflation-extension testing protocol was used in conjunction with intravascular ultrasound (IVUS) in both common iliac arteries (n = 6 swine) and common iliac veins (n = 9 dogs). Use of IVUS allows direct visualizations of lumen dimensions simultaneous with direct measurements of outer dimensions during loading. The arterial tissue was confirmed to preserve volume during various load conditions (p = 0.11) consistent with the literature, while the venous tissue was found to lose volume (about 35%) under loaded conditions (p < 0.05). Using a novel methodology, this study shows the incompressibility assumption does not hold for the venous wall especially at higher pressures, which suggests that there may be fluid loss through the vein wall during loading. This has important implications for coupling of fluid transport across the wall and biomechanics of the wall in healthy and diseased conditions.

Flow velocity is relatively uniform in the coronary sinusal venous tree: structure-function relation

The structure and function of coronary venous vessels are different from those of coronary arteries and are much less understood despite the therapeutic significance of coronary sinus interventions. Here we aimed to perform a hemodynamic analysis in the entire coronary sinusal venous tree, which enhances the understanding of coronary venous circulation. A hemodynamic model was developed in the entire coronary sinusal venous tree reconstructed from casts and histological data of five swine hearts. Various morphometric and hemodynamic parameters were determined in each vessel and analyzed in the diameter-defined Strahler system. The findings demonstrate an area preservation between the branches of the coronary venous system that leads to relatively uniform flow velocity in different orders of the venous tree. Pressure and circumferential and wall shear stresses decreased abruptly from the smallest venules toward vessels of order -5 (80.4 ± 39.1 µm) but showed a more modest change toward the coronary sinus. The results suggest that vessels of order -5 denote a hemodynamic transition from the venular bed to the transmural subnetwork. In contrast with the coronary arterial tree, which obeys the minimum energy hypothesis, the coronary sinusal venous system complies with the area-preserving rule for efficient venous return, i.e., da Vinci's rule. The morphometric and hemodynamic model serves as a physiological reference state to test various therapeutic rationales through the venous route.

NEW & NOTEWORTHY

A hemodynamic model is developed in the entire coronary sinusal venous tree of the swine heart. A key finding is that the coronary sinusal venous system complies with the area preservation rule for efficient venous return while the coronary arterial tree obeys the minimum energy hypothesis. This model can also serve as a physiological reference state to test various therapeutic rationales through the venous route.