VALVE TRANSPLANTATION TO THE CANINE POPLITEAL VEIN - THE UTILITY OF ADISTAL ARTERIOVENOUS-FISTULA AND THE HEMODYNAMIC RESULT OF A SINGLE FUNCTIONAL VALVE

Purpose: The objectives were to transplant a venous valve into the pop liteal vein of a canine insufficiency model that would maintain long-t erm function and then to measure the hemodynamic benefit of such a val ve. Methods: Indexes of venous valvular function, including venous fil ling time, 90% ofvenous refilling time, and simulated ambulatory venou s pressure, were measured in 11 greyhounds before intervention (Contro l) and after hind limb venous valvulotomy, which produces chronic veno us insufficiency. Three weeks later a valve-containing segment of exte rnal jugular vein was transplanted to the popliteal vein with (n = 6) or without (n = 5) a distal arteriovenous fistula. The fistula was lig ated in 4 to 6 weeks. Repeat venous indexes were obtained an average o f 2 weeks after the last operative intervention. Gross anatomic inspec tion +/- duplex scanning performed before the animals were killed were used to distinguished normal from damaged valves. Results: Pour of fi ve simple valve transplants demonstrated scarring and/or thrombosis an d the average venous filling time, ambulatory venous pressure, and 90% of venous refilling time were consistent with chronic venous insuffic iency and/or obstruction. One fistula failed in the six valve distal a rteriovenous fistula transplants, and that valve was incompetent. Anal ysis of the remaining five functional valves demonstrated venous filli ng time consistent with chronic venous insufficiency, normalization of ambulatory venous pressure, and 90% of venous refilling time between normal, and chronic venous insufficiency. These valves appeared normal . Conclusions: Popliteal vein valve transplant anatomy is preserved by an adjunctive distal arteriovenous fistula, and a competent valve tra nsplant improves postexercise venous hemodynamics to approach those of a normal limb.