J. Gomez-jorge et al., Percutaneous deployment of a valved bovine jugular vein in the swine venous system: A potential treatment for venous insufficiency, J VAS INT R, 11(7), 2000, pp. 931-936
PURPOSE: To develop a system for potential use in the treatment of chronic
venous insufficiency by using percutaneous techniques.
MATERIALS AND METHODS: A segment of a glutaraldehyde-fixed bovine external
jugular vein with valves was trimmed and sutured to a nitinol stent, Animal
s were premedicated and anesthetized (n = 11), Venography of the right exte
rnal jugular vein, inferior vena cava (IVC), and common iliac vein was perf
ormed. Deployment was accomplished via a sheath (12-24 F) with use of fluor
oscopic guidance, Eleven bioprostheses were deployed in 11 animals. Biopros
theses were deployed in the IVC (n = 3) or right external iliac vein (n = 6
), Animals were killed immediately after deployment (n = 7) at 1 week (n =
1) or at 2 weeks (n = 2), One animal was found dead in the cage. At necrops
y, each bioprosthesis (n = 4) was explanted and histopatholose analysis was
performed.
RESULTS: Deployments of the bioprostheses were successful in nine of 11 swi
ne. Two deployments were unsuccessful (one accidental deployment in the rig
ht renal vein, one deployment in the IVC caused rupture of the vein), Postd
eployment venography (n = 9) confirmed no reflux (in the recumbent position
of the swine) of the valve leaflets and patency of the vein inferior to th
e level of the bioprostheses. in the first group of animals (n = 5), valve
leaflets were normal and competent, In the survival animal group (n = 4), t
he bioprostheses remained patent without evidence of thrombus formation by
ascending and descending venography, Gross inspection of the explanted biop
rostheses (n = 4) demonstrated grossly normal valves that fully occluded th
e lumen. Complications included hemarthrosis (n = 1), death (n = 1), and bi
oprosthesis thrombosis immediately after deployment (n = 1), Histopatholose
analysis showed endothelial cells covering the luminal surfaces. The wall
of the bioprostheses had granulomatous response and foreign body reaction.
Bacterial contamination was noted in one bioprosthesis.
CONCLUSIONS: Deployment of a glutaraldehyde-fixed bovine vein sutured to a
self-expanding nitinol stent in the swine iliac vein or IVC is technically
feasible, Development of a venous bioprosthesis that can be placed percutan
eously may have important clinical applications as an endovascular treatmen
t for chronic venous insufficiency when it is due to valvular incompetence.