Ces radiol. 2007, 61(2):129-137

Percutaneous venous valve implantation in management of chronic deep venous insufficiency: An overview of our experimental work and early clinical experienceReview article

Dušan Pavcnik, Barry Uchida, John Kaufman, Fredericks Keller, Josef Rösch
Dotter Interventional Institute, Oregon Health & Science University, Portland

To present an overview of our 7 years of experimental work and early clinical experience with percutaneous implantation of a bioprosthetic venous valve (BVV) and our recent experimental work with percutaneous autogenous venous valve (PAVV) transplantation.
Three types of BVVs consisting of a (small) leaflet of small intestinal submucosa (SIS) attached to different types of metallic square stent frames were tested in the ovine jugular veins. Altogether 66 BVVs were tested in 32 sheep. Follow-up venograms were done from 1 to 6 months. In clinical work, 15 patients with advanced venous insufficiency were treated by placement of a single BVV into the femoral vein. PAVV transplantation with a vein segment containing a native valve attached to a stent template was explored in 9 sheep. BVVs were easy to deliver and remained in place and stable. The majority of the experimental BVVs remained competent, some up to 6 months, but demonstrated limited flexibility due to SIS remodeling. In clinical work, early follow-up studies gave similar results. Later, the BVVs became incompetent due to the leaflet thickening. Clinically, however, most patients experienced improvement of their symptoms including healing of their ulcers. PAVV transplantation gave excellent results with 3 month competency of 8 of 9 transplanted valves.
In percutaneous BVV implantation, more research needs to be done to find a valve that would keep its long-term flexibility with good function. In PAVV transplantation, long-term studies should be done prior to introduction of this method into clinical practice.

Keywords: deep venous insufficiency, endovascular therapy, venous valve

Accepted: April 15, 2007; Published: June 1, 2007  Show citation

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Pavcnik D, Uchida B, Kaufman J, Keller F, Rösch J. Percutaneous venous valve implantation in management of chronic deep venous insufficiency: An overview of our experimental work and early clinical experience. Ces radiol. 2007;61(2):129-137.
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