Primary venous insufficiency increases risk of deep vein thrombosis

Shaydakov, Maxim E.; Comerota, Anthony J.; Lurie, Fedor

doi:10.1016/j.jvsv.2015.09.008

Cited by 23 publications

(17 citation statements)

References 32 publications

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“…17 In chronic preclinical venous valve implants, it was found that the leaflet was thickened with neointima, especially at the leaflet base. 7,9 The focal thickening and intima at the base is highly consistent with the elevated SR found in the current study, i.e., up to five times higher SR at leaflet base vs. the leaflet average. The leaflet thickening can reduce leaflet mobility and affect valve opening and closing, resulting in valve stenosis or reflux.…”

Section: The Role Of Solid Stresses On Mechanobiologysupporting

confidence: 89%

“…The simulated high SR region at the leaflet base predicted the disease location of venous valves. 7,9 This study provides the scientific platform that enables the design of prosthetic venous valves based on both fluid dynamics and solid mechanics. The study will enable further prosthesis design optimisation for percutaneous delivery of prosthetic valves and can extend the simulations to virtual implantations of valves in disease conditions.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Additionally, a fully differentiated smooth muscle cell phenotype was found via smooth muscle cell a-actin staining within explanted venous valve leaflets. 7,9 This is a major mechanism for hyperplasia due to elevated solid intramural stress.…”

Section: The Role Of Solid Stresses On Mechanobiologymentioning

confidence: 99%

“…Another clinical study of 15 patients found that four valves occluded and the rest of the valves had leaflet thickening and rigidity, resulting in reflux and incompetence. 7,9 The leaflets were thickened and covered by neointima, which consisted of fibroblasts and collagen deposits, especially at the leaflet base. Improved haemodynamics on shear stress and residence time reduce propensity for thrombosis.…”

Section: Analysis Of Clinical Trials Of Previous Venous Valve Prosthesismentioning

confidence: 99%

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Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies

Chen

Tien

Chambers

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Valve incompetence is a progressive disease of the venous system that may lead to deep venous thrombosis. There is a need for a venous valve prosthesis to replace incompetent valves. However, computational and experimental studies on venous valve and associated haemodynamics are limited. The current study addresses this gap and creates a scientific platform for potential correlations with clinical pathological development and effective venous prostheses. Objective/background: Valve incompetence is a progressive disease of the venous system that may eventually lead to venous hypertension, pain, and ulcers. There is a need for a venous valve prosthesis to replace incompetent valves. Computational and experimental investigations on venous valve design and associated haemodynamics will undoubtedly advance prosthesis design and treatments. Here, the objective is to investigate the effect of venous valve on the fluid and solid mechanics. The hypothesis is that there exists a valve geometry that maximises leaflet shear stress (LSS) but minimises leaflet intramural stress (LIS; i.e., minimise stress ratio ¼ LIS/LSS). Methods: To address the hypothesis, fully dynamic fluidestructure interaction (FSI) models were developed. The entire cycle of valve opening and closure was simulated. The flow validation experiments were conducted using a stented venous valve prosthesis and a pulse duplicator flow loop. Results: Agreement between the output of FSI simulations and output of pulse duplicator was confirmed. The maximum flow rates were within 6% difference, and the total flow during the cycle was within 10% difference. The simulated high stress ratio region at the leaflet base (five times the leaflet average) predicted the disease location of the vast majority of explanted venous valves reported in clinical literature. The study found that the reduced valve height and leaflet dome shape resulted in optimal performance to provide the lowest stress ratio. Conclusion: This study proposes an effective design of venous prostheses and elaborates on the correlations of venous valve with clinical observations.

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Section: The Role Of Solid Stresses On Mechanobiologysupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: The Role Of Solid Stresses On Mechanobiologymentioning

confidence: 99%

Section: Analysis Of Clinical Trials Of Previous Venous Valve Prosthesismentioning

confidence: 99%

See 2 more Smart Citations

Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies

Chen

Tien

Chambers

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…It is important to note that VTE often occurs in patients with pre-existing venous reflux. Superficial reflux is about 5 times more common in patients with VTE than in controls [120]. Patients with refractory symptoms from PTS can be investigated with Doppler ultrasound to assess for co-existing reflux, which may be amenable to treatment.…”

Section: Venous Refluxmentioning

confidence: 99%

Prevention and Management of the Post-Thrombotic Syndrome

Makedonov

Kahn

Galanaud

2020

JCM

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The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.

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