Venous reflux repair with cryopreserved vein valves

Neglén, Peter; Raju, Seshadri

doi:10.1067/mva.2003.93

Cited by 60 publications

(40 citation statements)

References 21 publications

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“…Cryopreserved vein valve allografts have also been used but are limited because of frequent complications, such as early thrombosis, and poor patency and competency. 123 A novel technique involves neovalve construction of monocuspid or bicuspid valves from the intima and media of the thickened venous wall. Preliminary studies using this technique have been encouraging, with ulcer healing in 90% to 95% of patients with postthrombotic syndrome and active ulcers, but the studies are small.…”

Section: Valve Reconstructionmentioning

confidence: 99%

Chronic Venous Insufficiency

2014

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Section: Valve Reconstructionmentioning

confidence: 99%

Chronic Venous Insufficiency

2014

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“…A recent systematic review revealed mild improvement in clinical symptoms and ulcer healing with vein valvuloplasty especially in combination with superficial and perforating vein ligation [52]. However, there is minimal success with valve transplantation especially in patients with post-thrombotic valve incompetence [53]. Standard procedure Vein valvuloplasty, either external or angioscopic, involves the placement of sutures within the femoral vein valve itself or at the insertion sites with subsequent shortening of the valve reducing valve prolapse or narrowing the widened valve angle, both with improvement of reflux [54,55].…”

Section: Valve Reconstruction or Valvuloplastymentioning

confidence: 98%

“…Standard procedure Vein valvuloplasty, either external or angioscopic, involves the placement of sutures within the femoral vein valve itself or at the insertion sites with subsequent shortening of the valve reducing valve prolapse or narrowing the widened valve angle, both with improvement of reflux [54,55]. Transplantation of venous valves is accomplished by end-to-end anastomosis of the appropriately sized allograft containing a variable number of valve stations to the common femoral, femoral, profunda, or popliteal veins [53].…”

Section: Valve Reconstruction or Valvuloplastymentioning

confidence: 99%

Treatment of chronic venous insufficiency

Rathbun

Kirkpatrick²

2007

Curr Treat Options Cardio Med

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Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux. Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory process. Compression therapy using pumps, bandaging, and/or graded compression stockings is the mainstay of treatment for CVI. Compression therapy has been shown to be effective in reducing venous hypertension retarding the development of inflammation and pathologic skin changes. Pharmacologic agents such as diuretics and topical steroid creams reduce swelling and pain short term but offer no long-term treatment advantage. Herbal supplements may reduce the inflammatory response to venous hypertension, but are not licensed by the US Food and Drug Administration, and vary in their efficacy, quality, and safety. However, several randomized controlled trials using the herbal horse chestnut seed extract containing aescin have shown short-term improvement in signs and symptoms of CVI. Endovascular and surgical techniques aimed at treatment of primary and secondary venous valvular reflux have been shown to improve venous hemodynamics promoting healing of venous ulcers and improving quality of life. The newer endovascular treatments of varicose veins using laser, radiofrequency ablation, and chemical foam sclerotherapy show some promise.

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“…7,30,31 Initial clinical attempts that focus on cryopreserved homografts showed poor clinical outcomes with rejection of the transplanted valves, leading to high morbidity and occlusion rates. 32 This stimulated the development of autologous transplantation strategies in order to prevent graft rejection complications. Although some of these approaches showed promising experimental 33,34 and clinical results, 35,36 several approaches were limited by the lack of adequate or sufficient amounts of autologous replacement structures.…”

Section: Discussionmentioning

confidence: 99%

Living-Engineered Valves for Transcatheter Venous Valve Repair

Weber

Robert

Książek

et al. 2014

Tissue Engineering Part C: Methods

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Background: Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno-and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. Methods: Tri-and bicuspid venous valves (n = 27) based on polyglycolic acid-poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bonemarrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n = 18) and experimentally delivered (n = 7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. Results: The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. Conclusions: Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of currently used non-autologous replacement materials and may open new therapeutic concepts for the treatment of CVI in the future.

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Venous reflux repair with cryopreserved vein valves

Cited by 60 publications

References 21 publications

Chronic Venous Insufficiency

Chronic Venous Insufficiency

Treatment of chronic venous insufficiency

Living-Engineered Valves for Transcatheter Venous Valve Repair

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