Gregory T. Jones, PhD, Mark W. Grant, MBBS, Ian A

Slides:

Advertisements

Similar presentations

Ultrasound-guided percutaneous delivery of tissue-engineered endothelial cells to the adventitia of stented arteries controls the response to vascular.

Advertisements

Vascular Technology Lecture 23: Venous Hemodynamics HHHoldorf

A prospective study of the fate of venous leg perforators after varicose vein surgery Andre M. van Rij, MD, Gerry Hill, BSc (Hons), Chris Gray, BSc, Ross.

Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R

Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model Claus-Georg Schmedt,

Alfred Obermayer, MD, Katharina Garzon, MSc

Bioengineered vascular access maintains structural integrity in response to arteriovenous flow and repeated needle puncture Bryan W. Tillman, MD, PhD,

Mark F. Fillinger, MD, Emanuel R. Reinitz, MD, Robert A

Ning-Fei Liu, MD, PhD, Qing Lu, MD, Zhi-Xin Yan, MD

Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency Jordan R. Vincent, Gregory Thomas Jones,

Implantable sensor for intraoperative and postoperative monitoring of blood flow: A preliminary report Raphael S. Rabinovitz, PhD, Craig J. Hartley,

Fascial relationships of the short saphenous vein

Coarctation-induced degenerative abdominal aortic aneurysm in a porcine model Pao-Yen Lin, MD, Yeng-Ting Wu, MS, Guan-Cheng Lin, BS, Yao Hsiang Shih,

Alexey V. Kamenskiy, PhD, Iraklis I. Pipinos, MD, PhD, Jeffrey S

Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model Claus-Georg Schmedt,

Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence André M van Rij, MD, FRACS, Gregory T Jones, PhD, Gerry B Hill,

Neovascularization in acute venous thrombosis

Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: Case report and review of literature Chlodwig Kirchhoff, MD, Julia.

Nicos Labropoulos, PhD, DIC, RVT, Angela A

The nonsaphenous vein of the popliteal fossa: Prevalence, patterns of reflux, hemodynamic quantification, and clinical significance Konstantinos T. Delis,

Recurrent popliteal vein aneurysm

Christopher D. Owens, MD, MSc Journal of Vascular Surgery

Extraluminal lipoma with common femoral vein obstruction: A cause of chronic venous insufficiency Antonios P. Gasparis, MD, Stylianos Tsintzilonis, MD,

Does air plethysmography correlate with duplex scanning in patients with chronic venous insufficiency? Paul S. van Bemmelen, MD, PhD, Mark A. Mattos,

Long-term reduction of medial and intimal thickening in porcine saphenous vein grafts with a polyglactin biodegradable external sheath Vikram Vijayan,

Bernhard Partsch, MD, Hugo Partsch, MD Journal of Vascular Surgery

Christopher D. Owens, MD, MSc Journal of Vascular Surgery

Fascial relationships of the short saphenous vein

Duplex ultrasound changes in the great saphenous vein after endosaphenous laser occlusion with 808-nm wavelength Leonardo Corcos, MD, Sergio Dini, MD,

Gregory D. Jay, BE, BS, Frank L. Ross, MD, Robert A

Coarctation-induced degenerative abdominal aortic aneurysm in a porcine model Pao-Yen Lin, MD, Yeng-Ting Wu, MS, Guan-Cheng Lin, BS, Yao Hsiang Shih,

Alfred Obermayer, MD, Katharina Garzon, MSc

João Luis Sandri, MD, Fanilda S

Selection of Saphenous Vein Conduit in Varicose Vein Disease

Remodeling in peripheral vein graft revisions: Serial study with three-dimensional ultrasound imaging Daniel F. Leotta, PhD, Jean F. Primozich, BS, Kirk.

Luigi Pascarella, MD, Geert W. Schmid-Schönbein, PhD, John Bergan, MD

Adventitial endothelial implants reduce matrix metalloproteinase-2 expression and increase luminal diameter in porcine arteriovenous grafts Helen M.

Harry M. Salinas, MD, Saiqa I. Khan, MD, Michael C

Role of hemodynamic forces in the ex vivo arterialization of human saphenous veins Xavier Berard, MD, PhD, Sébastien Déglise, MD, Florian Alonso, PhD,

Popliteal vein external banding at the valve-free segment to treat severe chronic venous insufficiency Tao Ma, MD, Weiguo Fu, MD, Jie Ma, MD Journal.

Validity of duplex-ultrasound in identifying the cause of groin recurrence after varicose vein surgery Bruno Geier, MD, PhD, Achim Mumme, MD, PhD, Thomas.

Venous valves and major superficial tributary veins near the saphenofemoral junction Dominic Mühlberger, MD, Luca Morandini, MD, Erich Brenner, MD, PhD,

Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R

Juan Garrido-Gómez, MD, PhD, Maria L. Vizoso-Pérez, MD, Jose P

Loss of lymphatic vessels and regional lipid accumulation is associated with great saphenous vein incompetence Hiroki Tanaka, MD, Nobuhiro Zaima, PhD,

Dimensional analysis of human saphenous vein grafts: Implications for external mesh support Paul Human, PhD, Thomas Franz, PhD, Jacques Scherman, MBChB,

Regarding “The anatomy of the small saphenous vein: Fascial and neural relations, saphenofemoral junction, and valves” Alberto Caggiati, MD Journal.

Clifford M. Sales, MD, Michael L. Marin, MD, Frank J

Photodynamic therapy of vein grafts: Suppression of intimal hyperplasia of the vein graft but not the anastomosis Glenn M. LaMuraglia, MD, Michael L.

Masson's tumor in the ulnar artery

Quantification of venous reflux by means of duplex scanning

Criteria for defining significant central vein stenosis with duplex ultrasound Nicos Labropoulos, PhD, DIC, RVT, Marc Borge, MD, Kenneth Pierce, MD, Peter.

Successful treatment tailored to each splanchnic arterial lesion due to segmental arterial mediolysis (SAM): Report of a case Takuya Hashimoto, MD, Juno.

Recurrence of a popliteal venous aneurysm

Raul Garcia-Rinaldi, M. D. , Ph. D. , J. M. Revuelta, M. D. , Ph. D

Bilateral mechanical rotational vertebral artery occlusion

Popliteal arterial aneurysm associated with Klippel-Trénaunay syndrome: Case report and literature review Daisuke Akagi, MD, Shigeyuki Ishii, MD, Takeshi.

Harshal Broker, MD, G. Patrick Clagett, MD Journal of Vascular Surgery

Samuel C. Aldridge, MD, Anthony J. Comerota, MD, Mira L

Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts Mark Kissin, MD, Nikhil Kansal, MD, Peter.

Duplex scanning in the assessment of deep venous incompetence

Pathogenesis and etiology of recurrent varicose veins

The Giacomini vein as an autologous conduit in infrainguinal arterial reconstruction Konstantinos T. Delis, MD, PhD, FRCSI, EBSQvasc, Mark Swan, MRCS,

Regarding “Venous ulcers and the superficial venous system”

Renal artery aneurysm formation secondary to pseudoxanthoma elasticum

Relationship of venous reflux to the site of venous valvular incompetence: Implications for venous reconstructive surgery Natalia A. Gooley, M.D., David.

Superficial temporal artery aneurysm associated with immunoglobulin G4-related disease Sosei Kuma, MD, PhD, Tsubasa Takeshima, MD, Takefumi Ohga, MD,

Surgical repair of left internal jugular phlebectasia

Superficial venous aneurysms of the small saphenous vein

Prevention of stenosis after vascular reconstruction: Pharmacologic control of intimal hyperplasia—A review Alexander W. Clowes, MD, Michael A. Reidy,

Presentation transcript:

Characterization of a porcine model of chronic superficial varicose veins Gregory T. Jones, PhD, Mark W. Grant, MBBS, Ian A. Thomson, MBChB, FRACS, B. Geraldine Hill, BSc, DMU, André M. van Rij, MD, FRACS Journal of Vascular Surgery Volume 49, Issue 6, Pages 1554-1561 (June 2009) DOI: 10.1016/j.jvs.2009.01.070 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Porcine superficial varicose veins. Ipsilateral thigh varicose vein appearance during a Valsalva-like maneuver (assisted weight bearing on hind limbs with vocalization). (A) Six, (B) 12, and (C-D) 14 weeks postoperatively. Three significant veins are consistently observed in all pigs (denoted superficial veins a, b, and c). Veins a and b arose from a communicating junction (arrows) with the saphenous vein, while vein c arose from a secondary communicating junction (see Supplementary Fig 1). White arrowheads indicate the well-healed surgical incision site. (C) Vascular corrosion cast of the superficial varicose veins communicating with the deep venous system (*) via the saphenous veins (SV). Note the extensive network of tortuous varicose veins and region containing focal varicosities (black arrow heads). Scale bar equals 20 mm. (D) the same cast imaging the communicating vein (arrow) between the saphenous and superficial veins. (E) Duplex ultrasound of the communicating vein (arrow), demonstrating reflux into the superficial veins. SF, Superficial; DF, deep fascia. Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 The porcine saphenous bundle. (A) Transverse en bloc preparation of the saphenous bundle and overlying skin, mid thigh. Scale bar equals 3 mm. (B) Histological section (Verhoeff's elastic stain) of the same block. (C-D) Resin vascular cast of the saphenous venous network, demonstrating the relationship of both the superficial (SF) and deep fascia (DF) to the saphenous fascia (arrow heads). Within the saphenous compartment, the saphenous artery (SA) is bordered by the saphenous veins (SV). Note the numerous valves (arrows) and communicating veins within the saphenous network. Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Histological structure of porcine superficial veins. (A) Normal control vein (left thigh, segment BII), diameter 435 μm. Note the black stained elastic tissue forming a distinct layer separating (arrow heads) the sparse intima from the media, between the medial smooth muscle and a prominent network within the adventitia (arrows). (B) Varicose vein (Right (ipsilateral) thigh, segment BII), diameter 1300 μm. (C) Varicose vein (Right (ipsilateral) thigh, segment CII), diameter 1850 μm. Both (B and C) are from the same animal 14 weeks postoperative. While both vein segments are approximately 3-4 times the size of the equivalent unmanipulated veins, there is marked heterogeneity of histopathology, including intimal hyperplasia (arrow heads) and valve cusp fibrosis. All varicose veins displayed a marked reduction in the density of adventitial elastic tissue (arrows). Verhoeff's elastic stain and van Gieson's counter stain. Scale bars (A) 100 μm, (B-C) 500 μm. Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 Valvular incompetence. Superficial varicose veins, 14 weeks postoperatively. (A) Vascular corrosion cast of a tortuous vein segment, boxed region indicated the site of an incompetent valve. (B) The valve cusps are 500-550 μm in length (arrow) in a vessel greater than 2 mm in diameter. Histology of a similar sized varicose vein (in vivo diameter greater than 3 mm) shows valve cusps with lengths of 490 and 875 μm. Scale bars (A) 2 mm, (B) 1 mm, (C) 500 μm. Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 Conscious blood pressure profiles in superficial control (A) and varicose (B-D) veins. Blood pressure measurements in right thigh vein segment BII (A, B, and C) or right lateral flank vein (D), acquired via indwelling radio-telemetry. (A) In a normal control vein, standing superficial venous blood pressure of approximately 6 mmHg, a hind limb step, then a sustained (4 second) Valsalva (continuous vocalization). Note the gradual rise in pressure during Valsalva, consistent with increased out-flow resistance (elevated intra-abdominal pressure) rather than reflux. There was no indication of retrograde pressure transmission in the control animals (presumably due to the presence of competent valves). (B) Pressure changes with altered posture, six weeks postoperatively. The animal went from lying on its abdomen to sitting (forequarter raised) to standing (without walking). (C) Effect of Valsalva-like maneuver (loud sustained three-second vocalization) on superficial venous pressure. Notice the pronounced drop in pressure post-Valsalva. (D) A weight shift to ipsilateral limb (at 6-7 seconds) followed by five steps. Note the fall below standing pressures between steps (*) consistent with the actions of a thigh ‘muscle pump.' Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 6 Duplex ultrasound of superficial varicosities in unconscious supine pigs. (A) Retrograde flow within an ipsilateral superficial vein six weeks postoperatively. Note the flow of approximately 25 cm/s with an absence of significant pulsatility. (B) In this 14 week postoperative animal, increased intra-abdominal pressure (in this case via an abdominal augmentation [AUG]) resulted in both increased velocities and pressures (see Fig 5) within the right superficial thigh veins, via reflux from the deep system. Journal of Vascular Surgery 2009 49, 1554-1561DOI: (10.1016/j.jvs.2009.01.070) Copyright © 2009 Society for Vascular Surgery Terms and Conditions