Experimental repair of venous valvular insufficiency using a cryopreserved venous valve allograft aided by a distal arteriovenous fistula.
OBJECTIVE
To evaluate the patency and hemodynamic impact of a cryopreserved allograft venous valve transplanted to the superficial femoral vein (SFV) of a canine insufficiency model aided by a distal arteriovenous fistula (dAVF).


METHODS
Eight greyhounds had intravenous hemodynamic parameters measured (venous filling time [VFT], 90% of venous refilling time [VRT90], and simulated ambulatory venous pressure [AVP]) before (T0) and after complete hindlimb venous valvulotomy (T1) to produce venous insufficiency. Simultaneously, a valve-containing vein segment was harvested from the opposite SFV or external jugular vein (n = 1) and cryopreserved. Three weeks later a blood type-matched cryopreserved valve was transplanted to the insufficient SFV aided by a low-flow (n = 4) or high-flow (n = 4) dAVF. The fistula was ligated in 3 to 6 weeks, and venous indexes (T2) were obtained 3 weeks later. Analysis of variances compared the venous indexes at T0, T1, and T2 for statistical significance. Gross and histologic inspection assessed valve integrity.


RESULTS
Two valves aided by a low-flow dAVF exhibited thrombosis and scarring. The hemodynamics of the six remaining valves demonstrated normalization of the VRT90, an AVP consistent with insufficiency, and a VFT between normal and total venous insufficiency. The patent valves were normal on gross examination and by histologic examination with signs of normal external healing.


CONCLUSIONS
A cryopreserved venous valve allograft transplanted to the SFV of an incompetent hindlimb partially corrects venous hemodynamics. A high-flow arteriovenous fistula most consistently preserves transplant patency.
Burkhart
H M
HM
Department of Surgery, Indiana University Medical Center, Indianapolis 46202, USA.
Fath
S W
SW
Dalsing
M C
MC
Sawchuk
A P
AP
Cikrit
D F
DF
Lalka
S G
SG
D000818:Animals; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D015925:Cryopreservation; D004285:Dogs; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery; D006439:Hemodynamics; D012039:Regional Blood Flow; D014184:Transplantation, Homologous; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*; D014689:Venous Insufficiency / Q000503:physiopathology / Q000601:surgery*