title: Percutaneous vein occlusion with small intestinal submucosa: an experimental pilot study in Swine and sheep.
abstract: OBJECTIVE
  The objective of this study was to investigate the feasibility, outcomes, and amount of small intestinal submucosa (SIS) material needed for embolization of jugular vein (JV) in a swine and sheep model. Our hypothesis was that SIS would cause vein occlusion.
  
  
  METHODS
  The external JVs (EJV) in swine (n = 6) and JVs in sheep (n = 6) were occluded with SIS fan-folded compressed strips. After percutaneous puncture of the peripheral portion of the EJV or JV, a TIPS set was used to exit their lumen centrally through the skin. The SIS strips were delivered into the isolated venous segment with a pull-through technique via a 10-Fr sheath. Follow-up venograms were done immediately after placement and at the time of sacrifice at 1 or 3 months. Gross examinations focused on the EJV or JV and their surrounding structures. Specimens were evaluated by histology.
  
  
  RESULTS
  SIS strip(s) placement was successful in all cases, with immediate vein occlusion seen in 23 of 24 veins (95.8%). All EJVs treated with two strips and all JVs treated with three or four strips remained closed on 1- and 3-month follow-up venograms. Two EJVs treated with one strip and one JV treated with two strips were partially patent on venograms at 1 and 3 months. There has been one skin inflammatory reaction. Necropsies revealed excluded EJV or JV segments with SIS incorporation into the vein wall. Histology demonstrated various stages of SIS remodeling with fibrocytes, fibroblasts, endothelial cells, capillaries, and inflammatory cells.
  
  
  CONCLUSIONS
  We conclude that EJV and JV ablation with SIS strips using percutaneous exit catheterization is feasible and effective in animal models. Further exploration of SIS as vein ablation material is recommended.
authors.affiliation: Dotter Interventional Institute, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Man Deuk
authors.initials: MD
authors.lastname: Kim
authors.forename: Hanno
authors.initials: H
authors.lastname: Hoppe
authors.forename: Dusan
authors.initials: D
authors.lastname: Pavcnik
authors.forename: John A
authors.initials: JA
authors.lastname: Kaufman
authors.forename: Barry T
authors.initials: BT
authors.lastname: Uchida
authors.forename: Luiz O
authors.initials: LO
authors.lastname: Correa
authors.forename: Hans A
authors.initials: HA
authors.lastname: Timmermans
authors.forename: Won Kyu
authors.initials: WK
authors.lastname: Park
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Corless
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Keller
authors.forename: Josef
authors.initials: J
authors.lastname: Rösch
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D003094:Collagen / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D007413:Intestinal Mucosa; D007421:Intestine, Small; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000473:pathology; D010690:Phlebography; D012756:Sheep; D013552:Swine
chemical_list: D001672:Biocompatible Materials; D003094:Collagen