Percutaneous vein occlusion with small intestinal submucosa: an experimental pilot study in Swine and sheep.
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.
Kim
Man Deuk
MD
Dotter Interventional Institute, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Hoppe
Hanno
H
Pavcnik
Dusan
D
Kaufman
John A
JA
Uchida
Barry T
BT
Correa
Luiz O
LO
Timmermans
Hans A
HA
Park
Won Kyu
WK
Corless
Christopher L
CL
Keller
Frederick S
FS
Rösch
Josef
J
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
D001672:Biocompatible Materials; D003094:Collagen