Article

lock Open Access lock Peer-Reviewed

0

Views

CASE REPORT

Heterologous valve implantation in the infra-renal vena cava for treatment of the iliac venous valve regurgitation disease: experimental study

Otoni M. Gomes; Ricardo Zandin; João Batista Tomás Rodrigues; Emerson David Miranda; Divino Barros; Diva Maria de Oliveira

DOI: 10.1590/S0102-76382002000400015

It was demonstrated in recent studies employing the duplex-scanning technique that iliac venous valve regurgitation was observed in 78% of patients studied with varicosity in the lower extremities [1].
For the surgical treatment of valve insufficiency in patients with venous diseases of the lower limbs skilled procedures have been performed [2-5], although limited to the femoral and/or greater saphenous veins.
The evidence of simultaneous (bilateral) valve regurgitation disease in both left and right iliac veins sustain this hypothesis for the study of treatment by endovascular (valved stents) or direct surgical implantation of valve prosthesis in the initial segment of the inferior vena cava or in the iliac veins. In this case, the implantation above the ostium of the iliac intern vein preserves the resource of collateral circulation to the opposite side, reducing risk for the treated limb in case of implant obstruction.
In six mongrel dogs, (15 - 20 kg of body weight), under anesthesia with xylazine, thiopental and halothane, the vena cava was exposed below the renal vein by paramedian pararetal intern laparotomy. After systemic heparinization (5 UI/kg body weight) and proximal and distal clamping a segment of a porcine aortic valve cusp preserved in glutaraldehyde (Comex Ind. Com. Ltda - MG) was implanted through transversal incision. The base of the cusp segment was fixed by the same suture as the venae cavae wall repair.
The result in two initial cases showed after 15 days follow-up that the preservation of the implanted cusp tissue was without local thrombosis (figure 1). This confirms the good results reported by FONTAN and BAUDET [6] with implantation of valve bioprosthesis in the inferior and superior thoracic vena cava for treatment of tricuspid atresia.


Fig. 1 - Fifteen days follow-up: aortic porcine cusp (arrow) glutaraldheyde preserved implanted in the infrarenal vena cava (dog 3).

Should successful valve implantation in the abdominal infra-renal vena cava be confirmed, in the future, new horizons will be opened for treatment of venous diseases in the lower limbs. This will possibly be through implantation of valved biostents, in the inferior vena cava or in the iliac vein (figure 2), in cases of bilateral or unilateral commitment, respectively.


Fig. 2 - Options of valved stent implatation in common iliac or inferior vena cava.

BIBLIOGRAPHIC REFERENCES

1. Gomes OM, Gomes ES. Iliac valve regurgitation disease. In: X Meeting of the International Society for Heart Research - Latin American Section; 2002; La Plata, Argentina: International Society for Heart Research.

2. Queral LA, Whitehouse Jr. WM, Flinn WR, Neiman HL, Yao JS, Bergan JJ. Surgical correction of chronic deep venous insufficiency by valvular transposition. Surgery 1980; 87: 688-95.
[ Medline ]

3. Belcaro G. Plication of the sapheno-femoral junction. Phlebology 1991; 6: 159-65.

4. Raju S . Valvuloplasty and valve transfer. Int Angiol 1985; 4: 419-24.
[ Medline ]

5. Kistner RL. Surgical repair of the incompetent femoral vein valve. Arch Surg 1975; 110: 1336-42.
[ Medline ]

6. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971; 26:240-8.
[ Medline ]

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY