A multicenter, phase I evaluation of cryopreserved venous valve allografts for the treatment of chronic deep venous insufficiency

• Published in: Journal of vascular surgery 1999-11, Vol.30 (5), p.854-866
• Main Authors: Dalsing, Michael C., Raju, Seshadri, Wakefield, Thomas W., Taheri, Syde
• Format: Article
• Language: English
• Subjects: Actuarial Analysis; Blood Vessel Prosthesis Implantation; Cryopreservation; Feasibility Studies; Female; Femoral Vein - transplantation; Humans; Leg - blood supply; Male; Middle Aged; Postoperative Care; Preoperative Care; Prospective Studies; Regional Blood Flow - physiology; Time Factors; Transplantation, Homologous; Treatment Outcome; Vascular Patency - physiology; Venous Insufficiency - surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(99)70010-8

Purpose: A phase I feasibility study was conducted to determine whether cryopreserved venous valved segments would remain patent/competent in a short-term period (6 months). Methods: The target group consisted of 10 patients (C 4-6, E, A D, P R). The exclusion criteria included untreated superficial/perforator venous disease, significant venous or arterial obstruction, hypercoagulability or coagulopathy, and significant preexisting medical conditions. Required preoperative tests were venous duplex, ascending/descending venography, and a physiologic study (eg, APG, blood typing, an ankle/brachial index, and if post-thrombotic, a hypercoagulability work-up). A single-valve transplant was placed below all reflux, aided by anticoagulation with or without a distal arteriovenous fistula. Postoperative assessment included duplex scanning/clinical examination (at 1, 3, and 6 months), descending venogram (at 1 month), and physiologic study (at 1 and 6 months). The primary end point was valve patency/competence, with clinical outcome as a secondary end point. Adverse events were recorded. Results: After eliminating protocol violations, nine patients with superficial femoral (5) or popliteal (4) vein valve transplants were studied. Six-month actuarial results show a patency rate of 67% ± 16% and 78% ± 13%, respectively, a primary and secondary competency rate of 56% ± 17% and 67% ± 16%, respectively, and a 100% patient survival rate. Clinical outcome averaged 1.1, with healing and/or freedom from ulcer recurrence, in six of nine patients. A postoperative risk of seroma formation (3) and cellulitis (1) exists. Conclusion: In patients with few remaining therapeutic options, one can achieve a 6-month assisted patency and competency rate of 78% and 67%, respectively, with an improved clinical outcome. (J Vasc Surg 1999;30:854-66.)