Artificial venous valves: an ongoing quest to treat end-stage deep venous insufficiency

Michael C. DALSING Indiana University School of Medicine Indianapolis, USA ABSTRACT End-stage deep venous insufficiency is unrelenting venous hypertension with sequelae, and no standard option is available, or all options have been tried and found wanting. In such cases, there is an opportunity for an artificial venous valve to be used as a native valve. For decades, substitute valves have been studied experimentally, raising hope of bench-to-bedside transfer. This quest is reviewed with an emphasis on current clinical practice. Venous valves have been made entirely of non-autologous tissues: synthetics, xenografts, or allografts. Many have failed in early experimental evaluation, with…

Full text

Iliac vein outflow obstruction in ‘primary’ chronic venous disease

Seshadri RAJU Emeritus Professor of Surgery and Honorary Surgeon, University of Mississippi Medical Center and River Oaks Hospital, Flowood, MS, USA ABSTRACT The nonthrombotic iliac vein lesion (NIVL) was first described in 1908. Since then, it has become clear that the lesion is present in over half the general population in silent form. A clinical syndrome variously known as May- Thurner syndrome, Cockett syndrome, or “iliac vein compression syndrome”, caused by NIVL, is thought to be a rare form of chronic venous disease (CVD). However, with liberal use of intravascular ultrasound (IVUS), the lesion is found in over 90% of…

Full text

Nutcracker syndrome

Olivier HARTUNG Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Nord, Marseille, France The nutcracker syndrome is quite a rare condition. It is due to the compression of the distal segment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta (also called left renal vein entrapment). El Sadr reported the first case in 1950,1 but De Schepper named it.2 This syndrome needs treatment when symptoms are disabling. ANATOMY The LRV arises from the left kidney and opens into the inferior vena cava after 5 to 9 cm (Figure 1). In its distal part, the LRV…

Full text

Neovalve reconstruction in postthrombotic syndrome. Technique, indications, and results

Oscar MALETI Marzia LUGLI Department of Cardiac, Thoracic, Vascular Surgery Hesperia Hospital Modena, Italy ABSTRACT Patients with leg venous ulcer (C6 patients according to the CEAP classification) affected by deep venous reflux often fail to respond to conservative therapies, and the presence of non-healing or recurrent ulcers may lead one to consider surgery. However, even if surgery is properly indicated, traditional techniques such as femoral transposition and valve transplantation are not always suitable, and in these cases a de novo valve reconstruction represents a surgical opportunity. Our neovalve reconstruction technique consists in creating an intimal flap by performing a wall…

Full text