Endoscopic venous valve transplantation with a valve-stent device

In this report we describe the outcome of a 6-week study of the valve-stent device in a goat model. Six female goats underwent endoscopic subcutaneous harvest of a valve-containing segment of external jugular vein. This segment was sutured inside a 10-mm Wallstent (Schneider Inc., USA), and the device was compressed and loaded into a 12 Fr. introducer sheath and deployed through a venotomy into the contralateral external jugular vein. The animals were anticoagulated for 1 week and euthanized at 6 weeks. Flow studies, manual strip test, and angioscopic evaluation were performed prior to sacrifice. All six valve-stents were patent at harvest by Doppler flow studies, and five of six were competent as demonstrated by the manual strip test. At angioscopic evaluation, the valves were open. Gross and histologic examination revealed intact valve leaflets in five specimens. This technique is a minimally invasive approach to valve harvest and transplantation with a valve-stent device. We have demonstrated that valve-stent can remain patent and competent for up to 6 weeks. This technique may have potential application in venous valvular incompetence.