Percutaneous vein occlusion with small intestinal submucosa: An experimental pilot study in swine and sheep

Man Deuk Kim, Hanno Hoppe, Dusan Pavcnik, John A. Kaufman, Barry T. Uchida, Luiz O. Correa, Hans A. Timmermans, Won Kyu Park, Christopher L. Corless, Frederick S. Keller, Josef Rösch

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Abstract

Purpose: 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. Materials and 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)725-730
Number of pages6
JournalCardiovascular and interventional radiology
Volume30
Issue number4
DOIs
Publication statusPublished - 2007 Jul 1

Fingerprint

Jugular Veins
Veins
Sheep
Swine
Histology
Skin
Punctures
Catheterization
Endothelial Cells
Animal Models
Fibroblasts

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Man Deuk ; Hoppe, Hanno ; Pavcnik, Dusan ; Kaufman, John A. ; Uchida, Barry T. ; Correa, Luiz O. ; Timmermans, Hans A. ; Park, Won Kyu ; Corless, Christopher L. ; Keller, Frederick S. ; Rösch, Josef. / Percutaneous vein occlusion with small intestinal submucosa : An experimental pilot study in swine and sheep. In: Cardiovascular and interventional radiology. 2007 ; Vol. 30, No. 4. pp. 725-730.
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title = "Percutaneous vein occlusion with small intestinal submucosa: An experimental pilot study in swine and sheep",
abstract = "Purpose: 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. Materials and 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. Conclusion: 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.",
author = "Kim, {Man Deuk} and Hanno Hoppe and Dusan Pavcnik and Kaufman, {John A.} and Uchida, {Barry T.} and Correa, {Luiz O.} and Timmermans, {Hans A.} and Park, {Won Kyu} and Corless, {Christopher L.} and Keller, {Frederick S.} and Josef R{\"o}sch",
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Kim, MD, Hoppe, H, Pavcnik, D, Kaufman, JA, Uchida, BT, Correa, LO, Timmermans, HA, Park, WK, Corless, CL, Keller, FS & Rösch, J 2007, 'Percutaneous vein occlusion with small intestinal submucosa: An experimental pilot study in swine and sheep', Cardiovascular and interventional radiology, vol. 30, no. 4, pp. 725-730. https://doi.org/10.1007/s00270-007-9070-1

Percutaneous vein occlusion with small intestinal submucosa : An experimental pilot study in swine and sheep. / Kim, Man Deuk; Hoppe, Hanno; Pavcnik, Dusan; Kaufman, John A.; Uchida, Barry T.; Correa, Luiz O.; Timmermans, Hans A.; Park, Won Kyu; Corless, Christopher L.; Keller, Frederick S.; Rösch, Josef.

In: Cardiovascular and interventional radiology, Vol. 30, No. 4, 01.07.2007, p. 725-730.

Research output: Contribution to journalArticle

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T1 - Percutaneous vein occlusion with small intestinal submucosa

T2 - An experimental pilot study in swine and sheep

AU - Kim, Man Deuk

AU - Hoppe, Hanno

AU - Pavcnik, Dusan

AU - Kaufman, John A.

AU - Uchida, Barry T.

AU - Correa, Luiz O.

AU - Timmermans, Hans A.

AU - Park, Won Kyu

AU - Corless, Christopher L.

AU - Keller, Frederick S.

AU - Rösch, Josef

PY - 2007/7/1

Y1 - 2007/7/1

N2 - Purpose: 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. Materials and 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. Conclusion: 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.

AB - Purpose: 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. Materials and 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. Conclusion: 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.

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