COMMENTI INTERNAZIONALI NOSTRA ATTIVITÀ

Robert Rutherford - commento al nuovo capitolo edito sull?Encyclopédie Médico-Chirurgicale 06-09-2009):

The chapter is beautifully illustrated - the best I have ever seen on the methods of treating deep vein reflux - and the tables and references seem quite complete. I look forward to the English translation.
Robert Rutherford

 

Robert Kistner - commento al nuovo capitolo edito sull?Encyclopedie Medico-Chirurgicale 07-09-2009:

The illustrations are outstanding. Beautiful and clear, and accurate on first glance. The bibliography also looks complete and a valuable collection. This appears to be a great contribution and I will look forward to seeing it in English.
Robert Kistner

 

Françoise Pitsch - Servier International. 16-06-2009:

Dear Marzia, Dear Oscar,
on behalf of Servier International, I would like to thank you for your availability and kindness in welcoming the 2 American Fellows. I am very impressed by all the difficul patient cases you were able to treat during their short stay and I am sure they were happy to attend such operation session. Be sure they will mention this in the presentation they have to make at the next AVF meeting.

 

COMMENTO all'articolo pubblicato sul Journal of Vascular Surgery 2009: Neovalve construction in deep venous incompetence. J Vasc Surg 2009;49:156-62.

Commento del Dr. Michael C. Dalsing, Indianapolis, Ind. (J Vasc Surg 2009;49:162)
The quest for a substitute venous valve, which would function long-term and be readily available, has been extensive and often fruitless. A variety of synthetic, allograft, and even xenograft venous valves have been manufactured but to date have not been clinically successful. The only sporadically reported successes have been with valves made from autologous venous tissue obtained from distant sites or possible only under very restrictive conditions.
Dr Maleti and his associates have found a way to use readily available local autologous tissue (the inner vein wall even when postthrombotic) and a very delicate surgical technique to fashion, in most cases, a monocusp venous valve. The patients chosen to undergo this procedure had failed many other attempts to heal persistent venous ulcers and represent only about a tenth of such patients his group were treating. In the first series, the valve was dissected and the vein closed. Although 16 of 19 ulcers healed, the authors noted that six neovalves demonstrated reflux within a few years. Innovation requires observation and the imagination to envision a solution. Since the problem seemed to be re-adherence of the valve to the vein wall, two sutures were placed to keep the valve in the semi-open position. As mentioned in the text, this may reflect more closely the normal physiologic position of a venous valve. The result has been a dramatic improvement in the neovalve competency rate from 1.6/100 patient months to 9.2/100 patient-months and an improved clinical ulcer healing rate of nearly fourfold. Who would have thought that the vein wall could be dissected to make a flap resembling a valve without having the flap immediately resticking to the wall or result in complete venous thrombosis? Obviously, neither occurs in most cases and the authors had the insight and courage to test the hypothesis. The illustrations are superb, instructive, and clearly demonstrate the thickened postthrombotic vein being worked on. The authors demonstrate the correct position to place sutures to keep the valve in the semi-open position. The results are well presented, concise, and confirm the fact that the neovalve works to prevent venous reflux and improve the clinical condition.
I applaud the authors for an innovative approach to a very difficult clinical problem and for the scientific method employed in investigating the results. Adoption of the technique and confirmation of the results by other venous surgeons remains the final step for this new surgical technique.

 

COMMENTO all'articolo pubblicato sul Journal of Vascular Surgery 2006 Neovalve construction in posttrhombotic syndrome. J Vasc Surg 2006;43:794-9

Commento del Prof. Robert L. Kistner, MD, Honolulu, HI. (Venous Digest 2007; 14(1): 1-2).
This is landmark report of an exciting approach to definitive treatment of late post-thrombotic deep vein reflux in highly selected instances. The case series is thoroughly studied both pre-operatively and post-operatively and clearly reported. The operative technique is explained in detail and is believable. The results exceed other techniques in this most difficult group of cases and are so good that a confirmatory series is needed to establish this as a technique to be practiced more widely. The presentation of this method at the AVF meeting was dramatically improved by a movie which demonstrated actual surgical procedures.
I find no fault with this presentation and am anxious to see if others can duplicate the experience.
If so, it could be a significant breakthrough for many individuals with advanced postthrombotic venous insufficiency. Points that need to be expanded in this presentation are how many cases were evaluated and found not to be candidates for this procedure, the length of the learning curve for producing a reliably competent valve, and whether there is any sign that these new valves will degenerate with time. The advanced postthrombotic reflux cases that are not candidates for other known procedures have no alternative for return to health with an active lifestyle until a substitute valve can be found to be successful. If this technique can be successful the next question will be whether it can be achieved in a more minimally invasive method.
The success of this neovalve expands upon the realization that surgical manipulation of the late post-thrombotic vein is well tolerated under careful surgical techniques with anticoagulant coverage. The exact nature of the endothelial lining cells in these postthrombotic veins bears further investigation to learn if they are true endothelial cells or simply a paving type of architecture.
I congratulate the authors for this work. In addition, I advise would-be imitators of this procedure to study the precise technique carefully before practicing it on living patients and possibly having to report their own lack of success caused by failure to adequately master the method before employing it.

Commento del Prof. Paolo Zamboni, Direttore del Centro Malattie Vascolari dell?Università di Ferrara. (03/01/2007)
Caro Oscar, devo dire che la recensione del tuo articolo da parte del maestro Kistner rappresenta un passo storico...

 

COMMENTO alla relazione "The Italian Neovalve: who would have thought" presentata all?American Venous Forum 2006.

Commento del Prof. Robert L. Kistner, MD, Honolulu, HI. (28/03/2006)
Dear Dr. Maleti, I am excited by your experience with autogenous valve repair and creation. I think your work needs to be replicated by other surgeons and hope that your video and your honest presentation of your experience will encourage this to happen. If my practice affords the opportunity soon to try your technique I will certainly do so. Thank you for providing your video to me. In my experience, there is great risk when others try your techniques if they are not well grounded in the subtleties of the procedure--this is because they may have a negative experience because of poor patient selection or poor performance of the procedure and when they publish they may report negatively and do the concept great harm. There is a danger in today's atmosphere where everyone is searching for a very simple technique to insert a neo-valve because they may over-simplify and make errors. Ultimately, I guess truth will win out, but it can be a painful and slow process. The best protection against improper negative experiences is to have some others repeat your work after they are well grounded by watching you work or at least reviewing your videos and perhaps discussing their cases with you. I hope you continue with your important investigations. Please let me know if I can be of help to you.

 

COMMENTO alla relazione "Neovalve construction in post thrombotic syndrome" presentata all'American Venous Forum 2005.

Commento del Prof. Bo Eklof, MD, PhD; Past President of American Venous Forum. (28/02/2005) Dear Oscar and Marzia, Your paper on Neovalve construction in postthrombotic syndrome was one of the highlights of our meeting. The concept is very important and the presentation was superb. I will follow your development of this technique with great interest.

Commento del Dr. Michael C. Dalsing, Indianapolis, Ind. (06/04/2005) Oscar, I admire your willingness to try something innovative in a difficult situation. I try not to comment unless I can add to the discussion and I believe your work was well presented and nicely illustrated with excellent images.