The Distensibility of the Human Vena Cava and Its Importance to In Vitro Studies of Venous Compression Syndromes: A Search for a Suitable Polymer for 3-Dimensional Printing

• Published in: Annals of vascular surgery Vol. 94; pp. 301 - 305
• Main Authors: Puech-Leao, Pedro, Torres, Inez O., da Silva, Erasmo S., Cestari, Ismar N., Cestari, Idágene A., da Rosa, Jhenyfer M., Nahas, William C., De Luccia, Nelson
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-08-2023
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2023.03.003

Venous compression syndromes are clinical conditions in which the large veins are compressed by other anatomical structures. Laboratory simulations may help us better understand the hemodynamics in venous compressions by creating situations similar to those seen in vivo. The aim of this study is to produce a model of the caval bifurcation using a polymer with distensibility similar to the human vena cava.
Fragments of the inferior vena cava were collected from 13 deceased kidney donors (aged 15–37 years) and were tested for deformation (strain) when subjected to distension at 50 N/cm2. Strips of 5 different polymers–thermic polyurethane and Agilus30 with Vero Magenta (AV) (in 3 different hardnesses) and silicone–were subjected to the same biomechanical tests and compared with the vena cava. A model of the caval bifurcation was produced with 3-D printing.
The deformation (strain) of the vena cava wall was 0.16 ± 0.9 when submitted to stress close to 50 N/cm2. Silicone showed a strain higher than the standard deviation of venous fragments. The strain of AV resin 95 Shore was lower than the standard deviation of the venous fragments. AV Resins 70 and 85 Shore showed strains within the standard deviation of the venous specimen, with 70 Shore being closest to the mean venous strain. Therefore, this material was selected for modeling the caval bifurcation. The computed tomography scan image generated a computer model of the caval bifurcation and was printed in 3 dimensions. In addition, the segments of 2 adjacent vertebrae were also printed to reference the compression site.
The 3-D printing of large veins can produce models with anatomy and biomechanics similar to those of human veins and opens a field of investigation into the hemodynamics of venous compression syndromes. Polymers with Shore A70 appear to have biomechanical properties similar to those of the vena cava wall. The model obtained in this study can be used in several in vitro studies of May-Thurner Syndrome.