The need for a prosthetic venous valve in the treatment of chronic deep venous valvular incompetence (CDVVI) or insufficiency becomes evident only after other options have failed, or simply, are not practical. A valve made of autogenous vein and surgically positioned into the lower-leg venous system is currently the only artificial venous valve available with at least preliminary data to support its utility in the treatment of patients with end-stage CDVVI. There are potential nonautogenous off-the-shelf venous valve substitutes that reside in research and development, but lack clinical studies to support the transition to standard surgical use. All nonautogenous artificial venous valves have failed to reach full clinical investigation in early or mid-term analysis. The quest for a percutaneous option is just beginning to be investigated, but early study would suggest that minimizing nonautogenous tissue and exposed metallic components is best. However, no option can substitute a good autogenous venous valve in the treatment of CDVVI. However, the quest continues for those unfortunate individuals who require surgery, but have no current option available to them.
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