Vein StentingVein stenting is a procedure used to open up narrowings (stenosis) or blockages (occlusions) in veins. The typical area for vein narrowing is in the pelvis on the left side. However, it can be in the abdomen as well and may also affect the right side.
The vein is often compressed between the spine and an artery. Changes in abdominal and pelvic structure can aggravate this narrowing and cause symptoms such as swelling and thrombosis.
This may occur after spinal operations, after pregnancy, in athletes and sometimes just spontaneously.
Imaging modalities have improved and we now actively look for it and treat it.
How do we treat vein lesions?
The diagnosis will be suspected on duplex doppler ultrasound imaging.
Thereafter a CT Venogram or MR Venogram may be performed to more accurately delineate anatomy. However, of note, is that these imaging modalities may still miss lesions.
The most accurate diagnosis is by IntraVascular UltraSound (IVUS) (IntraVascular UltraSound).
How is Vein Stenting performed?The patient will need to go to theatre for vein stenting. A general anaesthetic will be given and a venogram performed. This is a small puncture in the groin inserting a sheath (small cannula) into the femoral vein. A venogram is then performed – this is the same idea as a coronary angiogram for the coronary arteries. However, we are looking at blood vessels in the pelvis.
The IVUS catheter will then be inserted to look directly inside the vein and assess for any narrowing. This will be marked with the venogram. The IVUS is accurate in measurement and will help determine what size stent is necessary.
Balloon being inflated
Thereafter a balloon will be used to inflate the area of narrowing and prepare the vessel for the stent.
Stent deployedThe stent will then be inserted and deployed.
This will result in clinical improvement of symptoms.
Treating symptomatic vein lesions is important. If they are not treated they can lead to thrombosis as well as swelling and chronic leg changes such as skin pigmentation, skin damage and wound formation.
Thereafter a venogram and IVUS will be done again to ensure the stent has opened nicely and blood is flowing well.