Venous stenting The Phlebology Clinic / Services / Venous treatments / Venous stenting Introduction Key information Description of treatment Venous embolisation Venoplasty Introduction Deep vein thrombosisdefined as the narrowing or complete blockage of a venous vessel, is a serious health problem that affects many patients worldwide. It can be a consequence of previous deep vein thrombosis or result from chronic compression of venous vessels. Untreated venous obstruction can lead to pelvic venous insufficiency and fully developed post-thrombotic syndrome with symptoms such as: chronic limb pain, swelling, skin changes due to venous stasis, and finally, venous ulcers of the lower leg. According to statistics, 20-50% of patients who have had deep vein thrombosis develop post-thrombotic syndrome, despite receiving standard anticoagulant treatment. Venous stenting procedure it is a minimally invasive method of restoring proper blood flow in the venous system. The procedure involves the insertion of a venous stent (a scaffold made of metal mesh) into a narrowed or blocked vessel to open it up and maintain its patency. It is a particularly effective method in treating patients with post-thrombotic syndrome and in individuals with venous insufficiency caused by vascular compression. According to the latest research, the effectiveness of venous stenting procedures reaches 90-95% in cases of compression-related lesions (in patients without a thrombotic history) and 80-85% in patients with post-thrombotic syndrome. The majority of patients experience a significant improvement in their quality of life and the resolution of bothersome symptoms of venous claudication after venous stenting procedures. Stenting in the Venous System: A Historical Perspective The beginnings of venous stenting date back to the 1980s, when attempts were made to use stents originally designed for arterial procedures. At that time, there were no stents specifically designed for veins. These stents were not ideal for use in veins due to the differences in the anatomy and physiology of both types of vessels. Venous stents need to be more flexible to adapt to the pliable walls of veins and resistant to crush, as veins are more susceptible to external compression. With the advancement of technology and a better understanding of the specifics of the venous system, stents began to be adapted for the treatment of pathologies in the venous system. In the early 21st century, along with the development of endovenous techniques and a better understanding of the pathophysiology of venous system diseases, the introduction of stents specifically designed for venous vessels began. The last few years have seen a dynamic development in the field of endovascular treatment, acute deep venous thrombosis and their complications, such as pulmonary embolism or post-thrombotic syndrome. The introduction to the market of increasingly advanced biocompatible venous stents with better mechanical properties has significantly increased the effectiveness and safety of vein recanalization procedures. What are the characteristics of venous stents? Venous stents differ from arterial stents in their unique properties, which are adapted to the specific characteristics of the venous system. An ideal venous stent is characterized by: high flexibility (this allows it to adapt to the natural shape of the vein and body movements); crush resistance (ensures the vein remains open despite external pressure); adequate radial strength (this prevents stent migration and ensures the appropriate diameter of the dilated vessel);" biocompatibility: minimizes the risk of rejection and inflammation; good visibility under X-ray; an open-cell design (this allows for free blood flow into the side branches of the venous vessel); and the ability for precise placement (implantation) and deployment within the venous vessel. What is venous claudication? Venous claudication is a characteristic symptom occurring in patients with obstruction in the femoro-iliac segment of the venous system. It is a specific type of lower limb pain that appears during walking and forces the patient to stop. Key features venous claudication are it: pain in the lower limb that intensifies during standing and walking (the pain forces the patient to stop); a sensation described as fullness and heaviness of the leg; it may be accompanied by tingling or numbness of the leg; the pain forces the patient – unlike arterial claudication – to elevate the lower limb (which brings relief); the lower limb is swollen and cyanotic (in arterial claudication – pale); the claudication distance (until stopping) is usually longer than in the case of arterial claudication; it is accompanied by other symptoms of venous stasis such as: varicose veins (C2), venous skin changes (C4), or venous ulcers of the lower leg (C5-C6). Venous claudication significantly impacts the quality of life of patients with post-thrombotic syndrome, limiting their mobility and daily functioning. It is an important symptom indicating the need for venous system diagnostics and potential qualification for venous stenting. indications for venous stenting. What can be treated using venous stents? The most significant indications for venous recanalization procedures are: acute deep vein thrombosis within the iliofemoral veins; post-thrombotic syndrome with typical symptoms of venous claudication; non-thrombotic Iliac Vein Lesion, NIVL, which can cause symptoms of pelvic venous insufficiency; venous compression phenomena with typical symptomatology (e.g., May-Thurner syndrome or Nutcracker syndrome); post-thrombotic changes in the right external iliac vein Post-thrombotic changes on Doppler ultrasound May-Thurner phenomenon on MR venography Compression of the left common iliac vein by the ipsilateral artery secondary venous obstructions caused by external compression, e.g., due to tumor infiltration or enlarged lymph nodes; recurrent venous thrombosis in the iliofemoral segment; venous leg ulcers unresponsive to treatment with compression therapy; Kluczowe informacje dotyczące zabiegu stentowania żył TYPE OF TREATMENT with the use of: ultrasound, IVUS, X-ray INVASIVENESS minimally invasive (2-3/5) TREATMENT AREA whole body PERFORMING ENSEMBLE interventional radiologist, phlebologist, anesthesiology team, hemodynamic nurse DURATION 40-120 minutes TYPE OF ANAESTHESIA local, light sedation BOLDNESS slightly painful (2/5) RISK OF COMPLICATIONS low-to-moderate (2-3/5) CONVALESCENCE 7-21 days Price range Phlebology Price list for venous procedures performed in the vascular laboratory Percutaneous venous segment stenting using 1 stent From £19,000 Make an appointment Percutaneous venous segment stenting using 2 stents from £27,000 Make an appointment venoplasty with stent From £18,000 Make an appointment Patient preparation for venous stenting procedure Before a venous stenting procedure, each patient undergoes detailed ultrasound diagnostics (Doppler ultrasound of the veins with blood flow assessment in the veins of the lower limbs, pelvis, and abdomen) and MR venography or, less frequently, CT venography. In some cases, we use digital subtraction angiography or intravascular ultrasound (IVUS). The patient should inform the doctor about all medications they are taking, especially anticoagulants, and about any allergies. Before the procedure, basic blood tests necessary for performing the stenting procedure are carried out.On the day of the procedure, the patient should be fasting for approximately 6-8 hours. It may happen that the doctor recommends discontinuing certain medications. Patients are also informed about the necessity of arranging transportation after the venous stenting procedure. The entire stay in the hospital ward usually lasts about 4-6 hours. Venous stenting – how is the procedure performed? Thrombosis? Post-thrombotic syndrome? Impaired blood flow in the veins? Venous stenting can help you! In this video, you will learn how this procedure can restore the health of your vessels. The venous stenting procedure is performed in the Vascular Laboratory of the Phlebology Clinic, using X-ray and ultrasound equipment. The patient is given local anesthesia and light sedation (usually this type of anesthesia is sufficient, rarely requiring intravenous anesthesia).The venous stenting procedure involves several stages:percutaneous access to the vein: performed using the Seldinger technique under ultrasound guidance by puncturing a vein in the groin or popliteal fossa; introduction of a guide wire and catheter: the catheter is guided over the guide wire to the site of narrowing or blockage under fluoroscopic (X-ray) control and, in selected cases, with the aid of intravascular ultrasound (IVUS); dilation of the vein: balloon angioplasty is performed at the site of narrowing (a balloon is placed and, upon inflation, widens the lumen of the narrowed vein); implantation of a stent of appropriate diameter and length: a special self-expanding venous stent is placed on the catheter, and after deployment, it supports the venous vessel and maintains its patency; - patency control: after the implantation of the venous stent, blood flow and stent position are checked.The entire procedure, depending on the complexity of the specific clinical case, lasts from 30 minutes to 2-3 hours. Post-procedure management after venous stenting Every patient after a venous stenting procedure at our Clinic receives detailed written instructions. Upon discharge from the ward, a prescription for the necessary medications is issued. Key elements of post-operative care include: physical activity: moderate physical activity is recommended for 4 weeks after the stenting procedure (walking is best); the patient should avoid strenuous physical exertion, especially intense running or heavy lifting. anticoagulation therapy: in the initial phase (for 2-6 weeks after the procedure), we usually use low molecular weight heparins; subsequently, we recommend switching to oral anticoagulants and using them for a minimum of 6-12 months. In the case of this type of procedure, an individualized approach to the patient is crucial, taking into account all known risk factors, the type of venous disease, and the response to treatment. In cases of chronic post-thrombotic changes, extending the duration of treatment is possible. compression therapy (compression treatment): in the post-operative period, it is necessary to wear compression stockings or other compression garments recommended by the attending physician (CCL2 – this is the minimum compression strength after venous stenting procedures); the duration of compression therapy varies – it depends on the specific clinical situation. monitoring stent patency: for one month after the venous stenting procedure, close observation of the patient with Doppler ultrasound of the veins is recommended; management in case of early stent thrombosis: in the event of venous thrombosis in the stent, mechanical or pharmacomechanical thrombolysis should be considered; Contraindications for venous stenting procedure Typical contraindications for the venous stenting procedure include: active infection at the planned vascular access site; severe blood clotting disorders that increase the risk of bleeding; complex thrombophilia significantly worsening the procedural prognosis; venous obstruction with significantly limited venous inflow in the popliteal and femoral segments (one of the more important prognostic factors!). known allergy to the contrast agent or the material the stent is made of; severe patient condition (e.g., advanced heart or kidney failure, active cancer); lack of possibility to use anticoagulant medications; lack of patient consent for the procedure; pregnancy Possible complications after venous stenting procedure Venous stenting is often performed in patients with significant comorbidities and advanced venous problems. Therefore, post-operative complications occur more frequently than after venous embolization procedures. The most common include: early thrombosis within the stent (most commonly within 30 days of the recanalization procedure); stent migration, meaning its displacement; development of venous thrombosis within the stent or elsewhere in the deep venous system; secondary pulmonary embolism; hematoma or infection at the vascular access site; arterial damage during the procedure or arteriovenous fistula; vein dissection; contrast-induced nephropathy; allergic reaction to the contrast agent; in the long term, stent stenosis or restenosis (re-narrowing) caused by ingrowth within the stent; pain in the lower lumbar/sacral (L/S) spine; insufficient resolution of symptoms due to the complexity of the post-thrombotic syndrome. Feedback from our patients Every positive review makes us proud and motivates us to keep going. Please add feedback and share your treatment story with others ? . Do you appreciate our care? Add your opinion! Add your opinion to Google All opinions As the only ones, they correctly diagnosed the problem of extensive venous insufficiency (varicoceles on both sides, measuring 15mm) and perfectly performed bilateral endovascular embolization as a causal treatment, subsequently addressing the consequences of the insufficiency during the treatment of varicose veins of the lower limbs. A year has passed since the procedures, and thanks to them, I have returned to above-normal performance in competitive sports. Krzysztof Opinia z: 5/5 Dr Venus: virtual patient counsellor Looking for an answer to your vein question? Ask our Dr. Venus! Ask Dr Venus a question Are venous stents used in May-Thurner syndrome? Yes, venous stents are used in May-Thurner syndrome. For patients with this syndrome, venous stents can be implanted to restore the patency of the iliac veins and improve blood outflow. Make an appointment at the Phlebology Clinic Contact us
