What are Venous Stents?
Most people are familiar with coronary stents placed in the arteries of the heart to improve blood flow. Venous stents function in the same way.
Venous stents are metal mesh tubes that expand against blocked or narrowed vein walls. They act as a scaffold to keep veins open. In most cases, surgeons place venous stents in larger, central veins, such as those found in the:
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Conditions We Treat with Venous Stents
Venous stents can help people with chronic blood clots or other conditions that compress or narrow the veins, limiting blood flow.
At the UPMC Heart and Vascular Institute, we use venous stents to treat conditions such as:
- Chronic deep vein thrombosis (DVT): DVT is a blood clot in one of the large, deep veins that returns blood from the leg — or less commonly, from the arm — to the heart and lungs.
- Post-thrombotic syndrome: DVT can damage veins, which can lead to symptoms such as chronic swelling and pain. People may not suffer from symptoms of post-thrombotic syndrome until years after DVT.
- May-Thurner syndrome: In this condition, the artery that runs from your abdomen to your right leg — called the right iliac artery — presses against the left iliac vein, causing it to narrow and scar, leading to chronic left leg swelling, pain, and sometimes fatigue.
- Nutcracker syndrome: In this condition, the arteries near the kidney compress the left renal (kidney) vein, making blood flow backward and causing symptoms like flank pain and blood in urine.
- Hemodialysis/arteriovenous fistulae: People who receive hemodialysis and whose grafts or fistulas experience decreased blood flow can sometimes benefit from venous stents. Stenting also opens the central veins in the chest, which helps drain for dialysis access.
Before Your Venous Stent Procedure
In addition to taking your medical history and performing a physical exam, your UPMC vascular surgeon may order imaging or other tests.
The most common imaging test — duplex ultrasound — uses high-frequency sound waves to create images of your blood vessels and measures the direction and speed of blood flowing through your veins. Ultrasound gives your doctor a clear picture of the structure of your blood vessels and helps to pinpoint the exact location of any narrowing or blockage.
Sometimes, ultrasound may not be effective because of the location of the vein. In this case, your vascular surgeon may suggest a venogram.
A venogram is an x-ray that allows your doctor to see the anatomy of your veins.
After inserting a catheter (thin, flexible tube) into a vein — most often in the leg — your doctor injects a contrast dye into the catheter, which allows your veins to be seen on the x-ray.
Your vascular surgeon can use the venogram to diagnose and treat your condition by performing venous angioplasty and stent placement at the same time if indicated.
What To Expect During Venous Stenting
Your UPMC vascular surgeon can place most venous stents on an outpatient basis, under moderate sedation.
If a clot or other obstruction is blocking the vein, your surgeon may first perform angioplasty before placing the stent.
During venous angioplasty, your vascular surgeon will:
- Insert a needle into a vein in your groin or behind your knee, depending on which vein needs stenting.
- Insert a guide wire and pass a catheter sheath over it, followed by a guide catheter through the sheath.
- Use x-ray guidance (fluoroscopy) to steer the catheter to the site of the narrowing.
- Advance a balloon-tipped catheter to the site of the narrowing.
- Inflate and deflate the balloon several times to widen the narrow vein.
To place a venous stent, your surgeon will:
- Remove the angioplasty balloon and insert a catheter with a closed stent on it.
- Place the stent in the vein. The stent pushes against the walls of the vein, serving as a support to keep it open.
- Remove the catheters and apply pressure to the insertion point to close the wound.
In most cases, people who undergo venous stenting go home the same day.
To prevent blood clots from developing, most people must take clopidogrel (Plavix) for a few months.
Why Choose UPMC for Venous Stenting?
At the UPMC Heart and Vascular Institute, we are experts at venous stenting. Many of our surgeons are leading experts in the diagnosis and treatment of conditions requiring the use of a venous stent.
If venous stenting isn’t the best option for you, we will recommend other treatments that are more appropriate for your individual circumstances.
We are also at the forefront of vascular research. Research programs at UPMC have helped establish some of the practice guidelines doctors use to place venous stents.