Chronic deep venous recanalisation and stenting

Chronic deep venous recanalization and stenting are interventional procedures used to treat chronic venous obstruction or stenosis in the deep veins of the legs or other parts of the body. These procedures aim to restore venous blood flow, alleviate symptoms, and improve the quality of life for patients with chronic venous insufficiency.

Indications for Chronic Deep Venous Recanalization and Stenting

• Chronic Venous Obstruction: Persistent narrowing or blockage in the deep veins, often due to post-thrombotic syndrome, May-Thurner syndrome . Non thrombotic iliac vein lesions (NIVL) or other vascular conditions. (Click here to read more on May Thurner Syndrome) (Click here to read more on Nonthrombotic Iliac Vein Lesions)
• Symptoms: Persistent leg swelling, pain, heaviness, skin changes (hyperpigmentation, ulceration), and recurrent venous ulcers despite conservative management.
• Risk of Complications: Risk of recurrent deep vein thrombosis (DVT), chronic venous insufficiency, and venous ulcers.

Procedure Steps

1. Pre-procedure Assessment:
   • Patient history, physical examination, and imaging studies (ultrasound, CT venography, MR venography) to evaluate the extent and nature of venous obstruction.
   • Assess patient suitability for the procedure, including coagulation status and general health.
2. Patient Preparation:
   • Informed consent, explanation of the procedure, risks, and benefits.
   • Pre-procedure fasting (if sedation or anesthesia is required).
3. Venous Access (Click here to read more on Venous access (PICC, Hickman, Tunelled dialysis catheter, venous ports)):
   • Typically, access is obtained via the femoral vein using ultrasound guidance.
   • Catheter insertion to access the affected deep vein segment.
4. Venography and Imaging:
   • Contrast venography is performed to visualize the extent and severity of venous obstruction.
   • Intravascular ultrasound (IVUS) may be used to assess vessel diameter, degree of stenosis, and plaque morphology.
5. Recanalization:
   • Use of specialized catheters and wires to navigate through the narrowed or blocked segment of the vein.
   • Mechanical techniques such as balloon angioplasty or atherectomy may be used to dilate the narrowed area and remove any obstructive material (plaque or thrombus).
6. Stenting (Click here to read more on Angioplasty/ stenting):
   • Placement of a venous stent (self-expanding metal or nitinol stent) across the treated segment to maintain patency and support the vessel walls.
   • Stent size and length are chosen based on the venous anatomy and degree of stenosis.
7. Post-stenting Assessment:
   • Venography is performed to confirm optimal stent positioning, patency, and resolution of venous obstruction.
   • Assess hemodynamic parameters and venous blood flow.
8. Post-procedure Care:

• • Monitoring for immediate complications such as bleeding, hematoma, or vascular injury.
  • Gradual mobilization of the patient.
  • Prescription of anticoagulant therapy if indicated.

Benefits

• Restored venous blood flow and alleviation of symptoms.
• Prevention of recurrent deep vein thrombosis (DVT) and progression of chronic venous insufficiency.
• Improved healing of venous ulcers and reduced risk of complications.

Risks

• Vascular injury during catheterization or stent placement.
• Risk of stent migration, fracture, or thrombosis.
• Allergic reactions to contrast agents.
• Post-procedural pain, bruising, or swelling.
• Rare instances of infection or stent-related complications.

Follow-up and Long-term Management

• Regular follow-up appointments to monitor stent patency, venous blood flow, and symptom improvement.
• Evaluation of anticoagulant therapy if prescribed.
• Lifestyle modifications (compression therapy, leg elevation, exercise) to manage chronic venous insufficiency.

Conclusion

Chronic deep venous recanalization and stenting are effective interventions for patients with chronic venous obstruction, stenosis, or May-Thurner syndrome causing significant symptoms and complications. These procedures aim to restore venous blood flow, alleviate symptoms, and improve the quality of life for patients with chronic venous insufficiency. Careful patient selection, procedural technique, and post-procedure management are essential for optimal outcomes and patient safety.