Vein doctors use stents to treat vein obstruction or blockage. During angioplasty, narrowed blood vessels are opened using a balloon catheter. Stents, tiny tubes of metal, fabric or plastic, can then be placed inside the vein to keep it open. Stents may be used in both arteries and veins. We will focus on common uses in veins.
The most common area to use stents are for vein problems in the iliofemoral vein (iliac vein and upper part of the femoral vein) and the inferior vena cava (major vein in the abdomen). It may also be used in cases of obstruction of the subclavian vein. Narrowing of these veins may occur secondary to blood clots, or from compression by other structures near these veins. Such narrowing reduces blood return from the legs back up to the heart. The reduced blood return may cause swelling, leg pain, leg ulceration and varicose veins as well as increase the risk for blood clots. It should be noted that acute blood clots, referred to as deep vein thrombosis (DVT), may be caused by vein narrowing. In such cases, the stent will reduce the risk of recurrence of clot by keeping the vein open.
Ileocaval vein obstruction has become better recognized as a contributor to chronic venous disease. In these cases, stenting seems to significantly reduce leg pain and swelling, improve healing of vein ulcers, and substantially improve quality of life.
Stent placement is a minimally-invasive outpatient procedure. It involves minimal discomfort and is generally well tolerated. After local anesthetic, a needle is placed into the femoral or popliteal vein. A guidewire is passed to the narrowed vein area. A balloon is placed and expanded so that it opens up the narrowed area. The stent is placed after the vein is opened up. Long-term anticoagulation may be indicated if the initial problem was caused by blood clots. It is generally not required if the blockage was due to compression from another structure.
Minimally-invasive stent procedures are cost-effective, much less risky and with an easier recovery than previous methods of treatment such as bypass surgery. Contact a vein specialist for more information about stents.
Reviewed by Steven E. Zimmet, MD, RVT, FACPh
Editor of Phlebology
President, Zimmet Vein & Dermatology
Past-President, American College of Phlebology