Name of the Procedure:

Transcatheter Placement of an Intravascular Stent (Initial Vein) Common name(s): Vein stenting, Percutaneous vein stenting

Summary

This procedure involves inserting a small, expandable tube (stent) into a vein to keep it open and ensure proper blood flow. The stent is placed using a catheter (a thin, flexible tube) that is threaded through the blood vessels to the targeted location. The process includes radiological supervision and may involve balloon angioplasty where the same vessel is widened using a small balloon.

Purpose

To address blockages or narrowing (stenosis) in a vein that can lead to poor circulation or blood flow. The expected outcome is to restore adequate blood flow, alleviate symptoms associated with vein obstruction, and prevent further complications.

Indications

• Chronic venous insufficiency
• Deep vein thrombosis (DVT)
• May-Thurner syndrome (compression of the iliac vein)
• Recurrent vein blockages
• Symptoms such as leg swelling, pain, or skin changes.

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Adjustment or cessation of certain medications as directed by a healthcare provider.
• Pre-procedure imaging studies such as an ultrasound or CT scan to assess the vein.
• Blood tests to check coagulation status.

Procedure Description

1. The patient is positioned and prepped in a sterile manner.
2. Local anesthesia is administered at the insertion site, typically in the groin area.
3. A small incision is made, and a catheter is inserted into the vein.
4. Using fluoroscopy (a type of X-ray guidance), the catheter is navigated to the site of narrowing.
5. If necessary, balloon angioplasty is performed to widen the vein.
6. A stent is deployed at the site of narrowing to keep the vein open.
7. The catheter is removed, and the incision is closed.
8. Continuous monitoring of blood flow is conducted to ensure proper stent placement.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

The procedure is performed in a hospital, catheterization laboratory (cath lab), or an outpatient surgical center.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Nurses
• Radiologic Technicians
• Anesthesiologist or Nurse Anesthetist (if sedation is required)

Risks and Complications

• Infection at the insertion site
• Allergic reaction to contrast material
• Bleeding or hematoma formation
• Blood clots
• Stent migration or malfunction
• Vein damage or perforation
• Kidney damage (from contrast dye)

Benefits

• Improved blood flow through the vein.
• Relief from symptoms such as leg pain, swelling, and skin changes.
• Prevention of complications related to chronic venous obstruction.

Recovery

• Monitoring in a recovery area for a few hours post-procedure.
• Instructions to avoid strenuous activities for several days.
• Keeping the insertion site clean and dry.
• Follow-up appointments for imaging studies to monitor the stent.

Alternatives

• Conservative management with compression stockings and medication.
• Open surgical repair of the vein.
• Thrombolytic therapy for clot dissolution.
• Pros and cons: Minimally invasive stenting offers quicker recovery compared to open surgery but may carry a higher risk of stent migration.

Patient Experience

• Mild discomfort or pressure during catheter insertion.
• Some pain or bruising at the insertion site post-procedure, manageable with pain medication.
• Most patients can resume normal activities within a few days, with full recovery expected within a week.

Pain management and comfort measures include local anesthesia at the insertion site and post-procedure analgesics.