Introduction
Venous stenting is a less intrusive technique to enhance blood circulation in cases where a vein is constricted or squeezed. This aids in the restoration of optimal blood circulation. A stent is a permanent wire mesh tube inserted into a vein to serve as a scaffolding, ensuring the veins remain open.
What Are Stents?
Stents are metallic mesh tubes inserted into the veins to offer structural reinforcement. They are available in a diverse range of patterns and sizes. Stents are typically transported to their location using a vascular catheter while squeezed. Some objects can expand on their own, while others need the help of a balloon filled with air.
Once installed, most stents are intended to remain in place indefinitely and pose significant challenges if removal becomes necessary. Furthermore, several stents can be coated or engineered to allow for the gradual and controlled release of drugs.
The Food and Drug Administration (FDA) approves various stents in veins and arteries. Venous stents are often engineered with greater radial strength than arterial stents due to the lower blood pressure within the venous system. Similarly, venous stents tend to be more elastic because veins undergo more frequent and significant contractions and dilations than arteries.
What Are the Indications for Using a Stent?
Stents are used to treat conditions characterized by a decrease in the size of a blood vessel's lumen, which hinders blood flow. Several of these illnesses comprise:
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Post-thrombotic Syndrome (PTS): It refers to a condition that occurs after a blood clot has formed and resolved. Post-thrombotic syndrome arises from the impairment or injury to the walls and valves of the venous system. For instance, a deep vein thrombosis (DVT) might result in persistent vein damage even after its removal or dislodgement. These compromised arteries may no longer maintain their structural integrity without the assistance of a stent.
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May-Thurner’s Syndrome (MTS): May-Thurner's syndrome is characterized by the constriction of the left iliac vein due to pressure from the right common iliac artery. This compression leads to the formation of fibrosis, which is scar tissue, in the wall of the blood vessel. Fibrosis leads to the constriction of the vein. A venous stent might be utilized to reopen the narrowing.
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Pelvic Congestion Syndrome (PCS): Pelvic congestion syndrome arises due to the accumulation of blood in the pelvic region of the affected person. There are multiple factors contributing to this, with one of them being compression of the iliac vein. In such instances, a stent can be inserted to reinstate the ideal circulation of blood from the pelvis.
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Peripheral Artery Disease (PAD): Peripheral artery disease is a condition resulting from the accumulation of atherosclerotic plaques in the arteries, leading to a decrease in blood circulation to the limbs. Without treatment, this condition can progress from slight discomfort to the formation of open sores and eventually to a severe lack of blood flow in the limb, necessitating amputation. Arterial stents are used to open up a damaged blood artery and restore the flow of blood to the affected limb.
What Are the Advantages Linked to Stents?
In recent decades, stenting has become more widespread and has demonstrated high safety and efficacy in treating vascular disorders. An essential advantage of the stent is its ability to be implanted via a catheter instead of a more intrusive surgical procedure. In addition, there are other advantages associated with this.
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Reduced duration of procedures.
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Reduced duration of recovery.
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Negligible likelihood of adverse effects.
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The option to undertake this treatment at a clinic rather than a hospital.
What Are the Potential Hazards Linked to Stents?
Like other medical operations, stenting has demonstrated a low level of risk; however, some risks remain present. Several of these hazards comprise:
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Risks Associated With Catheter Usage: Any medical treatment that entails the insertion of a catheter into a blood artery carries inherent hazards. The potential hazards encompass harm to the blood artery, contusion or hemorrhage at the puncture site, and infection. The probability of any of these occurrences occurring is less than one percent.
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X-Ray Contrast Material Hypersensitivity: The patient may experience an allergic response to the x-ray contrast material administered during endovascular operations. The severity of these episodes might vary from moderate itching to severe reactions that may impact breathing or blood pressure. A physician and a nurse closely supervise patients undergoing medical interventions during the procedure.
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Exposure to X-rays: Endovascular procedures are performed using fluoroscopy. Every imaging device, including X-rays, carries inherent dangers, such as exposure to radiation.
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Premature Menopause: Menopause occurs in approximately one percent of women immediately after embolization. This occurrence is more prevalent among women aged 45 years and above when they have the treatment.
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Hysterectomy: Hysterectomy refers to the surgical removal of the uterus. Certain women may ultimately require a hysterectomy due to enduring symptoms or other medical issues. The probability of needing a hysterectomy following embolization is minimal, less than one percent.
What Takes Place During a Venous Stent Procedure?
The interventional radiologist will go over the procedure and associated risks.
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Prior deep vein thrombosis (DVT) can also lead to venous obstruction. Previously, the sole treatment options for addressing these venous obstructions necessitated a surgical procedure to create an alternative pathway around the blocked vein. Angioplasty is now a viable treatment option for venous obstructions.
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Placement of a stent with an ultrasound-guided catheter is inserted into the vein. Subsequently, the physician can introduce a minuscule ultrasound device into the vein to locate and diagnose venous obstructions.
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Intravenous ultrasound (IVUS) is the most effective method for identifying venous stenosis and providing guidance for treatment choices.
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In the event of the discovery of substantial venous constriction or stenosis, the physician can perform angioplasty, which involves expanding the narrowed vein to restore its normal size.
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Once the vein has been dilated, a stent is inserted.
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A stent is a metallic tube woven in a braided pattern that serves as a supportive structure to maintain the patency of a vein.
Conclusion
Venous stenting is acknowledged as a potential therapeutic alternative to conventional surgery for patients presenting with symptomatic venous obstruction or blockage. Even though venous stents are safe, effective, and require minimal surgery, they were not originally made for the venous system. Until very recently, there were no stents specifically made for veins. The presence of venous blockage worsens the morbidity or death rate when it is linked to chronic venous insufficiency and chronic venous hypertension.
