Our primary mission as Circulation Specialists is to help you achieve the healthiest circulation possible for your stage in life.
Whatever your lifestyle, genetic predisposition or individual health aspirations – Your Circulation is your Lifeline.
Chronic Venous Insufficiency (CVI) is a condition characterised by poor venous return from the legs to the heart, leading to increased pressure in the veins of the lower limbs.
This venous hypertension can result from valvular incompetence, obstruction, or a combination of both, causing blood to pool in the legs.
Venous leg ulcers are some of the most severe complications associated with CVI. They are open sores or wounds when skin breaks down, revealing the underlying flesh.
Venous ulcers are typically located near the ankle and may be slow to heal. These ulcers arise from prolonged venous hypertension that damages the skin and surrounding tissues. If infected, they can also be painful and foul smelling.
The lower limbs contain a network of veins, which includes superficial veins (close to the skin’s surface), deep veins (located deeper within the leg), and perforating veins (which connect the superficial and deep veins).
Deep veins send blood back to the heart, and the iliac veins are major deep veins that carry blood from the legs to the heart. However, these veins can become blocked or compressed, leading to circulation problems.
The continuous high pressure in the veins from CVI causes inflammation and damages skin and tissues, eventually leading to ulcers, especially near the ankles.
Iliac vein stenting is a medical procedure designed to alleviate symptoms of CVI by treating obstructions in the iliac vein. It is usually performed for severe symptoms that do not respond to medical treatment and compression therapy, or to prevent a recurrent DVT (Deep Vein Thrombosis) in patients who have already had thrombosis (clotting) of the iliac vein previously.
The procedure involves placing a stent, which is a small mesh tube, inside the iliac vein. The stent acts to keep the vein open, preventing it from narrowing or being compressed, which ensures normal blood flow from the legs back to the heart.
Diagnosing CVI and deciding on iliac vein stenting involves several steps.
The first step is to talk about symptoms that may suggest CVI, such as leg swelling, pain, recurrent varicose veins, and skin changes. History of DVT or leg injuries is carefully reviewed.
The physical examination focuses on the legs, looking for signs of CVI. The surgeon may also check how well the leg veins are functioning.
The stenting procedure usually starts with the surgeon making a small incision under ultrasound guidance to access a vein in the leg or neck. Usually the leg on both sides is accessed to ensure a full evaluation of the veins being treated.
A catheter (a thin, flexible tube) is then guided to the site of the obstruction in the iliac vein, using X-ray imaging.
Once the obstruction is reached, it is first treated with a balloon angioplasty to expand the vein to its normal size. Intra vascular ultrasound is used to guide the size of stent required and the best position for it to be placed. A suitable sized stent is then deployed into the expanded vein. This stent expands, opening up the blocked section of the vein to restore normal blood flow.
After the stent is in place, the catheter is removed, and the incision is closed. The entire process typically takes 1-2 hours, depending on the complexity.
Like any medical procedure, iliac vein stenting carries certain risks and potential complications.
The catheter insertion site may bleed, though this is usually minor and controlled quickly. Bleeding or bruising can also occur from the blood thinners prescribed after vein stenting, and your doctor will advise you on how to manage this if it occurs.
There’s a small risk of infection at the catheter insertion site or within the treated vein.
Rarely, the stent may move from its original placement site. This risk is minimised using dedicated vein stents specifically designed to be placed in veins and not arteries (which are very different) and also well-suited to the patient’s vein size.
Blood clots can form within the stent, potentially blocking blood flow. These may require further procedures to re-establish the flow.
There’s a slight chance of damaging the vein during the procedure. However, such occurrences are infrequent and usually have minimal long-term consequences.
Even after successful stenting, some patients may experience ongoing symptoms like swelling and pain, known as post-thrombotic syndrome.
Most patients are discharged the same day or the next morning after iliac vein stenting, as it’s minimally invasive and recovery times are relatively quick.
Patients are given local anaesthesia at the insertion site, minimising pain during the procedure. Post-procedure discomfort is usually mild and manageable with over-the-counter pain relief. Some patients, especially if very slim, can have back pain after the stent for a few days after stenting as the stent continues to expand a little even after the procedure is completed. This is usually managed easily with simple analgesia.
If stent blockage or migration occurs, symptoms may return, and further intervention might be needed. Regular follow-up imaging helps in the early detection of such issues, allowing for timely management.
We’ll get back to you within 24hrs.
