Stents are alloy mesh tubes that are deployed into the veins to provide structural support. They come in a variety of designs and sizes. Stents are usually delivered to their target area using a vascular catheter and in a compressed state. Some are self-expanding while others require the assistance of an inflated balloon.
Most stents remain permanently in place once deployed and are very difficult to remove if the need arises. Additionally, some stents can be coated or designed to deliver medications slowly over-time.
The Food and Drug Administration (FDA) approves different stents for usage in the veins and arteries. Venous stents, compared to arterial stents, are typically designed with more radial strength because the venous system is under less blood pressure. Similarly, venous stents are typically more elastic because veins contract and dilate much more than arteries.
When Do You Use a Stent?
Stents are deployed to treat diseases involving partial or complete reduction in a vessel’s area open to blood flow. Some of these diseases include:
Post-Thrombotic Syndrome (PTS)
Post-thrombotic syndrome is caused by damage or trauma to the venous system’s walls and valves. For example, a deep vein thrombosis (DVT) may leave the veins damaged even after it has been removed or dislodged. These damaged vessels may no longer be able to retain their structure without the support of a stent.
May-Thurner’s Syndrome (MTS)
May-Thurner’s Syndrome is defined by compression of the left iliac vein by the right common iliac artery. This compression results in fibrosis (scar tissue) in the vessel wall. The growth of the fibrosis results in the narrowing of the vein. The narrowing can be reopened using a venous stent.
Pelvic Congestion Syndrome (PCS)
Pelvic Congestion Syndrome is caused by pooling of blood in the affected individual’s pelvis. This has many causes, one of which is iliac vein compression. In these cases, a stent can be deployed to restore optimal blood flow from the pelvis.
Peripheral Artery Disease (PAD)
Peripheral Artery Disease is caused by the buildup of fatty plaques in the arteries that reduce blood flow to the limbs. If left untreated, this can develop from mild pain to active ulceration to critical limb ischemia requiring amputation. Arterial stents can be deployed to reopen a diseased vessel and restore blood flow to the affected limb.
Benefits Associated with Stents
Stenting has increasingly become more prevalent in the past decades and has proven to be both safe and successful in the treatment of vascular diseases. One of the key benefits of the stent is that it can be inserted via a catheter as opposed to a more invasive surgery. Related to this, other benefits include:
- Shorter procedure durations
- Less time in recovery
- Minimal risk of complication
- The ability to undergo this procedure at an office-based lab rather than a hospital
Risks Associated with Stents.
Like all medical procedures, stenting has proven to be of low risk, but some risk still exists. Some of these risks include:
Catheter-related risks
Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site and infection. The chance of any of these events occurring is less than once percent.
Allergy to X-ray contrast material
The patient may have an allergic reaction to the x-ray contrast material used during endovascular procedures. These episodes range from mild itching to severe reactions that can affect breathing or blood pressure. Patients having procedures are carefully monitored by a physician and a nurse during the procedure.
X-ray exposure
Endovascular procedures are done under x-ray. There are risks with any imaging device including X-ray exposure.
Early onset menopause
Approximately one percent of women experience menopause shortly after embolization. This is more common in women who are older than 45 years when they have the procedure.
Hysterectomy
Some women may eventually need to have a hysterectomy because of persistent symptoms or other conditions. The likelihood of requiring hysterectomy after embolization is low - less than one percent.
What is the Procedure for Inserting a Stent?
Stent insertion is typically done under mild conscious sedation. You can expect sedation via an IV line and a local anesthetic applied to the insertion site. An inserted sheath allows entry of a guidewire, catheter, and delivery of the stent.
Stent deployment requires the support of advanced imaging to locate diseased vessels, ensure proper deployment, and confirm technical success metrics. Common imaging modalities include angiography, venography, and intravascular ultrasound (IVUS).
Angiogram procedure utilizes x-rays and a contrast dye to visualize blood flow in the arteries.
Venogram procedure is identical to angiography except that it is done in the veins.
IVUS uses ultrasonic vibrations to visualize the size and structure of a vessel. This can be done in both veins and arteries.
The stent is delivered to the diseased vessel along a guidewire and deployed using a balloon, if needed. Once deployment is complete, all other medical devices are removed and the patient is taken to the recovery area.
Preparation for the procedure:
Your vascular specialist should review the risks, benefits, and other expectations with you prior to your procedure. Each patient’s instructions should be tailored to their unique situation, but common recommendations include:
Detailed history needs to be obtained:
- Previous malignant disease
- Previous surgical history including history of venous catheterization or trauma
- Previous history of radiation
- Family history of venous disease
Careful physical examination is mandatory
- Pulses in affected extremity
- Diameter discrepancy between affected/unaffected extremity
- Ulcerations or skin changes
- Various examinations to rule out any other possible vascular conditions.
Pre-arrange for transportation to and from your procedure facility with a family member or friend. Due to the sedation used, it is highly recommended that you avoid operating any motor vehicle for at least 24 hours after your procedure.
You should be fasting for at least 12 hours prior to your procedure. Please inform the nursing team at your facility if you have forgotten to do so.
Postoperative instructions
Refrain from any heavy lifting (i.e. no more than 10 pounts), straining, pushing or impact exercises (i.e. running, jogging, cycling) for the first 3 days. You may walk, climb steps and even drive, so long as you do not have excessive bruising, swelling or pain at the puncture site.
You will be discharged with a dressing over the puncture site. This may be removed the next morning. Please inspect the puncture site daily for the first few days and notify us for any significant changes. Bruising around the area may be present. If you notice bleeding, swelling, or increase in bruising apply constant direct pressure over the area and seek medical attention IMMEDIATELY.
Refrain from soaking in a bathtub or hot-tub or pool until puncture is healed.
Follow-up Visit and Routine Surveillance
Routine follow-up for surveillance is vital after your procedure to detect short and long-term complications early. Center for Vascular Medicine recommends follow-up post-operatively at approximately 1 week, 6 weeks, 3 months, 6 months, 1 year, and then once every year further. Every other visit should involve ultrasonography unless otherwise indicated by your vascular specialist.
Venous Stenting FAQ
Most patients can return to work a few days after their procedure. Recovery is generally very quick and you should be able to leave the procedure facility within the same day.
Stents are designed to be permanently placed. In extenuating circumstances, stents can be surgically removed, but this is difficult and often reserved.
Placement of the stent itself should only result in mild discomfort that subsides quickly. Many patients report moderate to severe backpain in 1-2 weeks post-procedure. Pain or other anti-inflammatory medication can be prescribed to manage this discomfort.
You may shower within 24 hours of your procedure. We ask that you refrain from soaking in a bathtub, hot-tub or pool until the puncture site is healed.
Please call our office immediately if you notice any of the following signs or symptoms:
- Increase swelling or bleeding at the puncture site.
- Increased bruising down the leg or by the abdomen.
- Painful, cold leg or foot with or without discoloration.
- Increasing low back, abdominal, or leg pain.