Patient Information for patients undergoing deep venous intervention (stenting)

Introduction

Stents are metal tubes that placed to open narrowed or blocked veins in the top of the leg, pelvis, or abdomen. This is done using x-rays to guide where the stents should be placed. Problems with the deep veins in the leg can cause symptoms including leg swelling, heaviness, pain on walking and wounds on the lower legs (called ulcers). Treatment with stents aims to improve the flow of blood out of the leg and to improve these symptoms.

The main cause of poor flow through the deep veins is damage after a deep vein thrombosis (blood clot), scarring to the vein due to a previous line or procedure, or occasionally when the vein is narrowed or pinched by surrounding structures.

This leaflet provides information about the treatment of deep vein narrowing or blockages, including aftercare.

What does the procedure involve?

The anaesthetic

This procedure can be performed under either general anaesthetic (fully asleep) or local anaesthetic (awake with numbing injections) with perhaps some sedation (to make you drowsy). Your surgeon and/or anaesthetist will guide you to the best option for you, but it does depend on a few factors such as the size and number of stents to be placed and your other health conditions.

The operation

This procedure takes place in an x-ray operating theatre. Often calf-muscle pumps will be placed around the calves to gently squeeze the leg and keep the blood flowing from the leg during your procedure. You will also be given some blood thinning medication during the procedure.

Local anaesthetic is used to numb the skin if you are awake. Using a small cut and needle, a wire will be passed into a suitable vein, either from behind the knee, middle of the thigh or from the side of the neck, or a combination of these options. Pictures are taken of the veins by injecting dye (contrast) into the veins. These can make you feel warm or flushed if awake, this is normal and nothing to be concerned about.

Using X-ray guidance, a wire will be used to get across the narrowed or blocked vein. After this the vein can be stretched with a balloon which is then removed and then a stent (metal tube) can be inserted. Pictures are taken at the end to check that the vein has successfully opened. Stretching the vein and placing a stent can be uncomfortable if you are having this performed whilst you are awake, if needed you will be given painkillers to help with this.

At the end of the procedure, the wires will be removed, with pressure to the needle points and glue or a stitch to the skin.

Recovery and aftercare

After the procedure, you will be taken to the recovery area and then the ward. Sometimes, these procedures are day-cases, but can involve an overnight stay in hospital (this will be explained to you before the procedure).

Calf pumps will remain on until you are able to walk which will be soon after the procedure. You will be encouraged to drink plenty of water and be given some early blood thinning medications.

On discharge home you should try to walk around regularly, keep drinking plenty of water and take the regular blood thinning medication prescribed. Most patients who have a stent placed will require ongoing scans (ultrasound) to ensure the stent continues to work well.

How successful is this procedure?

Stents are successful in four out of every five people that have them placed (75-80%), although Sometimes (in around a quarter of patients) a repeat or further procedure is required to improve the flow of blood. If stenting is successful, this usually means that there will be an improvement in your symptoms. This can be a gradual process and your treating team will discuss this with you.

If you had a DVT that caused damaged to the veins in the lower leg as well as the upper leg/pelvis, some of the symptoms may not change as the lower leg veins are not treated.

Do I have to take blood thinners after the procedure?

Blood thinner injections and/or tablets are very important after the procedure to reduce the chance of clots or blockages forming. Sometimes, these may be altered of stopped but your treating team will advise you on this, with input from a blood clotting specialist (Haematologist). Information is available from these teams for advice regarding sport and lifestyle whilst being on a blood thinner.

Will I have any scans after the procedure?

Yes, monitoring the stent with regular ultrasound (‘jelly’) scans is important and sometimes maintenance procedure (re-balloon stretching or similar) is required.

Do I need to wear stockings after the procedure?

After your stenting procedure you will be typically advised to wear a stocking during the day for a few weeks following the procedure. These will help with venous blood flow. You may not be required to wear stockings in the long-term, but some patients prefer to help with symptoms.

If you have a wound or ulcer, then you will need to follow the specific guidelines by your treating team. This is often compression bandaging. Your treating team will advise you.

Are there any risks with the procedure?

There are potential risks with any procedure. The overall risks are very low. These are in groups below.

At the puncture/needle site:

Some bruising is common after the puncture to the vein.

It is very rare for any significant bleeding after these procedures.

Related to the contrast (dye):

Some patients experience an allergic reaction to the contrast, but this is very rare (1 in 3000).

Any procedure involving X-ray and dye can affect the kidney function (particularly in patients with kidney disease), but this usually recovers quickly. There is a 1 in 100 of permanent damage.

Staying well hydrated and precautions such as stopping metformin if diabetic can help reduce the chances of kidney problems.

Related to the treatment:

• Stenting can sometimes cause back pain, but this usually settles with time and simple pain killers.
• There is a very small chance of internal bleeding, damage to the veins being treated and a very small chance of clots travelling to the lungs (pulmonary embolus) at the time of treatment.

Unfortunately, despite our best efforts, there is occasionally the chance that a definitive procedure may not be possible at the time of your initial procedure, or that there is a problem afterwards with the flow of blood through the new stent. Sometimes this requires a ‘re-do’ of the procedure and sometimes there are no further options. If this is the case your previous symptoms will remain, but your doctor and team will talk you through this.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart

Contacts/further information

Do feel free to contact the Cambridge Vascular Unit vascular specialist nurses on 01223 596382 or email the vascular nurses if you have any questions or anxieties.

References/sources of evidence

• The Vascular Society website (opens in a new tab)
• The Circulation Foundation website (opens in a new tab)