Venous

You have two chambers on the left side of your heart: your left atrium and your left ventricle. Your mitral valve, which is located between the two, is designed to allow blood to flow into the left ventricle but blocked from flowing back into the left atrium.

Venous

You have two chambers on the left side of your heart: your left atrium and your left ventricle. Your mitral valve, which is located between the two, is designed to allow blood to flow into the left ventricle but blocked from flowing back into the left atrium.
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Venous

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Venous

You have two chambers on the left side of your heart: your left atrium and your left ventricle. Your mitral valve, which is located between the two, is designed to allow blood to flow into the left ventricle but blocked from flowing back into the left atrium.

Venous cardiac problems occur when your leg veins don’t allow blood to flow back up to your heart. Normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don’t work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs.
Non-Invasive Services
Venous Doppler Ultrasound
A Doppler ultrasound is a non-invasive test that can be used to estimate the blood flow through your blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can’t show blood flow.

A Doppler ultrasound may help diagnose many conditions, including:

  • Blood clots
  • Poorly functioning valves in your leg veins, which can cause blood or other fluids to pool in your legs (venous insufficiency)
  • Heart valve defects and congenital heart disease
  • A blocked artery (arterial occlusion)
  • Decreased blood circulation into your legs (peripheral artery disease)
  • Bulging arteries (aneurysms)
  • Narrowing of an artery, such as in your neck (carotid artery stenosis)

A Doppler ultrasound can estimate how fast blood flows by measuring the rate of change in its pitch (frequency). During a Doppler ultrasound, a technician trained in ultrasound imaging (sonographer) presses a small hand-held device (transducer), about the size of a bar of soap, against your skin over the area of your body being examined, moving from one area to another as necessary.

This test may be done as an alternative to more-invasive procedures, such as angiography, which involves injecting dye into the blood vessels so that they show up clearly on X-ray images.

A Doppler ultrasound test may also help your doctor check for injuries to your arteries or to monitor certain treatments to your veins and arteries.
Chronic Venous Insufficiency
Chronic venous insufficiency (CVI) occurs due to inadequate functioning of venous wall and/or valves in lower limb veins resulting in excessive pooling of blood.

Pathology

The condition results from venous hypertension which in turn is usually caused by reflux in the superficial venous compartment. Less common causes include:

  • deep venous compression
  • post-thrombotic stenosis or occlusion
  • deep venous reflux
  • venous hypertension caused by vascular malformations, arteriovenous fistulae, and neuromuscular disorders (rare)

Radiographic features

Plain radiograph

Findings are nonspecific but most commonly are seen in the leg 5,6:

  • solid undulating periosteal reaction, often symmetrical
  • dystrophic soft tissue calcification
  • varicose vein phleboliths
  • soft tissue swelling from subcutaneous edema

Ultrasound

Venous Doppler ultrasound

Considered the primary imaging modality of choice. Typically the great saphenous vein and the small saphenous vein and their primary tributaries are assessed.
The presence of reflux is determined by the direction of flow because any significant flow toward the feet is suggestive of reflux. The duration of reflux is known as the “reflux time” (replacing the commonly used “valve closure time”):

  • a reflux time of > 0.5 (or 1.0 according to some publications) second has been used to suggest the presence of reflux, although a more refined definition with a variable “cutoff” based on location has been suggested
  • the longer the duration of reflux or the greater the reflux time implies more severe disease

Venous duplex imaging may provide information about local valve function to construct an anatomic map of disease in terms of the systems and levels of involvement.
The presence and location of perforators are also documented. The patient should be able to stand for this procedure.

CT Venograms

A venogram is a test that lets your healthcare provider see the veins in your body, especially in your legs. A special dye is injected that can be seen on an X-ray. The dye lets your healthcare provider see your veins and how healthy they are.

A venogram is used to diagnose deep vein thrombosis (DVT) or other abnormalities of your veins. This test can also help your healthcare provider diagnose other health problems.

A venogram can be done in several ways:

  • Ascending venography. This looks for a DVT and finds out where it is in your vein.
  • Descending venography. This looks at how well your deep vein valves are working.
  • Venography of the upper extremities. This looks for blockages, blood clots, or other vascular problems in your neck and armpits.
  • Venacavography. This looks at your inferior or superior vena cava. The vena cava is the vein that brings blood to your heart. The healthcare provider looks for blockages or other problems.

X-rays use a small amount of radiation to create images of your bones and internal organs. X-rays are often used to detect bone or joint problems, or to check the heart and lungs. A venogram is one type of X-ray.

Why might I need a venogram?

A venogram is used to confirm a diagnosis of DVT. It is also used to tell if a vein problem is a blood clot or another kind of blockage. It can be used to look at vein problems present at birth (congenital) or to find a vein for bypass graft surgery. It may be used to find out what is causing swelling or pain in a leg. It can also be used to find out where a blood clot started that has traveled to a lung (pulmonary embolism).

What are the risks of a venogram?

A venogram is done with X-rays. These use a small amount of radiation. Talk with your healthcare provider about the amount of radiation used and any risks that apply to you.
Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if you are pregnant or think you may be pregnant. Radiation exposure during pregnancy may lead to birth defects.

Because contrast dye is used, there is a risk for allergic reaction to the dye. Tell your healthcare provider if you are allergic to or sensitive to any medicines, contrast dye, or iodine.
Tell your provider if you have:

  • Kidney failure or other kidney problems. In some cases, the contrast dye can cause kidney failure, especially if you are taking certain diabetes medicines.
  • A bleeding disorder or are taking blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting.

You may not be able to have a venogram if you are allergic to the contrast dye, or have severe congestive heart failure or severe pulmonary hypertension.

You may have other risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

Some things may make your venogram less accurate. These include:

  • Moving your leg during the procedure
  • Extreme obesity
  • Severe swelling in your legs

How do I get ready for a venogram?

  • Your healthcare provider will explain the procedure to you. Ask him or her any questions you have about the procedure.
  • You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • Tell your healthcare provider if you have ever had a reaction to any contrast dye. Tell your provider if you are allergic to iodine.
  • Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).
  • You may be asked to stop eating and drinking for at least 4 hours before the test.
  • Tell your provider if you are pregnant or think you may be pregnant.
  • Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.
  • Tell your provider if you have a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.
  • You will need to have someone drive you home after the test if the healthcare provider gives you medicine to relax (sedative) during the test.
  • Follow any other instructions your provider gives you to get ready.

What happens during a venogram?

You may have the venogram done as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider’s practices.
Generally, a lower leg venogram follows this process:

  • You will be asked to remove your jewelry or other objects that might get in the way of the test.
  • You will be asked to remove clothing. You will be given a gown to wear.
  • The healthcare provider may use a pen to mark places on your leg where pulses are before the test. This will make it easier for the medical team to check the pulses after the test.
  • You will lie on your back on the X-ray table.
  • The healthcare provider will clean an area on your foot. Then he or she will put an intravenous (IV) line into a vein in your foot.
  • The healthcare provider will inject the contrast dye. You may feel some effects when the dye is added to the IV line. These effects include a flushing sensation, a brief headache, nausea, or vomiting. These effects usually last for a few moments. Let the healthcare provider know if you are having problems breathing, itchy skin, or hives.
  • The healthcare provider will take X-rays at timed intervals as the dye moves through your legs.
  • The healthcare provider may use a tourniquet on your leg to control how fast the blood flows.
  • When the test is done, the healthcare provider will flush the IV site, and remove the needle from the vein.
  • The healthcare provider will put a pressure dressing over the puncture site.

What happens after a venogram?

After the procedure, the medical team will watch your heart rate, breathing rate, and blood pressure. They will also check the pulses in your feet, as well as the temperature, color, and sensation in your legs. They will watch the injection site for redness, warmth, swelling, and tenderness.

You can go back to your normal activities and diet as directed by your healthcare provider.
Drink plenty of fluids to keep from getting dehydrated. This will also help the contrast dye to leave your body.

Call your healthcare provider right away if you have any of these:

  • Fever of 100.4°F (38.0°C) or higher or chills
  • Pain, redness, or swelling at the injection site
  • Bleeding or other drainage from the injection site

Your healthcare provider may give you additional instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Invasive Services

Endovenous Laser Treatment

Endovenous laser varicose vein surgery is a procedure that uses heat from a laser to reduce varicose veins. Varicose veins are swollen, bulging veins that often happen on the thighs or calves. A laser is a device that sends a thin beam of radiation in the form of light.

Laser surgery closes and shrinks the varicose vein and causes scar tissue within the vessel. This seals off the vein. Blood then flows through other nearby veins instead.

Why might I need endovenous laser varicose vein surgery?

Your healthcare provider may suggest laser surgery if your varicose veins are sore, or red and swollen (inflamed). Laser surgery may also be recommended if the skin over your varicose veins is irritated.

Varicose veins are not usually a serious health problem, but they can be painful. You may also not like how they look.

What are the risks of endovenous laser varicose vein surgery?

All surgeries have some risks. Some possible risks of laser varicose vein surgery include:

  • Infection
  • Pain over the vein
  • Bleeding
  • Bruising
  • Nerve damage
  • Redness or swelling (inflammation) of the vein
  • Blood clots
  • Changes in skin color over the treated vein
  • Burns

You may have other risks, depending on your general health. Be sure to talk with your healthcare provider about any concerns you have before your surgery.

How do I get ready for endovenous laser varicose vein surgery?

  • Your healthcare provider will explain the procedure to you. Ask him or her any questions you have about the procedure.
  • You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • Your healthcare provider will ask questions about your health history. He or she may also give you a physical exam. This is to make sure you are in good health before the procedure. You may also need blood tests and other diagnostic tests.
  • Tell your healthcare provider if you have a history of bleeding disorders. Let your healthcare provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
  • Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, tape, contrast dyes, and anesthesia medicines (local and general).
  • Tell your healthcare provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
  • You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.
  • You may have medicine to help you relax (sedative).
  • Arrange to have someone to drive you home after the procedure.

Your healthcare provider may have other instructions for you.

What happens during endovenous laser varicose vein surgery?

This procedure doesn’t require a hospital stay. It may be done in your healthcare provider’s office. The procedure usually takes less than an hour. You can likely go home the same day. Bring loose-fitting clothing to wear right after your surgery.
Generally, endovenous laser varicose vein surgery follows this process:

  • You’ll change into a hospital gown and lie down on an exam table. The table may be tilted in different positions during the procedure. You may be given special goggles or eye glasses to wear during the surgery. This is to protect your eyes from the laser light.
  • Your healthcare provider will numb the area where the tube or catheter will be put into your vein. Your healthcare provider will also give you a shot or injection of numbing medicine along the length of the vein that will be treated.
  • Your healthcare provider will use a Doppler ultrasound device to check the vein before and during the procedure. This process uses sound waves to make an image of the vein on a computer screen.
  • Your healthcare provider will make a small cut or incision in your skin and insert the catheter. It will be guided into the varicose vein. A laser fiber will be put into the catheter. As your healthcare provider slowly pulls out the catheter, the laser will heat up the length of the vein. The vein will close up and should eventually shrink.

The procedure usually takes less than an hour. The cut where the catheter was inserted will likely be small enough that you won’t need stitches. A bandage will be put on the site.

What happens after endovenous laser varicose vein surgery?

You will be encouraged to walk right after the procedure, for about 30 to 60 minutes.

Your leg may have some bruising. The bruises should go away in about 2 weeks.

You’ll need to have someone drive you home after your surgery.
At home
After you go home, be sure to follow any instructions from your provider. You may be told to:

  • Put an ice pack over the area for 15 minutes at a time, to help reduce swelling.
  • Check the incision sites every day. It’s normal to see light pink fluid on the bandage.
  • Keep the incision sites out of water for 48 hours. You may need to take a sponge bath until the bandages are removed.
  • Wear compression stockings for a few days or weeks, if advised. These stockings gently squeeze your legs. This helps to prevent swelling in your legs. It can also help stop your blood from clotting or pooling.
  • Not sit or lie down for long periods of time. Keep your leg raised when sitting.
  • Not stand for long periods of time.
  • Walk about 3 times a day for 10 to 20 minutes each time. Do this for 1 to 2 weeks.
  • Keep active, but don’t run, jump, or lift heavy things for 1 to 2 weeks.
  • Not take hot baths for 1 to 2 weeks.

When it comes to medicine, be sure to:

  • Take over-the-counter pain medicine as needed, and only if advised by your healthcare provider. Some medicines can increase bleeding.
  • Ask your healthcare provider when it will be safe to take blood-thinning medicine again, if you stopped taking it for the surgery

Your healthcare provider may want to give you an exam at a follow-up visit. He or she may use ultrasound to make sure the laser procedure worked.

Call your healthcare provider if you have:

  • Signs of infection in the treated area. These include redness, warmth, or fluid leaking from the incision.
  • Swelling that gets worse, or new swelling
  • Any pain that keeps you from doing your normal activities

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Radiofrequency Ablation

Radiofrequency ablation uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals.

Needles inserted through your skin near the painful area deliver the radio waves to the targeted nerves. Your doctor will use imaging scans during radiofrequency neurotomy to make sure the needles are positioned properly.

Radiofrequency neurotomy is most commonly used for pain in the back, neck and buttocks (sacroiliac joint). It may also be helpful for long-term knee or hip joint pain.

Why it’s done

Radiofrequency neurotomy is usually done by a doctor who specializes in treating pain. The goal is to reduce chronic back, neck, hip or knee pain that hasn’t improved with medications or physical therapy, or when surgery isn’t an option.
For example, your doctor may suggest the procedure if you have back pain that:

  • Occurs on one or both sides of your lower back
  • Spreads to the buttocks and thighs (but not below the knee)
  • Feels worse if you twist or lift something
  • Feels better when you’re lying down

Radiofrequency neurotomy might also be recommended to treat neck pain associated with whiplash.

Risks

Common side effects include:

  • Temporary numbness
  • Temporary pain at the procedure site

Rarely, more-serious complications may occur, including:

    • Bleeding
    • Infection
    • Nerve damage

How you prepare

To determine if you’re a good candidate for radiofrequency neurotomy, your doctor may refer you to a pain specialist or order more tests. For example, a test may be done to see if the nerves commonly targeted by the procedure are the same nerves responsible for your pain. A small amount of numbing medication is injected into the precise spots where the radiofrequency needles will go. If your pain significantly lessens, radiofrequency treatment at those spots may help you.

However, the doctor may determine a different procedure is needed to help your specific symptoms.

What you can expect

Before radiofrequency neurotomy

Let your doctor know if you take blood-thinning medications. You may need to stop taking them for a period of time before the procedure.

Follow these steps:

      • Arrange for someone to drive you home.
      • Swallow any necessary medications with clear liquids only and take them as early in the day as possible. Don’t take medications within two hours of your surgery.
      • Don’t smoke or use any tobacco products the day of your procedure.

During radiofrequency neurotomy

Radiofrequency neurotomy is an outpatient procedure, so you’ll go home later that same day.
You’ll wear a hospital gown and lie on your stomach on an X-ray table. An intravenous (IV) line will be placed in your arm or hand to deliver medication that will keep you comfortable during the procedure. Numbing medication will be injected into your skin before the radiofrequency needles are inserted.

The doctor will then use a special X-ray machine (fluoroscope) to guide the radiofrequency needles to the precise area — so only the targeted nerve tissue will be treated.

After radiofrequency neurotomy

You’ll be taken to another room to rest until you feel ready to go home. You might notice some soreness in the area where the needles were inserted, but this usually goes away in a day or two.

When you get home:

      • Use an ice pack on the injection sites if you have discomfort. Place the pack on the sore spot for 20 minutes, three or four times a day, during the first day of your recovery.
      • Don’t use a heating pad on the injection sites.
      • Avoid baths for two days. You may take a warm shower 24 hours after your procedure.

Results

Radiofrequency neurotomy isn’t a permanent fix for back or neck pain.

Studies on the success of treatment have been conflicting. Some people may have modest, short-term pain relief, while others might feel better for several months. Sometimes, the treatment does not improve pain or function at all.

For the treatment to work and for you to feel better, it’s important that the nerves targeted by the procedure are the same nerves responsible for your pain.

Venograms

A venogram is a test that lets your healthcare provider see the veins in your body, especially in your legs. A special dye is injected that can be seen on an X-ray. The dye lets your healthcare provider see your veins and how healthy they are.

A venogram is used to diagnose deep vein thrombosis (DVT) or other abnormalities of your veins. This test can also help your healthcare provider diagnose other health problems.

A venogram can be done in several ways:

      • Ascending venography. This looks for a DVT and finds out where it is in your vein.
      • Descending venography. This looks at how well your deep vein valves are working.
      • Venography of the upper extremities. This looks for blockages, blood clots, or other vascular problems in your neck and armpits.
      • Venacavography. This looks at your inferior or superior vena cava. The vena cava is the vein that brings blood to your heart. The healthcare provider looks for blockages or other problems.

X-rays use a small amount of radiation to create images of your bones and internal organs. X-rays are often used to detect bone or joint problems, or to check the heart and lungs. A venogram is one type of X-ray.

Why might I need a venogram?

A venogram is used to confirm a diagnosis of DVT. It is also used to tell if a vein problem is a blood clot or another kind of blockage. It can be used to look at vein problems present at birth (congenital) or to find a vein for bypass graft surgery. It may be used to find out what is causing swelling or pain in a leg. It can also be used to find out where a blood clot started that has traveled to a lung (pulmonary embolism).

What are the risks of a venogram?

A venogram is done with X-rays. These use a small amount of radiation. Talk with your healthcare provider about the amount of radiation used and any risks that apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if you are pregnant or think you may be pregnant. Radiation exposure during pregnancy may lead to birth defects.

Because contrast dye is used, there is a risk for allergic reaction to the dye. Tell your healthcare provider if you are allergic to or sensitive to any medicines, contrast dye, or iodine.
Tell your provider if you have:

      • Kidney failure or other kidney problems. In some cases, the contrast dye can cause kidney failure, especially if you are taking certain diabetes medicines.
      • A bleeding disorder or are taking blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting.

You may not be able to have a venogram if you are allergic to the contrast dye, or have severe congestive heart failure or severe pulmonary hypertension.

You may have other risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

Some things may make your venogram less accurate. These include:

      • Moving your leg during the procedure
      • Extreme obesity
      • Severe swelling in your legs

How do I get ready for a venogram?

      • Your healthcare provider will explain the procedure to you. Ask him or her any questions you have about the procedure.
      • You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
      • Tell your healthcare provider if you have ever had a reaction to any contrast dye. Tell your provider if you are allergic to iodine.
      • Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).
      • You may be asked to stop eating and drinking for at least 4 hours before the test.
      • Tell your provider if you are pregnant or think you may be pregnant.
      • Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.
      • Tell your provider if you have a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.
      • You will need to have someone drive you home after the test if the healthcare provider gives you medicine to relax (sedative) during the test.
      • Follow any other instructions your provider gives you to get ready.

What happens during a venogram?

You may have the venogram done as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider’s practices.

Generally, a lower leg venogram follows this process:

        • You will be asked to remove your jewelry or other objects that might get in the way of the test.
        • You will be asked to remove clothing. You will be given a gown to wear.
        • The healthcare provider may use a pen to mark places on your leg where pulses are before the test. This will make it easier for the medical team to check the pulses after the test.
        • You will lie on your back on the X-ray table.
        • The healthcare provider will clean an area on your foot. Then he or she will put an intravenous (IV) line into a vein in your foot.
        • The healthcare provider will inject the contrast dye. You may feel some effects when the dye is added to the IV line. These effects include a flushing sensation, a brief headache, nausea, or vomiting. These effects usually last for a few moments. Let the healthcare provider know if you are having problems breathing, itchy skin, or hives.
        • The healthcare provider will take X-rays at timed intervals as the dye moves through your legs.
        • The healthcare provider may use a tourniquet on your leg to control how fast the blood flows.
        • When the test is done, the healthcare provider will flush the IV site, and remove the needle from the vein.
        • The healthcare provider will put a pressure dressing over the puncture site.

What happens after a venogram?

After the procedure, the medical team will watch your heart rate, breathing rate, and blood pressure. They will also check the pulses in your feet, as well as the temperature, color, and sensation in your legs. They will watch the injection site for redness, warmth, swelling, and tenderness.

You can go back to your normal activities and diet as directed by your healthcare provider.
Drink plenty of fluids to keep from getting dehydrated. This will also help the contrast dye to leave your body.

Call your healthcare provider right away if you have any of these:

        • Fever of 100.4°F (38.0°C) or higher or chills
        • Pain, redness, or swelling at the injection site
        • Bleeding or other drainage from the injection site

Your healthcare provider may give you additional instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

        • The name of the test or procedure
        • The reason you are having the test or procedure
        • What results to expect and what they mean
        • The risks and benefits of the test or procedure
        • What the possible side effects or complications are
        • When and where you are to have the test or procedure
        • Who will do the test or procedure and what that person’s qualifications are
        • What would happen if you did not have the test or procedure
        • Any alternative tests or procedures to think about
        • When and how will you get the results
        • Who to call after the test or procedure if you have questions or problems
        • How much will you have to pay for the test or procedure

Venous DVT Lysis

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms.

Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. It can also happen if you don’t move for a long time, such as after surgery or an accident, or when you’re confined to bed.

Deep vein thrombosis can be very serious because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism).

Symptoms

Deep vein thrombosis signs and symptoms can include:
Swelling in the affected leg. Rarely, there’s swelling in both legs.

  • Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness.
  • Red or discolored skin on the leg.
  • A feeling of warmth in the affected leg.

Deep vein thrombosis can occur without noticeable symptoms.

When to see a doctor

If you develop signs or symptoms of deep vein thrombosis, contact your doctor.
If you develop signs or symptoms of a pulmonary embolism — a life-threatening complication of deep vein thrombosis — seek immediate medical attention.

The warning signs and symptoms of a pulmonary embolism include:

  • Sudden shortness of breath
  • Chest pain or discomfort that worsens when you take a deep breath or when you cough
  • Feeling lightheaded or dizzy, or fainting
  • Rapid pulse
  • Coughing up blood

Causes

The blood clots of deep vein thrombosis can be caused by anything that prevents your blood from circulating or clotting normally, such as injury to a vein, surgery, certain medications and limited movement.

Risk factors

Many factors can increase your risk of developing deep vein thrombosis (DVT). The more you have, the greater your risk of DVT. Risk factors include:

  • Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors.
  • Prolonged bed rest, such as during a long hospital stay, or paralysis. When your legs remain still for long periods, your calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
  • Injury or surgery. Injury to your veins or surgery can increase the risk of blood clots.
  • Pregnancy. Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after you have your baby.
  • Birth control pills (oral contraceptives) or hormone replacement therapy. Both can increase your blood’s ability to clot.
  • Being overweight or obese. Being overweight increases the pressure in the veins in your pelvis and legs.
  • Smoking. Smoking affects blood clotting and circulation, which can increase your risk of DVT.
  • Cancer. Some forms of cancer increase substances in your blood that cause your blood to clot. Some forms of cancer treatment also increase the risk of blood clots.
  • Heart failure. This increases your risk of DVT and pulmonary embolism. Because people with heart failure have limited heart and lung function, the symptoms caused by even a small pulmonary embolism are more noticeable.
  • Inflammatory bowel disease. Bowel diseases, such as Crohn’s disease or ulcerative colitis, increase the risk of DVT.
  • A personal or family history of deep vein thrombosis or pulmonary embolism. If you or someone in your family has had one or both of these, you might be at greater risk of developing a DVT.
  • Age. Being older than 60 increases your risk of DVT, though it can occur at any age.
  • Sitting for long periods of time, such as when driving or flying. When your legs remain still for hours, your calf muscles don’t contract, which normally helps blood circulate. Blood clots can form in the calves of your legs if your calf muscles don’t move for long periods.

Complications

Pulmonary embolism

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A serious complication associated with deep vein thrombosis is pulmonary embolism.

Pulmonary embolism

A pulmonary embolism occurs when a blood vessel in your lung becomes blocked by a blood clot (thrombus) that travels to your lung from another part of your body, usually your leg.
A pulmonary embolism can be life-threatening. It’s important to watch for signs and symptoms of a pulmonary embolism and seek medical attention if they occur. Signs and symptoms of a pulmonary embolism include:

  • Sudden shortness of breath
  • Chest pain or discomfort that worsens when you take a deep breath or when you cough
  • Feeling lightheaded or dizzy, or fainting
  • Rapid pulse
  • Coughing up blood

Postphlebitic syndrome

A common complication that can occur after deep vein thrombosis is known as postphlebitic syndrome, also called postthrombotic syndrome. Damage to your veins from the blood clot reduces blood flow in the affected areas, which can cause:

  • Persistent swelling of your legs (edema)
  • Leg pain
  • Skin discoloration
  • Skin sores

Prevention

Measures to prevent deep vein thrombosis include:

    • Avoid sitting still. If you have had surgery or have been on bed rest for other reasons, try to get moving as soon as possible. If you’re sitting for a while, don’t cross your legs, which can hamper blood flow. If you’re traveling a long distance by car, stop every hour or so and walk around.
      If you’re on a plane, stand or walk occasionally. If you can’t do that, exercise your lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes with your heels are on the floor.
    • Make lifestyle changes. Lose weight and quit smoking.
    • Exercise. Regular exercise lowers your risk of blood clots, which is especially important for people who sit a lot or travel frequently.

Large Venous PTA/Stent

What are Venous Stents?

Most people are familiar with coronary stents placed in the arteries of the heart to improve blood flow. Venous stents function in the same way.
Venous stents are metal mesh tubes that expand against blocked or narrowed vein walls. They act as a scaffold to keep veins open. In most cases, surgeons place venous stents in larger, central veins, such as those found in the:

  • Legs
  • Chest
  • Abdomen

Conditions We Treat with Venous Stents

Venous stents can help people with chronic blood clots or other conditions that compress or narrow the veins, limiting blood flow.
At the UPMC Heart and Vascular Institute, we use venous stents to treat conditions such as:

  • Chronic deep vein thrombosis (DVT): DVT is a blood clot in one of the large, deep veins that returns blood from the leg — or less commonly, from the arm — to the heart and lungs.
  • Post-thrombotic syndrome: DVT can damage veins, which can lead to symptoms such as chronic swelling and pain. People may not suffer from symptoms of post-thrombotic syndrome until years after DVT.
  • May-Thurner syndrome: In this condition, the artery that runs from your abdomen to your right leg — called the right iliac artery — presses against the left iliac vein, causing it to narrow and scar, leading to chronic left leg swelling, pain, and sometimes fatigue.
  • Nutcracker syndrome: In this condition, the arteries near the kidney compress the left renal (kidney) vein, making blood flow backward and causing symptoms like flank pain and blood in urine.
  • Hemodialysis/arteriovenous fistulae: People who receive hemodialysis and whose grafts or fistulas experience decreased blood flow can sometimes benefit from venous stents. Stenting also opens the central veins in the chest, which helps drain for dialysis access.

Before Your Venous Stent Procedure

In addition to taking your medical history and performing a physical exam, your UPMC vascular surgeon may order imaging or other tests.

Ultrasound

The most common imaging test — duplex ultrasound — uses high-frequency sound waves to create images of your blood vessels and measures the direction and speed of blood flowing through your veins. Ultrasound gives your doctor a clear picture of the structure of your blood vessels and helps to pinpoint the exact location of any narrowing or blockage.

Venogram

Sometimes, ultrasound may not be effective because of the location of the vein. In this case, your vascular surgeon may suggest a venogram.

A venogram is an x-ray that allows your doctor to see the anatomy of your veins.

After inserting a catheter (thin, flexible tube) into a vein — most often in the leg — your doctor injects a contrast dye into the catheter, which allows your veins to be seen on the x-ray.

Your vascular surgeon can use the venogram to diagnose and treat your condition by performing venous angioplasty and stent placement at the same time if indicated.

What To Expect During Venous Stenting

Your UPMC vascular surgeon can place most venous stents on an outpatient basis, under moderate sedation.

If a clot or other obstruction is blocking the vein, your surgeon may first perform angioplasty before placing the stent.

During venous angioplasty, your vascular surgeon will:

      • Insert a needle into a vein in your groin or behind your knee, depending on which vein needs stenting.
      • Insert a guide wire and pass a catheter sheath over it, followed by a guide catheter through the sheath.
      • Use x-ray guidance (fluoroscopy) to steer the catheter to the site of the narrowing.
      • Advance a balloon-tipped catheter to the site of the narrowing.
      • Inflate and deflate the balloon several times to widen the narrow vein.

To place a venous stent, your surgeon will:

      • Remove the angioplasty balloon and insert a catheter with a closed stent on it.
      • Place the stent in the vein. The stent pushes against the walls of the vein, serving as a support to keep it open.
      • Remove the catheters and apply pressure to the insertion point to close the wound.

In most cases, people who undergo venous stenting go home the same day.
To prevent blood clots from developing, most people must take clopidogrel (Plavix) for a few months.

Why Choose UPMC for Venous Stenting?

At the UPMC Heart and Vascular Institute, we are experts at venous stenting. Many of our surgeons are leading experts in the diagnosis and treatment of conditions requiring the use of a venous stent.

If venous stenting isn’t the best option for you, we will recommend other treatments that are more appropriate for your individual circumstances.

Category
Venous
Type of service
Surgery
Cost of service
Starting from $2800

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