Specialties

  • Venous Reconstruction

  • Venous reconstruction is a surgical procedure to reconstruct a weakened or damaged vein. The procedure is most often used to treat venous insufficiency, a chronic condition in which a vein has problems sending blood from the legs to the heart. The problem arises as a result of a weakened vein wall or leaking valves. Over time venous insufficiency may lead to a potentially life-threatening condition called deep vein thrombosis (DVT).

    DVT is a blood clot (thrombus) that forms in a large, deep vein, usually in your lower leg, thigh, or pelvis. This blood clot can break off and travel through the blood stream. If the loose clot (embolism) travels to your lungs, brain or heart, it can cause serious damage or death. For this reason, if you suffer from chronic, serious venous insufficiency or chronic DVT, your doctor may recommend venous reconstruction to address the underlying cause.

     In addition to DVT, venous insufficiency can lead to ulcers within the veins. Most ulcers heal quickly after superficial vein surgery, but if the ulcers are deep within the vein, treatment to correct the insufficiency may be recommended. To reconstruct a faulty valve causing venous insufficiency, your radiologist uses advanced X-ray imaging technology to maneuver a tiny (catheter) tube outfitted with surgical tools through a small incision in the vein near the damaged or weakened valve.

    Several techniques exist to reconstruct ineffective valves, including suturing a fold into the external wall of the vein or wrapping it in a sleeve or band. Both procedures are performed to decrease the diameter of the vein to improve venous flow. Venous reconstruction may require an overnight stay in the hospital, although some patients return home the same day.

    Before venous reconstruction became available, venous insufficiency treatment focused primarily on lifestyle changes, such as wearing compression stockings, not sitting for long periods, quitting smoking, and losing weight.

    Risk factors for venous insufficiency may include:

    • Age sixty and above
    • Obesity
    • Sitting, standing, or bed rest for extended periods
    • Pregnancy
    • Female (related to the hormone progesterone)
    • Being tall
    • Recent surgery
    • History of DVT or venous insufficiency


    Symptoms of venous insufficiency may include:

    • Cramping in legs, dull aching legs
    • Itching and tingling
    • Slow healing wound on the legs or ankles
    • Thick, hard skin on the legs and ankles
    • Red legs and ankles
    • Pain exacerbated by standing
    • Pain improves when legs are raised
    • Swollen legs and ankles (edema)
    • Skin color changes around the ankles
    • Varicose veins
    • Ulcers on legs and ankles


    Diagnosis of Venous Insufficiency:

    To diagnose venous insufficiency, your doctor will ask about your symptoms and take a detailed medical history. He or she will also perform a physical exam to look at your leg veins when you are standing and sitting with your legs dangling. A duplex ultrasound exam of your leg may also be recommended to check blood flow in the veins and rule out other problems, such as a blood clot.

    Deep Vein Thrombosis Clots

    Before venous reconstruction became available, anticoagulants (blood thinners) were often the standard of care for people with deep vein thrombosis (DVT). Blood thinners gradually dissolve the clot but don’t get rid of it completely. In the case of chronic, serious blood clots, your doctor may recommend venous reconstruction to completely remove the clot and repair the vein at the surgical site. The rationale for removing the clot is two-fold: to eliminate the obstruction and to preserve valve function.

    To remove the clot and repair the valve, your radiologist uses advanced X-ray imaging technology to maneuver a tiny tube (catheter) through a small incision in the vein near the clot. The radiologist opens the vessel to physically remove the clot rather than dissolve it. After removing the clot, your doctor may reconstruct the valve. This often involves attaching a small piece of artery to reroute blood flow to an area that has been prepared with stents, temporary tubes placed in the blood vessel to lend support. An interventional radiology procedure called balloon angioplasty may also be used to open blood vessels by inserting tiny surgical balloons.

    Preventive measures for DVT include:

    • Wearing compression stockings
    • Moving your legs often during extended travel or bed rest
    • Taking prescription anticoagulants (blood thinners)
    • Quitting smoking
    • Losing weight if you are obese


    Risk factors for DVT may include:

    • Sitting, standing, or bed rest for extended periods
    • A pacemaker catheter used in the groin vein
    • Giving birth in last six months
    • Age sixty and above
    • Obesity
    • Recent surgery, such as knee, hip, or female pelvic surgery
    • Having cancer
    • Having congestive heart failure
    • Family history of DVT 


    Symptoms of DVT may include:

    DVT primarily affects the large veins in the lower leg and thigh, almost always on one side of your body and may include:

    • Redness of skin
    • Leg pain
    • Leg swelling (edema)
    • Warmer skin in the affected area


    Diagnosis of DVT:

    To diagnose DVT, your doctor will conduct a physical exam, ask about your symptoms, and take a detailed medical history. He or she may also order a D-dimer blood test to detect small protein fragments that are present after a blood clot degrades and a Doppler ultrasound exam to measure the blood flow in the major arteries and veins of your legs.

    If ongoing treatment has not been successful in treating serious, chronic venous insufficiency or DVT, your doctor may recommend venous reconstruction to address the underlying problem. Your doctor will talk to you about all of your treatment options and explain the venous reconstruction procedure in depth to make sure it is right for you.

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