For most women, lifestyle changes, compression stockings, and procedures to close off or remove diseased veins are enough to relieve the symptoms of chronic vein disease and prevent serious complications such as blood clots.
However, a few women with severe chronic venous insufficiency (vein disease that prevents blood from flowing back to the heart) may need more complex procedures to attempt to prevent blood from pooling in the legs. These procedures are rarely done, and will only be used after treatments have failed or because they cannot be performed.
Vein stenting is a procedure to treat chronic vein disease in women who have narrowed veins in the pelvis that are preventing blood from leaving the legs. Opening the blocked vein can restore normal blood flow and improve symptoms of chronic vein disease such as swelling, pain, and ulcers on the legs. Vein stenting may also be used to treat women with repeated blockages of the leg veins.7
Vein stenting is similar to angioplasty and stenting to treat PAD, except that it is performed in the veins instead of the arteries. During the procedure, a long, thin tube called a catheter is inserted into the vein and an inflatable balloon is used to open the vein. To prevent the vein from closing again, a tiny wire mesh tube called a stent is expanded and left in place.
Vein bypass surgery is a surgical alternative to vein stenting for women with severe chronic vein disease that is preventing blood from flowing back to the heart. Instead of propping open the vein that is preventing blood from leaving the legs, a vein from elsewhere in the body (or a synthetic vein graft) is sewn in place to re-route blood around the blocked vein.
Vein valve reconstruction is a procedure to treat women with chronic vein disease caused by misshapen or damaged vein valves. Normal vein valves open to allow blood to flow up the legs, then close to stop the blood from flowing backwards. If the vein valves are not working properly, blood can pool in the leg, causing swelling, pain, and an increased risk of blood clots.
Vein valve reconstruction can be performed with surgery, or through a long, thin tube called a catheter. To fix the broken valves, the surgeon will make a small incision to access the vein and fold or tuck the vein valves to create a smaller but stronger valve. A fabric sleeve may be placed around the outside of the vein to press the walls of the vein together, allowing the valves to close completely. In some cases, a section of vein with working valves from elsewhere in the body may be transplanted to replace the vein with the broken valve, a procedure called valve transposition.
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- Rigby KA, Palfreyman SJ, Beverley C, Michaels JA. Surgery versus sclerotherapy for the treatment of varicose veins. Cochrane Database Syst Rev. 2004(4):CD004980.
- Wakefield TW. Varicose veins section of Veins and lymphatics. In: Doherty GM, ed. Current Surgical Diagnosis and Treatment, 13th ed. New York: McGraw-Hill Medical; 2010:790.
- Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. Jun 5 2004;363(9424):1854-1859.
- Desmyttere J, Grard C, Wassmer B, Mordon S. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg. Dec 2007;46(6):1242-1247.
- Min RJ, Khilnani NM. Endovenous laser treatment of saphenous vein reflux. Tech Vasc Interv Radiol. Sep 2003;6(3):125-131.
- Alhadad A, Kolbel T, Herbst A, Holst J, Alhadad H, Gottsater A. Iliocaval vein stenting: Long term survey of postthrombotic symptoms and working capacity. J Thromb Thrombolysis. Jul 17.