A vein occlusion ensues when blood can no longer flow properly through a vein. The reasons for which a vein occlusion might occur are manifold, including the narrowing of the vein, metastatic lung cancer, peripheral edema, the presence of a blood clot inside the vein, pregnancy, as well as certain infections such as tuberculosis or syphilis.
Most obstructions develop in one of the venae cavae, which are responsible for returning deoxygenated blood to the heart.
Lung cancer is the underlying cause of over 90% of superior vena cava occlusions, whereas kidney cancer is occasionally the culprit behind inferior vena cava occlusions. Because vein occlusions are frequently a serious medical problem, as the obstruction prevents blood from flowing at a normal pace, they might require surgery.
The goal of reconstruction surgery is to remove the blockage from the vein and to prevent further damage by placing a stent – a self-expanding metal mesh tube – inside the weakened portion, which is meant to reinforce the wall of the blood vessel. While the procedure can be successfully carried out via a traditional, open repair approach as well, endovascular surgery is minimally invasive and thereby benefits patients in numerous ways, such as by lowering the risk of postoperative complications and by shortening the recovery time. Nevertheless, not everyone suffering from a deep vein occlusion might be eligible for endovascular reconstruction surgery. To determine whether you are a good candidate, Dr. Alexander Marmureanu at the California Heart & Lung Surgery Center will thoroughly evaluate your health and order some of the following medical tests, which you will have to undergo before the procedure:
If you have a deep vein occlusion and qualify for endovascular reconstruction surgery, we will schedule the procedure and explain to you how you should prepare for it. On the day of surgery, depending on the complexity of your vein obstruction and your general health, you will receive general or local anesthesia. After it takes effect, a small incision or a needle puncture is made in your groin area, usually in one of the iliac veins. Then, a catheter – a thin flexible plastic tube – is subsequently threaded through your vein by Dr. Marmureanu until it reaches the blockage. The operating team permanently oversees the movement of the catheter through your blood vessels, as the tube is going to be injected with a special dye which is visible on X-rays during insertion.
There are multiple techniques which the surgeon can employ to remove the obstruction from your vein and subsequently place the stent in the problematic segment, the most common being angioplasty (also known as percutaneous transluminal angioplasty) and vascular stenting. Oftentimes, they are used in conjunction. During angioplasty, the catheter is inserted through your vein with a deflated balloon attached, which the surgeon will gradually inflate once it is inside the blockage to compress the obstruction against the wall of the blood vessel. Then, the stent is delivered to your vein via the catheter, which functions as a rail. Alternatively, the stent can cover the deflated balloon before the catheter is threaded through your blood vessels and thereby be delivered to the damaged portion of the vein while the occlusion is being compressed against its wall.
Following stent placement, the catheter is carefully taken out of your vein and your incision is closed with stitches. A sterile dressing will be covering the wound until it heals completely to avoid infection. If a puncture was made, it will be closed by applying pressure on the area for several minutes.
Deep vein occlusions often cause very distressing symptoms, affecting everyday life to a great extent, and may even be fatal. For this reason, people with the following conditions are generally recommended endovascular reconstruction surgery to avoid serious complications such as pulmonary hypertension or heart failure:
While the effect of the anesthesia is wearing off, you will be moved from the operating room to the intensive care unit, where a team of medical professionals will regularly monitor you to ensure that you are not experiencing any postoperative complications. Feeling discomfort for the next few days after endovascular reconstruction surgery is absolutely normal and if it is too severe, you will be prescribed pain relievers. Additionally, you may notice one or more of the following symptoms after the procedure, which shall also subside within several days:
The majority of patients who undergo endovascular reconstruction surgery have to spend 2-4 days in the hospital, during which they gradually resume eating and walking. Upon discharge, your doctor will provide you with thorough advice on how to safely navigate your recovery. Some of the restrictions you have to be mindful of are:
Complete recovery is achieved within 4 to 6 weeks following surgery.