Deep vein thrombosis (DVT) is when a blood clot forms in your limbs, most often your legs. The condition could put your overall health at risk. If you or a loved one has DVT, you might wonder what comes next. How can you prevent the clot from getting worse? And what if it comes back? Stents are a treatment to consider.
What Are Stents?
Stents are tiny metal mesh tubes that help narrowed or blocked blood vessels stay open, so that your blood can flow freely. You may have heard of stents as a treatment for heart attacks (myocardial infarctions) caused by blocked arteries. That’s their most common use. Venous stents, which are used in DVT, work much the same way. But, they’re designed especially for the needs of your veins. The FDA has approved several stents for this specific use: Abre, Venovo, Vici, Venous Wallstent, and Zilver Vena.
Why Are Stents Used in DVT?
With DVT, the initial treatment is usually anticoagulation, which lessens the risk of clotting. You can take this medicine (also called blood thinners) by mouth or through an IV. In more serious cases your clot may need to be dissolved (thrombolysis) or removed surgically (thrombectomy). Stents, an add-on treatment not used in all cases, play an additional role. They physically support your vessel walls, so that your blood can flow freely.
Your doctor might notice just after dissolving or removing the clot that your vein is still narrow. This narrowing, called stenosis, may have been part of the reason DVT developed in the first place. Stents can help prop these areas open. They can provide support in veins that have scar tissue caused by long-time blockages.
Around 20% to 50% of people with DVT go on to develop a condition called post-thrombotic syndrome (PTS), which can cause leg swelling, venous ulcers, and disabling leg pain. These symptoms can hurt your quality of life and even make it hard to work or do your daily routine. Stents can ease them.
What Comes Before the Procedure?
If you and your health care team decide a stent might be a good option for you, the next step is learning more about your blood vessels and clot. This can be done through imaging tests.
Duplex ultrasound, the most common, uses high-frequency sound waves to take a picture of your blood vessels. It can show how your blood flows in your veins and in which direction it’s flowing. All of these details will help your doctor know the exact spot where your veins are narrowed or blocked. Ultrasound has no known risks and doesn’t use radiation. You won’t have to do much ahead of time to prepare for this test, though your doctor may ask you to avoid eating or drinking for a few hours beforehand. First the ultrasound technologist will apply gel to the surface of your skin. Then they will use a handheld wand, called a transducer, to send sounds into your body and measure how they bounce back.
Venography is a backup option for when veins are in a place where it’s hard to get a good look using ultrasound. The exam, also known as a venogram, is an X-ray. Like ultrasound, it will help your doctor learn more about how your veins are shaped. A doctor will insert a thin tube, called a catheter, through the surface of your leg into your vein. Then they inject dye into the catheter. This special liquid is what allows the X-ray to capture images of your vein. In some cases, your vascular surgeon may choose to diagnose and treat your DVT at the same time. Venography can be used to guide stent placement.
With X-rays, there is a small amount of radiation involved. So your doctor will want to know if there is any chance you might be pregnant. You’ll also need to discuss whether you are allergic to the contrast dye used. You might need to avoid eating or drinking anything in the hours before the test.
What’s the Stent Procedure Like?
Most often, your doctor will insert your stent during an outpatient procedure without requiring a hospital stay. It involves only mild sedation, not general anesthesia.
To start, your doctor may need to clear any blockage in your vein. They can do this through balloon angioplasty. They will insert a needle into your skin to reach your vein. They then insert various tools, including a guidewire and catheter sheath, that will be used to steer the catheter to the right place. X-ray images will help your doctor know where to find the blockage. A tiny balloon on the tip of the catheter will inflate and deflate to widen your narrowed vein.
Afterward, your doctor will remove the angioplasty balloon and insert a different catheter. This tool will place the stent in the correct position in your vein, then allow it to expand. After the stent is inserted, they remove the catheter then apply pressure on your skin to encourage your wound to close and to prevent bleeding. Or, they might seal the small hole in your vein. You won’t get any stitches on your skin, but a nurse will likely cover your skin with a bandage. Once you’ve had time to recover, you’ll probably return home the same day.
Will the DVT Stent Work?
Use of stents is on the rise in cases where the DVT happened because of blocked or narrowed arteries. The evidence that it works is early but encouraging. One study, for instance, showed that among patients who had surgery to remove their clot (thrombectomy), those who also had a stent inserted were less likely to see their DVT return. Patients whose stent was inserted after their clot was dissolved (catheter-based thrombolysis) haven’t been studied as much yet. What’s known, though, is that your procedure is far more likely to be successful if, before stenting, your clot is completely removed and your blood flow is restored. This way the stent can do its job in the years to come. One year after receiving a stent it’s 84% to 90% likely that your vein will remain open.
What Are the Risks?
As with any procedure, there are risks with venous stents. For example, there have been reports of stents not expanding fully in the blood vessel, not staying in place, and breaking. In rare cases, the catheter used to insert your stent could damage your blood vessel or lead to bleeding or infection. Some people are allergic to the dye used during venography.
Additionally, there’s the chance your blood clot might come back.
What’s Recovery Like?
After your stent is put in, you’ll likely need to rest for several hours at the hospital or clinic where your procedure is done. This allows your health care team to keep an eye out for early complications. You will probably receive a prescription for an antiplatelet drug and need to take aspirin to prevent blood clots from forming on your new stent. Ask your doctor for specific instructions on how to take care of the puncture site where the catheter entered your skin. You’ll also want to ask about what kind of movement or exercise is safe for you. It will take about a week to recover from your procedure.