Your physician may prescribe blood-thinning medication to prevent blood clots. When use of blood thinners is indicated, your physician will closely monitor you to ensure utmost safety. You may be referred to the Anticoagulation Clinic.
Catheter-directed thrombolytic therapy
Catheter-directed thrombolytic therapy is a nonsurgical venous disease treatment that uses clot-dissolving medications, referred to as thrombolytics, to dissolves blood clots. The medications can be delivered via a catheter, a long slender tube, which is guided through the vein to the segment where the blood clot is located. The clot-dissolving drug is infused through the catheter into the clot. The clot usually dissolves in a matter of hours to a few days. In some cases, the narrowed area of the vein will need to be treated with angioplasty to prevent further clots from forming. For more information about catheter-directed thrombolytic therapy.
Angioplasty is a nonsurgical treatment option used to widen the vein after a blood clot has been dissolved. During angioplasty, a small balloon at the tip of the catheter is inflated to stretch the vein open and increase blood flow. A stent is often placed during the angioplasty procedure to keep the vein open. A stent is a small, metal mesh tube that acts as a scaffold and provides support inside the vein. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed vein. Once in place, the balloon is inflated and the stent expanded to the size of the vein holding it open. The balloon is deflated and removed, and the stent stays in place permanently.
Vena cava filters
Vena cava filters may be used as a venous disease treatment option for select patients who cannot take anticoagulant (blood-thinning) medications, such as heparin, low-molecular weight heparin or fondaparinux, or for patients who are taking anticoagulants and continue to develop clots. The filter can prevent blood clots from moving from the vein in the legs to the lung (pulmonary embolism). During a surgical procedure, the filter is inserted through a catheter (thin tube) into a large vein in the groin or neck, then into the vena cava (the largest vein in the body). It can catch clots as they move through the body to the lungs. This treatment will help reduce the risk of a pulmonary embolism, but will not prevent the development of more clots.
Sclerotherapy is a nonsurgical treatment for varicose veins that involves the injection of a concentrated salt solution directly into the varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results. Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming aging mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent can have better contact with the vein wall.
Endovenous thermal ablation
Endovenous thermal ablation, also called laser therapy, is a newer technique that uses a laser or high-frequency radio waves to create intense local heat in the varicose vein. The technology is different with each energy source, but local heat is directed through a catheter to close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results.
When is surgery necessary for venous disease?
Surgery may be necessary when pooling of blood or a blood clot affect circulation and completion of everyday activities. It also may be necessary to prevent the condition from progressing into deep vein thrombosis or a pulmonary embolism. Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations to treat superficial venous thrombosis or phlebitis.
Surgical treatments are performed in the hospital or outpatient setting by a vascular surgeon.
Ligation and stripping
Ligation and stripping often are performed in combination. During surgery, the dilated vein is either removed or tied off through small skin incisions. Some surgical techniques include removing the saphenous vein, or closing the vein with a special catheter that applies radiofrequency, laser or thermal energy. In some cases, the vein can be removed during a minimally invasive surgical procedure called endoscopic vein removal.
A surgical bypass reroutes blood flow around the blood vessel blockage by creating a new pathway for blood flow using a graft. To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased artery and places a graft, which is either a portion of one of your veins or a man-made synthetic tube. The surgeon will connect the graft above and below a blockage to allow blood flow around the blockage.
In valve repair, the surgeon shortens the valves inside the vein to improve valve function. The surgeon accesses the affected vein through a small skin incision and folds or tucks the valve flaps of the vein. The surgeon may place a fabric sleeve around the outside of the affected vein to help press the walls of the vein together to maintain valve function. In some instances, a portion of vein with a normal functioning valve from another part of the body may be used to replace a section of vein with a non-functioning valve. This is termed a valve-transposition.
SEPS (subfascial endoscopic perforator surgery)
SEPS (subfascial endoscopic perforator surgery) is a minimally invasive surgical venous disease treatment technique used to treat chronic venous ulcers caused by perforating veins that may have been damaged due to deep vein thrombosis or chronic venous insufficiency. Perforating veins, located above the ankle, carry blood from the superficial veins into the deep veins. The surgery is performed through small incisions and has a low rate of wound complications. Using a balloon to separate the surrounding tissues from the veins, the culprit veins are dissected, resulting in long-term healing of the ulcers.
Outcomes for Venous Disease Surgery at Cleveland Clinic
Experience in venous disease at Cleveland Clinic has increased nearly ten-fold over the past five years. Increases in our ability to identify and treat venous conditions have led to a marked increase in the number of patients treated. We are now the leading center for venous disease in the area with more than 1,000 venous procedures performed each year.