Veins are flexible, hollow tubes with flaps inside called valves. The valves open and close to allow blood to move in one direction toward the heart. Veins become larger and larger as they get closer to the heart. The superior vena cava is the large vein that brings blood from the head and arms to the heart, and the inferior vena cava brings blood from the abdomen and legs into the heart.
Treatment of venous disease includes medications, procedures and surgery.
Anticoagulation: Your physician may prescribe blood-thinning medication to prevent blood clots.
Catheter-directed thrombolytic therapy: Clot-dissolving medications, referred to as thrombolytics, are delivered via a catheter (a long slender tube) through the vein to the segment where the blood clot is located. The clot-dissolving drug is infused through the catheter to dissolve the clot in a matter of hours to a few days.
Angioplasty: 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.
Percutaneous 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.
Sclerotherapy: 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.
Endovenous thermal ablation: Endovenous thermal ablation, also called laser therapy, is a technique that uses a laser or high-frequency radio waves through a catheter to close up the targeted vein.
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.
Valve repair and transposition
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 Treatments 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.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons
Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:
Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.
IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.
You may also use our MyConsult second opinion consultation using the Internet.
The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:
Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.