Endovascular Iliocaval Reconstruction: Helping Restore Iliac Veins

by Steven Abramowitz, MD, Vascular Surgeon, MedStar Heart & Vascular Institute
July 9, 2019

Healthy veins are critical to returning blood from the body to the heart. However, in some cases, scar tissue from blood clots can form in the veins, causing them to narrow or become blocked. This can lead to significant swelling in the legs which may cause wounds. People often develop scar tissue in the veins due to:

  • Anatomic compression
  • Blood clots
  • Prior catheters in veins
  • Radiation therapy for cancer
  • Surgery on adjacent organs or body parts

The iliac veins, which are responsible for draining your legs, are susceptible to a buildup of scar tissue from blood clots. Iliac veins then merge with veins draining the pelvis to form one large vein called the inferior vena cava, which is responsible for carrying blood from the lower body and kidneys to the heart.

Endovascular iliocaval reconstruction allows us to repair the veins draining our legs and the inferior vena cava damaged by scar tissue. As a result, people can regain healthy blood flow from their legs to their heart and reduce the risk recurrent swelling or wound formation.

LISTEN: Dr. Abramowitz discusses endovascular iliocaval reconstruction in the Medical Intel podcast.

How Endovascular Iliocaval Reconstruction Works

To understand how endovascular iliocaval reconstruction may work, think of veins with scar tissue as four-lane highways after a snowstorm. If a snowplow plowed a single lane of the highway and only opened a path a small car could drive through, you could imagine the traffic that would result! Now if you think of that narrow path as a blood vessel, it’s too small for blood to flow through—which causes a buildup in pressure. By using stents, or metal tubes, that we insert into the veins from minimally invasive puncture sites behind the knee or in the groin, we push the remaining scar tissue to the side, making sure that you get all four lanes of blood vessel flowing again and alleviating any pressure that has built up in the legs.

We’ve found that about 87 percent of the veins we open up with a stent remain open after five years—a significantly higher number than surgeons achieved using older techniques, such as open bypass surgery.

An endovascular iliocaval reconstruction can clear scarring or #bloodclots in the veins that carry blood from the legs to the #heart. Learn how one college student received this treatment after doctors insisted it wasn’t possible. https://bit.ly/2YLjBHB via @MedStarWHC

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How Does This Technique Compare to Traditional Ones?

Older techniques used to reconnect veins typically bypassed (went around) the blocked or narrowed veins. These surgeries were invasive, requiring a large incision that spread from the bottom of the chest to below the belly button. During surgery, surgeons would make an incision in both groins, take plastic tubing or a donated vein, and use it to make a detour around the blocked area.

The problem with this surgery is that it leads to many more complications than newer minimally invasive techniques and people experienced recurrent blood clots or scarring in the same veins years after surgery. Compared to bypass surgeries, endovascular reconstructions allow patients to have:

  • Natural blood flow: Following bypass surgery, patients’ blood moves in a new bypass tunnel as opposed to a person’s own vein.
  • Shorter recoveries: Patients return home the same or next day with the new procedure, compared to five to seven days after a bypass surgery.
  • Additional surgeries: If scar tissue recurs after the bypass, many other surgical options aren’t possible after open surgery. Endovascular iliocaval reconstruction usually doesn’t limit future treatment options if a vein becomes narrowed again.

Expert Care at MedStar Washington Hospital Center

As leaders in the field of vascular surgery, we are always up to date with the latest, most innovative treatments at MedStar Washington Hospital Center. In fact, we were one of the first healthcare facilities in the country to perform an endovascular iliocaval reconstruction. Regardless of your situation, you can be confident that our experts will always offer you the best possible treatments.

Through an endovascular iliocaval reconstruction, select patients can clear their veins of blood clots or scarring with a significantly higher success rate than in years past. Make sure to speak to your doctor to learn whether you’re a candidate.

Call 855-546-1974 or click below to make an appointment with a vascular surgeon.

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Category: Healthy Living, Medical Intel     Tags: endovascular iliocaval reconstructioniliac veininferior vena cava