A new hybrid approach to complex deep venous disease
A viable surgical treatment for deep vein post-thrombotic syndrome (PTS) and similar obstructive venous conditions is being pioneered by MedStar Heart & Vascular Institute’s Steven Abramowitz, MD.
Using a reconstructive technique called endovenectomy, Dr. Abramowitz carefully removes scar tissue from within a vein, which creates a clean channel for flow into an inserted stent, allowing blood to flow freely. “The procedure requires a connection between healthy sections of the vein,” says Dr. Abramowitz. “Usually a clean path, just over three inches, is all we need.”
Post-thrombotic syndrome is an under-recognized disease that affects patients’ quality of life, says Vascular Surgeon Misaki Kiguchi, MD, who teams up with Dr. Abramowitz on some cases.
“After deep vein thrombosis, the scar that forms in the vein often narrows the channel in which blood can flow back to the heart, increasing venous pressure in the legs. This leads to symptoms of heaviness, swelling, and in the most severe cases, ulcers. Dr. Abramowitz’s endovenectomy skill adds to the comprehensive venous team at MedStar Heart & Vascular Institute, by increasing the population of patients who can be treated endovascularly by adjuvant endovenectomy. These patients otherwise would have limited surgical options and limited success in revascularization without an endovenectomy.”
Dr. Abramowitz has used the procedure to treat PTS in the external iliac vein, femoral vein, and profunda vein. He reports that the two-to-four hour-long procedure has so far yielded good outcomes, and any patient with PTS is a candidate.
“Rather than having to rely on wound care and compression to treat chronic, non-healing venous wounds, we’re able to improve the patient’s own venous drainage, addressing the root of the problem,” Dr. Abramowitz says. “Many patients are healed within a matter of months.”
Dr. Abramowitz is using the results of adjuvant endovenectomy with endovascular stenting to study ways to refine the technique, from varying segment lengths to investigating ways to accelerate the healing process. Although there may also be ways endovenectomy can help address conditions in other parts of the body, Dr. Abramowitz says the procedure’s most promising area of treatment is in the legs, where deep vein clots and other occlusions most frequently occur.
Dr. Kiguchi adds, “At the MedStar Health Vein Centers, I treat a wide range of venous disease, from cosmetic varicose veins to large venous ulcers. Having a colleague like Dr. Abramowitz, and his success with endovenectomy to improve venous hypertension in many patients with PTS, is an asset to the comprehensive venous disease treatment paradigm.”