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By Erin Murphy, MD, FACS, Director of Sanger Heart & Vascular Institute’s Venous and Lymphatic Program

Deep vein obstructions can cause symptoms like leg pain, swelling, hyperpigmentation and ulceration. These symptoms can get so severe that they make it hard to walk and hinder quality of life. But many patients don’t get the right treatment because their obstructions are never diagnosed, or are misdiagnosed as lymphedema or superficial vein problems.

Fortunately, referring patients for specialized care and testing can help pinpoint obstructions and open the door to treatments that go far beyond compression socks. At Sanger Heart & Vascular Institute, we’re using the latest endovascular techniques to restore blood flow, alleviate symptoms and prevent long-term complications – and we were the first in the world to implant the innovative ABRE stent, which could make treatment even more effective.

Venous Obstruction Symptoms

Iliac vein obstruction is a particularly common cause of symptoms in people with a history of clots who present with symptoms like leg swelling and/or pain, and skin hyperpigmentation and/or ulceration. This can signal that a patient suffered deep vein thrombosis (DVT) and may have post-thrombotic syndrome – making it important to quickly refer them to a venous surgeon, ideally within two weeks.

Iliac vein obstruction can also be caused when external pressure from an artery compresses the vein and causes scarring.

How to Manage Venous Obstructive Disease

Historically, physicians have used compression socks and anticoagulants to treat acute DVT. This can help control symptoms. But it doesn’t address the underlying disease, leaving the door open to chronic problems – up to 90 percent of patients with iliac vein thrombosis will have evidence of chronicity and up to 50 percent will develop post-thrombotic syndrome.

The good news is, venoplasty and stenting of obstructed venous segments has been proven to re-establish venous flow, relieve symptoms and improve quality of life. This can be combined with clot removal techniques for patients with extensive, acute DVT to significantly reduce the risk of post-thrombotic syndrome. This approach can also prevent further damage in patients who already have post-thrombotic syndrome, and can help patients with obstructions caused by scar tissue.

Here at Sanger, we have a deep understanding of venous disease and have the tools to investigate potential iliac vein blockages – and to intervene when necessary. We routinely perform endovascular venous surgery for acute and chronic deep venous obstruction. We also give patients access to clinical trials including the US arm of the multicenter ABRE-IDE trial, which tests an innovative stent that could make endovascular treatment even more effective.

The ABRE Stent: Designed for Veins

The ABRE stent is one of the first stents designed specifically for use in veins. Made of a nickel titanium alloy, it’s meant to be strong enough to resist external compression. It’s also designed to have the radial force to open old scar tissue, and to bend as veins move.

The FDA has granted an Innovative Device Exemption to the stent and the current trial investigates it for treatment of symptomatic iliofemoral venous outflow obstruction in patients with venous occlusive disease.

We were the first in the world to implant the device. So far, it has effectively treated the obstructions and alleviated symptoms in our patients. No data has been published but we’re hopeful that ABRE will be an improvement over current technology and will help veins stay open long-term.

Raising the Bar on Venous Care

The ABRE-IDE trial is only one part of our Vascular Surgery & Medicine Program’s push to improve treatment for a wide range of venous conditions.

Our team includes more than a dozen experts in vascular imaging, vascular medicine and vascular surgery. As one of the region’s highest-volume vascular centers, we perform more than 2,500 procedures each year.

That gives us the experience to give your patients the best chance of an excellent outcome, and the expertise to raise the bar by participating in clinical trials, collecting data to improve outcomes, and developing new surgical approaches and techniques.

For more information, or to make a referral, call 877-999-7484.

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