Deep Venous Intervention (DVI)
Whilst we make every effort to ensure that the information contained in this patient information sheet is accurate, it is not a substitute for medical advice or treatment. The Circulation Foundation recommends consultation with your doctor or health care professional. The information provided is intended to support patients, not provide personal medical advice. The Circulation Foundation cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third-party information, such as information on websites to which we link.
What is Deep Venous Intervention?
Deep Venous Intervention (DVI) refers to x-ray-guided procedures aimed at opening narrow, tight, or blocked veins in the top of the leg, pelvis, or tummy. These procedures are often performed for symptoms such as swelling, pain when walking, and for wounds to the skin called ulcers. The goal of DVI is to improve blood flow out of the leg to alleviate these symptoms.
The causes of blockages in the deep veins can include previous deep vein thrombosis (DVT) or situations where the vein is squashed or pinched.
What if I am taking blood thinners?
You will be given clear instructions on what to do before your procedure. Usually, tablet blood thinners are changed to injectable blood thinners about 48 hours beforehand and continued until the day of the procedure.
What does the procedure involve?
The Anaesthetic
This procedure can be performed under general anaesthetic, or local anaesthetic with sedation may be used. Your surgeon and/or anaesthetist will decide on the best option for you, depending on factors such as the extent of the planned stenting and your other health conditions.
The Operation
The procedure takes place in an x-ray operating theatre/room. Often, calf-muscle pumps are used to gently squeeze the leg to keep the blood flowing during the procedure. You will also be given some blood-thinning medication.
If you are awake, local anaesthetic is used to numb the skin. Using a small cut and needle, a wire will be passed into a suitable vein, either from behind the knee, the middle of the thigh, from the neck, or a combination of these options. A series of pictures of the veins are taken by injecting dye (contrast) into the veins. This can make you feel warm or flushed if you are awake, and this is normal.
Using x-ray guidance, a wire is used to cross the tight or blocked vein. After this, the vein is stretched with a balloon, which is then removed, and a stent is placed. Pictures are taken at the end to check that the procedure has been successful. This can be uncomfortable if you are awake during the procedure.
At the end of the procedure, the wires are removed, and pressure is applied to the needle points. Glue or a stitch is used to close the skin.
Recovery and Aftercare
After the procedure, you will be taken to a suitable recovery area and then to a ward. These are normally day-case procedures, but an overnight stay in the hospital may be required.
Pump cuffs on the calf will remain until you are able to walk soon after the procedure. You will be encouraged to drink plenty of fluids and be given early blood-thinning medications.
Upon discharge, you will be asked to walk around regularly, keep drinking water, and take regular blood-thinning medication. Most patients who have a stent placed will require ongoing ultrasound scans to monitor the stent.
How successful is this procedure?
Most procedures with stents are successful in 75% to 80% of cases. However, some patients may require a second procedure to maintain blood flow. About one in five patients may need a repeat or further procedure to improve blood flow.
Do I have to take blood thinners after the procedure?
Yes, blood thinner injections and/or tablets are required after the procedure to keep the blood thin and reduce the chance of clots or blockages forming. After about a year, these may be stopped, but your treating team will advise you on this with input from a blood clotting specialist (haematologist).
Will I have any scans after the procedure?
Yes, regular ultrasound scans are important to monitor the stent. Sometimes, maintenance procedures, such as re-balloon stretching, may be required.
Are there any risks with the procedure?
There are potential risks with any procedure, but the overall risks are very low. The risks can be categorized as follows:
At the puncture/needle site:
- Some bruising is common after the puncture to the vein.
- Life-threatening bleeding is very rare in these procedures.
Related to the contrast (dye):
- Some patients experience an allergic reaction to the contrast, but this is very rare (1 in 3000).
- Any procedure involving x-rays and dye can affect kidney function, but this often recovers quickly. Medications and precautions, such as stopping metformin if diabetic, can help reduce the chances of kidney problems.
Related to the treatment:
- Stenting can sometimes cause back pain, but this usually settles with time.
- There is a very small chance of bleeding and a very small chance of clots traveling to the lungs.
- Occasionally, the procedure may not be possible at the time of treatment, or there may be a problem with blood flow through the new stent afterward. Sometimes this requires a repeat procedure, and sometimes there are no further options. If this is the case, your previous symptoms may remain, but your doctor and team will discuss this with you.