Venous Disease

A DVT is a blood clot in a deep vein of the leg or arm. A DVT often occurs after an injury or surgery, especially during periods of inactivity. A DVT causes pain and swelling in the affected limb. DVTs can be dangerous as they provide a direct route to the central circulation, and if a blood clot breaks loose, it can travel to the heart and lungs, which can be serious or even life threatening. A DVT is diagnosed with an ultrasound and is often treated with blood thinners. Occasionally, a DVT will need intervention with clot busting drugs to treat and/or prevent long-term effects.

A vascular malformation is an abnormal tangle or communication between blood vessels. They can be present in the brain or other parts of the nervous system, lungs, or other parts of the body. Vascular malformations can involve arteries, veins, or vessels of the lymph system. Vascular malformations can be visible on the surface of the body, or deep within. Vascular malformations can cause pain, swelling, bleeding, or strokes. Most vascular malformations are present from birth and may stay the same, grow or, occasionally, shrink with aging. Some types of vascular malformations can be hereditary and affect more than one area of the body.

The most common vein problem is spider veins. These broken capillaries, properly named telangiectasias, are small red, blue or purple web-like veins on the surface of the skin and cause some people to be self-conscious. Spider veins are small, thin dilated veins that lie close to the surface of the skin. Although spider veins do not pose health risks, they can cause significant discomfort, particularly in the legs after prolonged standing.

Healthy veins return blood to the heart so it can be re-oxygenated. One-way valves within the veins ensure that the blood flows in one direction, towards the heart. When valves fail or leak, the blood flows backwards, causing blood to pool in the veins. The increased pressure from the pooling stretches the vein, causing enlarged, twisted blood vessels. The resulting bumpy, rope like veins are varicose veins. It normally takes years for symptoms of varicose veins to develop. While varicose veins are commonly inherited, anyone can get them. Hormonal changes brought on by puberty, pregnancy, and menopause, can trigger the onset of varicose veins.

An inferior vena cava filter (IVC filter) is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to help prevent life-threatening pulmonary emboli (PEs). They are generally recommended in some high-risk scenarios.

A transjugular portosytemic shunt is a tract, or tunnel, created within the liver to connect two veins within the liver, the portal vein and the hepatic vein. The portal vein carries blood to the liver from the stomach, intestines, and other gastrointestinal organs. The hepatic vein takes blood from the liver and returns it to the central circulation.

A TIPS procedure is sometimes used for patients that have portal hypertension, meaning increased pressure in the portal vein. This is often caused by cirrhosis, or scarring of the liver. Portal hypertension can cause blood to flow backward from the liver into the veins of the spleen, stomach, lower esophagus, and intestines, causing enlarged blood vessels. This can cause bleeding and accumulation of fluid in the chest (hydrothorax), or abdomen (ascites).

During the TIPS procedure, an interventional radiologist accesses the venous system through the jugular vein (neck vein) and the femoral vein (groin vein). Under a special type of x-ray called fluoroscopy, a tunnel is created thru the liver to connect the portal vein with the hepatic vein. A stent is placed in this tunnel to keep it open. Contrast, or x-ray dye, is used to visualize the veins under the fluoroscopy. You will be given sedatives or anesthesia during the procedure. Most patients will stay one night in the hospital and go home the next morning.

• Variceal bleeding: abnormal bleeding from veins that drain the stomach, esophagus, or intestines into the portal vein.
• Portal gastropathy: engorgement of veins in the wall of the stomach that can bleed.
• Ascites or hydrothorax: severe and/or recurrent accumulation of fluid in the abdomen or chest.
• Budd-Chiari Syndrome: a blockage or severe narrowing in one or more hepatic veins that carry blood back from the liver back to the heart.

The tunnel that is made in TIPS/DIPS reroutes some of the blood flow from the portal vein to the central circulation, and reduces the abnormally high blood pressure in the veins of the stomach, esophagus, bowel and liver. This reduces the risk of bleeding and fluid accumulation.

You will be admitted through the outpatient department at Sacred Heart Medical Center. A nurse will start an IV, send a blood sample for lab work, and fill out your health information in your chart.

The interventional radiologist who will do your procedure will come talk with you before the procedure and answer any additional questions you may have. When it is time for the procedure, you will be taken to the Radiology department. You will receive moderate sedation or general anesthesia.

The procedure will take about 2 hours. You will be in the procedure room for 2-3 hours. When you wake up you will have a bandaid on your neck and groin. The access sites are so small, no sutures are necessary. After the procedure you will go to a bed in the hospital to recover. Most patients will spend the night after the procedure to treat any side effects and make sure there are no complications

• You may feel tired for a few days after the procedure.
• The more you over do activities, the longer it takes to feel back to normal.
• You may have a bruise on your neck and/or groin.
• You may have mild abdominal pain after the procedure. Severe pain should be reported to your physician.
• You may return to normal activities in 7-10 days after the procedure.

Benefits:

• The TIPS/DIPS is a minimally invasive surgery to treat portal hypertension, with a shorter recovery time and less risks than open surgery.
• You can continue to be a transplant surgery candidate after a TIPS/DIPS.
• Studies have shown that this procedure is successful in reducing variceal bleeding in more than 90 percent of patients.

Risks:

• There is a risk of infection, bruising, or bleeding any time the skin is penetrated. This can be at the access site or anywhere within the system treated. There is a very small risk of damage to the blood vessels during the procedure.
• There is a small risk of an allergic-type reaction to the contrast, or x-ray dye. It is important to report allergies or prior reactions to contrast.
• The contrast can be damaging to kidneys, especially in patients with unhealthy kidneys, diabetes, or renal failure.
• The stent can become narrowed or blocked in the months after treatment, which may require another procedure to open the stent up again.
• Shunting of blood past the liver can lead to build up of toxins in the blood that cause confusion (called encephalopathy), or increased pressure on the heart (congestive heart failure).