A new, minimally invasive approach to deep venous disease.

Obstructive deep venous thrombosis (DVT) in the deepest reaches of the leg’s circulatory system is painful and potentially hazardous if not addressed quickly. Although DVT can be treated effectively in a variety of ways, including anticoagulation, exercise, and occasionally surgery, the pain and discomfort doesn’t always end when the clot dissipates.

Many patients with DVT experience post-thrombotic syndrome (PTS), an equally painful condition that results when a portion of the dissolved clot converts into collagen, leaving scar tissue in the vein, that prevents normal blood flow. While the symptoms of PTS are typically similar to those for a deep vein clot, treatment options are far more limited. Until now, bypass procedures have been the only surgical alternative, but these are associated with high morbidity and are often only moderately effective.

Medication may help moderate PTS symptoms, but not entirely alleviate them. As a result, patients often find themselves coping with intermittent bouts of pain, swelling, and skin discoloration that may vary in intensity for months or even years.

A new approach.

Steven Abramowitz, MD

A new approach pioneered by MedStar Heart & Vascular Institute’s Steven Abramowitz, MD, could provide a viable surgical treatment alternative for deep vein PTS. Using a reconstructive technique called endovenectomy, a vascular surgeon carefully removes scar tissue from the vein, creating a clean channel for inserting a stent that allows blood to flow freely.

“The procedure requires a connection between healthy sections of the vein,” says Dr. Abramowitz, a recognized leader in endovenectomy applications. “Usually a clean path just over three inches is all we need.”

Dr. Abramowitz has used the procedure to treat PTS in the common femoral vein, profunda femoral vein, and femoral vein. He reports that the two-to-four-hour-long procedure has so far yielded positive outcomes. Any patient with PTS or a similar condition is a potential candidate. “

Rather than having to rely mainly on medication to treat non-healing venous wounds, we’re able to have the condition treated quickly,” Dr. Abramowitz says. “Many patients are healed within a matter of months.”

Dr. Abramowitz is using the outcomes of endovenectomy procedures to study ways to refine the technique, from modifying segment lengths to ways to accelerate the healing process. Although endovenectomy may help address conditions in other parts of the body, Dr. Abramowitz says the procedure’s most promising area of treatment is in the lower extremities, where deep vein clots and other occlusions most frequently occur.

“It’s an attractive method for addressing very painful conditions, including those that can become more serious if left untreated,” he says.

Endovenectomy allows for the careful removal of scar tissue from the vein, creating a clean channel for stent insertion that allows blood to flow freely.

Contact Dr. Abramowitz at 202-877-0275 to learn more or to refer a patient.