The new era of vascular interventions: The venous side

Abstract

In spite of the huge advances in endovascular management of arterial diseases, surgery remained for a long time the only available option for treating veins. The situation has changed dramatically since the introduction of minimally invasive interventions for treating superficial as well as deep venous diseases. To review the recent advances in venous imaging and interventions for treatment of varicose veins, venous outflow obstruction and deep vein thrombosis. Reviewing available literature providing evidence for the new technologies available for treating: 1- Chronic Venous Disease (including superficial varicose veins and deep venous obstructions). 2- Deep Vein thrombosis (DVT). RCTs showed that ultrasound-guided endovenous thermal or chemical ablation of superficial varicose veins are as effective as surgical ligation and stripping with the additional advantages of being minimally invasive, with less complications and more patient satisfaction, potential treatment in out-patient setup and early return to work. Stenting of chronic deep venous obstruction is safe, effective in improving symptoms and treating venous leg ulcers. Catheter-directed thrombolysis and pharmaco-mechanical thrombolysis are both effective in treating acute DVT and reducing post-thrombotic manifestations. Current evidence shows that management of venous diseases is now shifting towards minimally invasive interventions with very promising results. Given the lots of research work done in the field nowadays and evolving technologies provided by manufacturers, it will soon be the standard of practice offered for patients with chronic venous disease.