Venous Stent

Okay, my name is Usman, I'm a vascular surgeon. You had the venous stenting performed over at UCLH. Yes. Under Professor Toby Richards. Yes. Would you possibly be able to describe your experiences in your own words, where it started from and you know anything you want to tell us? Sure, so I am myself into medical profession and into imaging so for me it was it has helped me a lot I would say it's a very good experience overall not only so I have history of deep vein thrombosis since 1997 that happened when I was in medical school because of an episode of trauma and prolonged hospital immobilization and then there is a gap of about 10-12 years and I was coming it was a transatlantic flight I was coming back from and it was a very unusual presentation that I noticed one of the vein of my abdomen that has swollen up and then it was investigated and on CT scan they picked up that there is a thrombus which has extended from the leg veins up to the major vein which is going to the heart. So that is how the chain of investigations and the referral to the specialist center started. I was having symptoms of leg swelling but I was used to it. It was not something which was worrying me. It is expected and you just get on with your routine with it. But this problem with the superficial vein was a bit worrying because you don't know where the next thrombus is going to go. And other thing was that at that time there were not many procedures which was done. So it was actually, I looked at the data within UK it was not very satisfactory results. There is a gap of about 3-4 years and 5-6 episodes happened within 7-8 months and I was again referred to the specialist centre and I was shown data with all pluses and minuses and side effects and the success. So I had a chance to look at should I go ahead or not and with informed consent I decided that I basically proceed with the procedure. So I had the IVC reconstruction. IVC is the major blood vessel which is going back to the heart and they also stented the major vessels in the lower part of my tummy and also a touch of it in the upper part of my right leg. So this is all area which was all blocked because of a problem with the chronic blood clots yes the procedure was done on general anesthesia so before so I was explained the procedure in detail by the radiologist as well as the vascular surgeon they took me through the steps what is going to be involved and most importantly told me what you're going to feel after the procedure. So pain and side effects of the procedure itself, I was fully informed about that. But to be honest, it was a very pleasant surprise as none of those things happened and next day when I actually woke up, I was feeling systemically a lot better. Systemically I mean that when I was even taking a breath in, I was feeling as if it's a very smooth ride. And I was not aware of this thing that I'm actually exerting, taking a breath in. And my colleagues at work, one of a very eminent colleague who was himself a chest radiologist, just mentioned to me that I was, before procedures, getting short of breath. So this is one thing which actually really helped me. And the swelling of the legs immediately after the procedure, that had gone completely. I hadn't seen the bony contours near the ankle so clearly defined because of the procedure and stuff and surprisingly I had a lot of collateral these veins which were visible on the skin of the abdomen tummy and all of those have disappeared completely so it's like it's like a magic you know this you can you can see the results in front of your eyes you're not waiting for anything to happen you can just see where is all that gone which you're used to for 5 10 15 years So that was very good for me. At present, I had, I would say, a slightly unexpected experience of pain in the right groin, but that was physiotherapy people. They helped me, and after just only two sessions, that was muscular strain, and that just resolved, and I'm walking, and I'm going to the gym, and I started on with the swimming, and every single day, my stamina is improving. So I would say, overall, for me, It was a very successful procedure. You described that the leg swelling is better, much better, and you say that you breathe much easier because you had a major blockage in your inferior vena cava and the blood vessel going back to the heart. Is there anything else that you could describe in your experience that was unexpected perhaps? With, my right leg was more swollen compared to the left before procedure because the original problem had happened on the right side. So I was aware that if anything had to happen, if anything had to go wrong, it will be my right side. So I was taken back to the, after the procedure, I was kept in a very, very strict follow-up. A consultant hematologist, Professor Hannah Cohen, who has done a marvelous job looking after the blood thinning agents and the medication. Then the radiologist, Julian Haig, and Professor Toby Richards. They're all just working in the form of a team, looking after every step. This right groin, it was in one of the follow-up ultrasounds, it was picked up that there is a thrombus stick to the wall, and it is just at the edge where the stent finishes, and the rest of the thrombus burden starts. They can't just go all the way into the ankle and stent everything because of the size. And then they did another follow-up ultrasound, and they noticed the size of that increased. So at that point, they decided why not to just treat it at this stage so that it does not block the blood vessels. So I had a procedure called angioplasty done, a venous angioplasty. It was just half an hour, 40-minute thing. They went in there through one of my neck vein and it was like I was talking to them. It was not under general anesthesia and they just opened it up with the help of a balloon. I did not feel anything, any pain or anything during the procedure and after the ultrasound results are satisfactory and discharged same day home. That was to keep the stents open to prevent that narrowing from causing further stents. Exactly. So it was from management point of view, if you look at it, that such a good follow-up program actually picked up something very early and it was treated early. rather than waiting for a complication to happen so it was treated well in time and there's a follow-up ultrasound one which has been done which showed satisfactory results and there's another planned to just to tick box that you know everything is okay. Is there anything that in particular you want to convey to someone thinking about having this procedure done for blockages in the veins? The most, the thing which actually really won my heart was the honest consent which was when it was obtained. When my two respected colleagues, they sat down and they told me, these are the patients who hadn't had response, these are the complications we had and this is the success. And one very important factor is that it is the leg swelling which you see and you experience. But there is a lot to it what happens inside your body. expect okay my leg swelling should be cured but the data suggests it's between 70 to 75 percent or between 65 to 75 percent patient you know so you still may not see that response over there. One should be one should enter the process with all information in hand. I would recommend it by the way because the overall well-being is it affects the well-being. I'm physically more active I feel that I have more energy to do things and I'm taking initiative for those things which were not happening before because I'm I was too much occupied by this thing that I it is something which is slowing me down so if you ask me I would say I would recommend this procedure and go ahead rather than waiting for a complication to happen