Can surgery be avoided by using angioplasty and stenting?
Angioplasty refers to the use of a small balloon to stretch the narrowed portion of the vein back to normal size. Angioplasty is not effective until the rib is removed since the rib is a principal element in compressing the vein, and angioplasty can not overcome the compression produced by the rib. Stenting refers to use of small wire mesh scaffolds inside the vein to help support it and keep it from re-compressing. These wire scaffolds do not have sufficient strength to overcome the compression caused by the rib. In the instances where this has been tried, it has invariably resulted in crushing of the stent and irreparable damage to the vein. For this reason, we strongly advise all patients and physicians to avoid use of stenting before the rib is removed. Additionally, our experience has shown that once the rib is removed, stenting is not needed. If there is a persistent narrowing of the vein after the rib is removed, then angioplasty alone has been sufficient.
