Daniel Torrent: This Should Be An Ice Cold Take… But Veins Aren’t Arteries
Daniel Torrent, Vascular Surgeon at Longstreet Clinic, shared on LinkedIn:
”This should be an ice cold take… but veins aren’t arteries.
A vein is not just a “blue artery.” I see plenty of people try to import their thinking about endovascular arterial interventions wholesale into venous pathology.
Arteries are high-pressure, structural tubes. Veins are low-pressure, highly compliant reservoirs.
They respond to volume changes and pressure changes with breathing.
This study caught my attention because it highlights that point.
A recent study in JVS: Venous and Lymphatic Disorders (Schultz et al.)
The team used the time of day as a proxy for fasting (NPO) duration.
Before 11:00 AM: Interventionalists used larger stents (18–22 mm).
After 11:00 AM: Interventionalists used smaller stents (12–16 mm).
The study’s sample size is small and the 11 AM split is binary, but the underlying principle is sound: dehydration changes the anatomy.
As patients remain NPO longer, they become volume-depleted.
Their veins collapse and measurements change. It’s not an issue on the arterial side where vessels are more muscular and rigid.
Venous intervention is its own expertise. Move beyond the static image:
Hydrate aggressively (especially for late-day cases).
Trust IVUS over venography to find the true vessel wall.
Watch the compression point on IVUS as the patient breathes
Think physiologically, not just mechanically.
Let’s stop pretending a vein is a rigid pipe.
It’s time to treat venous disease with the specific expertise it demands.”
Read the full article here.
Article: Timing of outpatient stenting is associated with stent size in nonthrombotic iliac vein lesions
Authors: Kurt S. Schultz, Paula Pinto Rodriguez, Sahar Ali, Robert R. Attaran, Juan Carlos Perez Lozada, Steffen Huber, Britt Tonnessen, Edouard Aboian, Raul J. Guzman, Cassius Iyad Ochoa Chaar
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