drsclafani wrote:hoodyup wrote:Hi, Dr. Sclafani.
About 2 weeks my wife had her right IJV balloned in 3 places and experienced some drastic improvements for about a week, then she reverted to her previous state. We are going to have to schedule another MRV and repeat the process again.
Question #1 If you were treating a suspected restenosis would you repeat this scan or just go for another venogram?
Question #2 Our IR, who is a 30+ year surgeon says he is reluctant to stent jugulars. I was wondering if you had any advice for other vascular surgeons or would be open to sharing "trade secrets" with other IR's regarding placement of stents in jugulars. I'm sure it would be on a case by case basis as patients veins are all different. I could PM you with his contact info if you are willing to consult with him.
dear andrew. this is not that uncommon.
i would go right back to a venogram.
and I would likely do another angioplasty but without the images i can only speak generally..
Many people have asked if i would speak to their doctor and then want to send me their doctors name etc. I cannot do this. I think it would be unethical. Besides while i love you all and care about you, i am not your doctor and i cannot barge in on your doctor's treatment of you.
i am just a plumber writing a gossip column
One of my first questions, over in the thread for patients of Dr. Mehta, was along these lines...basically "How do they avoid going through the heart?" and his answer was that they do go through the heart but the catheter is small enough that it's not an issue. So I'm okay with that now.hoodyup wrote:I have a general question about the route the catheter takes when probing the jugular and azygos veins. I know the insertion point is in the groin but where does it go from there?
Zeureka wrote:- and also what "IVUS" is?
costumenastional wrote:So, here goes: how come the doppler AFTER the operation showed that flow in both my jugs is now perfect???
Cece wrote:Could a blockage in the azygous be so bad that it blocks up the whole system, so that the right jugular was affected only because nothing was flowing?
Cece wrote: Could a blockage in the azygous be so bad that it blocks up the whole system, so that the right jugular was affected only because nothing was flowing? I am thinking of plumbing pipes...if it's at a standstill below, it'd be at a standstill further up, even if nothing is physically blocking it at that point. Just the fact that they found a problem in the azygous may mean that it was a pretty bad azygous (it is my belief that the azygous is being generally undertreated because of the difficulties in imaging there...
hoodyup wrote:Is the azygos a branch off of or is it the main route when doing the jugular venogram? Does the probe have to go there or is it a detour down a difficult road?
Hey Cece, don't think anyone thinks that...I'm sorry for costumenastional too that until now no improvements, but my dear Greek friend, you remember me being sceptical when started posting on TIMS and not ever believed they would find a stenosis ?Cece wrote:I am sorry, I hope it's clear that I don't mean anything I offer as anything beyond cross-talk, while the expert is away. I did not mean to offend when I commented so directly on costumenational's post. If what I was thinking truly is science fiction, that is good to know! And if not, that would be good too.
Dr Sclafani might be more capable to recognize if i have had ccsvi for real and to what extend after i upload my operation cds in the near future.
I suggest we wait for him to share with us.
drsclafani wrote:It is difficult to not do followup on patient i have already treated and to take care of the patients who were about to be treated when i got shot dow
As regards the valve issue, would be interested Dr Sclafani if in case of several CCSVI issues found in a patient in different places (eg two or three), were these always of the same type? For example, all with problems of pathologic valves or all due to stenosis of the wall... I have only been wondering since CCSVI is congenital then maybe one has maybe genetically the same type of pathology in several veins in the body?
And an additional question: if in the azygous those valve issues are often not detected or underestimated...hmmm...with a friend of mine that also has extensive spinal cord issues no stenosis in the azygous was found, but he got angioplasty of his left internal jugular, where a larger stenosis was found.
(I still wonder that it is indeed "enigmatic" not to detect these valve problematics in the azygous after MRV and then the catether venography at the moment of percutaneous venoplasty itself?! Are they easier to detect in the jugulars since there the doppler exam reveals them? So in the MRV you would not see a malformed valve in the jugular that you saw in the doppler exam? And what could be done to improve techniques to find these valve pathologies in the azygous?)
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