This Is MS Multiple Sclerosis Community: Knowledge & Support

With all my respect for Paolo Zamboni, i think that there is a real battle here also.
Sclafani's work here is very, VERY important to say the least, as well as the patients efforts who are pushing hard in order for CCSVI to be researched.

Dr Sclafani, yesterday had percutaneous balloon angioplasty performed on my left and right jugular veins (in Katowice). The balloon catheter used in my case was Invatec 12x40 mm in both veins.

I was told they found that in particular my left jugular was narrower than usual, and that therefore they used a smaller balloon in my case. In fact I afterwards also checked with my room-mates and their reports all say that a 12x50 mm Invatec used in both their jugulars. I however do not understand how the length 40 versus 50 mm plays a difference - and for what reason - and not the width?

They said a stent was not necessary and that even if would have been so, stents for my size of left jugular would not currently be in their possession - if I understood that one correct from the English I understood? Would this make sense?

So my narrower jugular, is this a common/or rather uncommon issue and is this something you already came across? And different balloon catheter sizes chosen on what basis?

What you are doing here is unusual (no other doctors here) and valued.

(edited out: presumptious advice on setting boundaries!)

It certainly is both unusual and valued.

I was worried about posting dr Z's words, fearful of him being misconstrued. My fear is realized.

Dr. Sclafani,

By all means take time off ! Thank you for the reply; common terms of discussion would be great. I have one followup; you wrote at the very end: "...suspect that those images have a duplication on each side" -- were you referring to the MR images (which are the same except for the viewing mode) or the doppler image? And what do you mean by a duplication.

Your conversation with all of us is, I think, unprecedented. I'm not sure that if I totaled all the hours I've met with my GP over the years it would equal the time you've spent online here.

Dr. Sclafani or anyone else,

Can anyone please tell me what you can see on the Doppler test and what you can see on the MRV?
Can the Liberation Surgery be done without a Doppler and only a MRV with the same results?
Is MRV the same as venography?

Which one tests for blockages in the neck?
Which one tests for blockages in the chest?
Which one tests for blockages in the abdomen?

I would really appreciate this information.
Thank you

Dr. Sclafani, thank you once again for your patience and dedication to us. We all appreciate it!

When do you think you can commence the Liberation treatment again?

Hello Doc.,

A very basic question ...

Do you think it is possible (or come across such a case) where dilating a vein might not help. And the vein narrowing itself is resultant of lack of blood flow.

A related question - MRV will show presence of narrowing but will say nothing about blood flow. Doppler on the other hand relies solely blood flow.
In your opinion, would be prudent to treat a vein narrowing that shows up in MRV but Doppler looks normal.

1. accept protocol as written. Liberations can begin. Yeah!!! javascript:emoticon(':lol:')
2. Accept provisionally with specific wording changes. Liberations resume Yeah!!! javascript:emoticon(':D')
3. Request detailed changes. This would require revision of the application. The revision would be reviewed at the next meeting of the Group reviewing my application. Each group meets once monthly javascript:emoticon(':evil:')

Dr. Sclafani,

I just had an MRV done at Buffalo (BNAC-selfpay option) and wanted to see if you think this image shows treatable stenosis/narrowing? Is this something common you've seen? Is this area too high to be reached? Below is a direct quote from the report which I can't really make heads or tails of.. Also, I only presented with one of the five Zamboni criteria via doppler.. #2 - Reflux propagted upward to the Deep Cranial Veins (DCV's) and/or from the White Matter (WM) to the Subcortical Gray Matter (SCGM). Perhaps a bunch of clollateral veins too? Possible lower right IJV valve issue (sticky valve?) and Iron measures very high (higher than the avg. MS Pt.)

From the report: "MR VENOGRAM FINDINGS: The superior sagittal sinus with appears to drain predomininatly on the right. The transverse sinuses are relavetly symmetric in size. The sigmoid sinuses and jugular bulbs are relatively symmetric in size. At the base of the brain, the internal jugular veins are well visualized. At the level of the cranical/cervical junction junction on the right, the internal jugular on the right takes on a flattened morphology with respect to flow charactists. This segment is small in size being less than 10mm. Throughout the neck, the internal jugular veins have an ellipsoid morphology. The junction of the internal jugular veins with the subclavian veins is normal in apperance. There is slight asymmetry of the internal juglar veins with the right being larger than the left."

I'm not quite sure if or how this correlates, but my very first two presenting symptoms showed up on the left side. Left arm/hand numbness (still have it approx. 10 yrs later and left eye Optic Neuritis 2002 - complete, but temporary blindness that resolved in about 3 mths with steroids..

Anyway, the rest of the report comments on the arterial side.. all good



Thanks again for all your help.. I decided on investing the $4500 to hopefully get some answers and further research, but would really rather give it to someone who needs it more than I do instead..

Assuming that stents are implanted in the internal jugular veins, and a long term anti-coagulation regime is followed, would it ever be possible for the patient to donate a pint of whole blood?

You may donate blood while taking nonnarcotic pain relievers. Aspirin interferes with platelet function and should be discontinued prior to platelet donation as follows:

Aspirin: You cannot donate platelets if you have taken aspirin in the last 48 hours.