This Is MS Multiple Sclerosis Community: Knowledge & Support

This is probably a difficult question to give a direct yes or no answer to but I'll pose it anyway. If a patient had been prescribed Coumadin, in the past, for a blood clot behind the knee, would that be an indication that it, or another anti-coagulant, should be prescribed post-CCSVI procedure?

no

Factors Increasing Central Venous Pressure

Primarily a change in compliance (C) or volume (V)
Decreased cardiac output V
Increased blood volume V
Venous constriction C
Changing from standing to supine body posture V
Arterial dilation V
Forced expiration (e.g., Valsalva) C
Muscle contraction (abdominal and limb) V, C

Hi Dr Sclafani, I found this table on a website as I am still interested in the issue of blood flow.
Its been mentioned that MSers may not have enough blood flowing through the veins which could create the narrowing we see in some cases.
It seems that even if this narrowing is fixed that the blood still doesn't flow.
In my last question to you I asked if there was anything we could do to increase venous pressure to create more of a flow.

Now I am stuck with the idea that on one hand we are looking to decrease venous pressure but on the other hand we need to increase it for better blood flow.
(maybe once the valves and blockages are sorted maybe we need to increase pressure)

What are your thoughts on this? Could we do anything from the above list to see if they would improve symptoms. (Maybe pregnancy helps some MSers because the blood flow is increased not just because the immune system is supressed)

Hi Dr S,

If you have the time, I have some questions based on my test reports (shown below):

1) What might "reflects the jugular arterial flow" in the US report mean?
2) What might "Distortion of distal jugular vein due to the presence of leaflet valves" in the MRv-neck report mean?
3) How does my R-IJV flow velocity of 175.0 compare to the average flow velocities of MSers you've seen? How "paradoxical" is this velocity?
4) Is "A dural sinus is more like a built-in drainage pipe than like a flexible vein" a somewhat valid statement?

US: "... Right jugular vein Upright velocity is abnormal measuring 175.0 cm/sec. which probably reflects the jugular arterial flow." (R-supine = 31.9); (L-IJV = 60.2 supine, 56.7 upright).

MRv-head: "Abnormal examination with absent proximal segment left transverse sinus and markedly attenuated remainder of left transverse sinus and sphenoid sinus. In retrospect, the vertical Doppler recordings in the right jugular vein may represent a paradoxical high reading."

MRv-neck: "... Distortion of distal jugular veins due to the presence of leaflet valves."

If I understand correctly, my inoperable intracranial dural sinus malformations might, by way of the vertebral veins, be a contributing cause of my longitudinally-extensive thoracic lesion per Dr. Schelling's paper, "The Ways to Lesion Understanding." Considering the state of my dural sinuses and neck veins, I'm almost afraid to learn about my azygous vein in an upcoming catheter venogram.

Thank you very much for your very valuable time!

Wishing you a happy and safe holiday weekend
~HappyPoet
.

Greetings Dr. Sclafani. This was my impression too, thank you for codifying it. I recently intimated in my follow up thread the discovery of an abnormality that was discovered via IVUS, after having 4 stents put in that took care of the stenosed areas, after my 9 month follow up, the collaterals were shown to be filling again, the stenosed area near C1 was just too tight to deal with at that time, however after the membranous flap was discovered, and angioplastied open, at the collarbone level, it then immediately reduced the upper pressure gradient (at C1) from 4 mmHg to 1, and the collaterals once again vanished.


Leaving external UT out of it for the time being of course, since that's essentially out of reach for the vast majority of MS patients. Least any UT worth using on us.

Good day sir, and sorry if this has been covered a hundred times on here already.

Mark

a friend had his second angioplasty thursday. his stenosis was a very tight thing (dunno the label) high enough into his skull that he had trouble finding an IR who would work on it.

first time, the balloon was inflated for 3 min. post-op, he felt significant improvement, for a few days, then back to square 0. now is a month later, and SFSG.

initial reports are that it wasn't quite like buttah, or even i-can't-believe-it's-not-buttah. they wound up using "the wire", which i gather is a pre-balloon thing that sounds even creepier than the cutting balloon animation i saw elsewhere.

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can you comment? are you still a CB fan?

Thank you very much for your answer Dr. You're very kind.

But I would like to ask you, How can the yugular cranial hole that has little size be stretching ?

When the blood flow from internal venus to the neck ( yugular ) always will find the little yugular cranial hole that don't allow the rigth external flow. How can it be solved?

Thanks again.

CUREious and I were just talking/posting about this here late last night...those stenoses that are high up need to be looked at with IVUS to see if they expand under valsalva conditions (thus making them not a true stenosis and no need to treat) or if they stay tight under valsalva condition, making them necessary to treat.

As I understand it, a malformed valve down by the juncture of the jugular and subclavian veins (?) can cause reflux to go up a bit and then out through a network of collaterals, causing the higher-up area to narrow alarmingly due to the low blood pressure and low inflow caused by the low outflow caused by the lower down malformed valve. If this is what was happening in your friend's case, it was not the cutting balloon that was in error, but the location where it was being used. Lower down valves & membranes can get missed when the catheter lifts them out of the way when the venogram is being performed; I think this is sometimes suspicious/suspected when flow issues show up on a Doppler Ultrasound but not on the venogram itself.

We need to get Dr. Sclafani off the sideline and performing liberations, particularly on me , so that he can publish this, so that there is a paper to refer to when this question comes up, so that all doctors can do this in a standardized best-way, which still needs to be learnt, so that every MSer in the world (not just the "white world") can be treated in a gold-standard fashion. Deep breath.

Understand right from this that an overall narrower jugular is not necessarily congenital then, but that for example a pathologic valve causing blood flow blockage can cause the narrowing of the jugular with time?

If the pathologic valve blockage is removed by balloon angioplasty will the jugular then again increase with time in diameter?

Hi, Dr. S.,

How can we find data on patients post-procedure? There are general comments by Dr. Zamboni and others that CCSVI should be studied or that it has benefit, but, surely, they have more quantifiable data that they are sharing with their peers. I've found a couple of short over-view publications that say things like "every patient showed some improvement", but there was no additional data that gave a clue as to what changed. Was it cog fog, gait/balance, improvement over time, etc.?

Other than a few folks who have shared their own experience, there doesn't seem to be much in terms of an organized data base (i.e., by type of MS, symptoms pre- and post-, location of abnormality and potential relationship to symptoms, etc., etc.)

I'm guessing at least 400 people have been treated around the world. Where do YOU look for this kind of information?

Gratefully, Rosegirl

Dr. Sclafani ... a new question if I may that nobody has broached yet.

COULD acne be a sign of CCSVI? It happens along the lower jaw just below the mouth only and then out to the sides before stopping at the ear.

It isn't "normal" acne though (not white nor blackheads nor puss fulled at all) but what she describes as painful blood filled lumps just below the skin that never really "pop".

I'm just wondering if it's collateral veins trying to move bloodflow from obstructed jugulars ...


If you say no and tell me I'm crazy that's ok too ... just wondering if it was possible.

am not sure i would have used a cutting balloon that high. There are some important things up there.
into the skull? i have my own trepidation doing that. Thankfully i havent had the opportunity to meet that critter yet.

Thrombosis of the dural sinuses is pretty bad, since it prevents flow much higher, before the rich collaterals are available.

I took the liberty of shortening the quote and correcting the translation on the bottom half.
The point I want to make is that, as you noticed, only arteries are mentioned; the reason is that few years ago nobody paid attention to the veins. But, as you know, in our body any artery is accompanied by a vein. The other point is that if you have external pressure, as the one applied by an hypertrophic muscle, the veins are going to be affected much more then the arteries due to their lower pressure and higher flexibility.
So my contention is that Dr. Noda, with his surgery, was improving the venous return, specially from the vertebral vein, and that is the real reason MS patients improved so much after his surgery.