This Is MS Multiple Sclerosis Community: Knowledge & Support

No more pushing the envelope? You can get nasty paper cuts that way....

I worried a bit too, it had been awhile. Glad you're doing good.

hi, dr. sclafani. so glad you are home all so safe and sound. i too was a

little worried. with the united states so in debt to China financially i was

getting worried that they may decide to keep one of our "National

Treasures" as collateral. welcome home!!

Dear dr. S,

only few words, please.

Best regards,
A.

Dr. Sclafani:

1. Regarding collateral veins, are we born with all the collateral veins we will ever have and they just sit on the sidelines unless needed OR does the body quickly try and create more of them as the need for them arises? (Like in CCSVI, chronic and slowly progressing or other vascular conditions)


2. What relationship would decreasing spinal fluid have on the blood flow in or out of the brain? Could tapping the spinal fluid cause a significant reduction in venous pressure in the brain/IJV's/Azygos?


Thanks again for all that you do!

-SaintLouis

Dr. Sclafani:
Could you please give us an update on the "cutting balloon" use for venoplasty since your first use in March when it was like "butta". Is there a higher risk of thrombus and should more follow-up be given to check by ultrasound when it is used? Dr. Gary Siskin did discuss this in his lecture at the SUNY conference Aug. 2010. There is no published guidance for the use of this device in veins with MS disease and I would like to hear about development of a standard for using the cutting balloon. Veins can be much weaker than arteries are they not? Dissection is a risk with venoplasty, and what benefits does the cutting balloon have? Very few have been proven in cardiac artery uses. Please help. This is becoming a hot trend on the west coast. Thanks....

Dear Dr Scaflani,

I do hope you had an interesting holiday in China.

I have been going through the information you were kind enough to share with the MS Community with regard to CCSVI and more specifically restenosis. However, I have not been able to find an answer to my current problem with regard to restenosis shifting from place to place.

I had a Doppler Ultrasound in March this year which showed bilateral mid internal jugular stenosis. However, no reflux was detected presumably because the Sonographer was very new to the concept of CCSVI.

An angioplasty/venogram was done in May which showed evidence of stenotic change at the valves on both sides. Both valves were balloon dilated to 12mm. The azygos was found to be normal with pressure in the distal azygos at 12mm, in the middle azygous vein at 12mm and in the superior azygos vein at 9mm.

There was some improvement in fatigue which disappeared within 7 days.

A second Doppler examination a month after the procedure showed “unaltered stenosis” of both jugular veins. However, there was an improvement in the flow of both jugulars. Reflux was detected in both veins. A second angioplasty/venogram was performed. In the RIJV the stenosis was found to be in the upper portion of the RIJV with no stenosis at the valve. This was ballooned to 12mm and there was good flow with significant reduction in collateral venous return. In the LIJV there was mild stenosis at the valve which was ballooned with improvement in venous flow.

However, there was no impact on my symptoms. A third Doppler ultrasound was performed one month later. There was reflux only in the LIJV which had a CSA of 0.4cm2 and a venous flow recorded at 208 ml/m in the supine position. There was stenosis of the RIJV but venous flow was recorded at 618 ml/m in the supine position. An MRV was performed a few weeks later which confirmed that there was no stenosis in the LIJV. However, there was stenosis in the proximal RIJV from C1 to C4. There was filling of the collateral venous return via asymmetric intraspinal epidural venous plexus along the right.

You had mentioned that upper IJV stenosis may be transient and may be the result of problems lower down the jugulars.

However, I am nervous to undergo angioplasty/venogram for a third time because the restenosis keeps shifting from place to place. I am worried that the next time round the restenosis may spread to the transverse and sigmoid sinus. Are my fears justified? I greatly appreciate any feedback you can give me based on you experience.

Dear Dr. Sclafani,

I had my CCSVI examination (only MRV) appointment with Prof. Vogl. According to the findings I have collateral networks on both sides. My rIJV shows some stenosis about 20%. My lIJV is hypoplastic (about 3-4mm diameter). Some retrograd flow has been detected.

Prof Vogl told me he would be able to dilate the hypoplastic lIJV. I have read some posts about hypoplastic lumbar veins which are said to be inoperable at the moment.

How do you consider the chances of a successful surgery/dilatation for hypoplastic IJV? How would you estimate the risk of restonsis i such a case - especially high, especially low, quite the same as in other cases of "regular" stenosis.

Thanks!
--Frank

_________________
Treatment: CCSVI both IJV ballooned 09/2010, No DMDs, Tysabri on hold after 24 Infusions, after LDN, ABX Wheldon Regime for 1 year.

Dear Dr Sclafani,
I was also tested (mrv only) and based on the findings treated by Dr Vogl in August. LIJV, 40% and RIJV, 10% blocked very high, the azygous was judged to be in order but was also run through quickly after the ballooning to 'be sure'. I experienced immediate lack of fatigue and improved mental clarity (which I hadn't been aware that I was lacking) There was initially improved muscle strength in the legs and much better bladder symptoms which quickly faded.

I am wondering whether, considering Dr Tariq's experiences with azygous irregularities, if azygous problems might be being missed, particularly when only a mrv is done for diagnosis. I think there would be no identification of flow disturbances, if I understand correctly. Perhaps, flow disturbances are also being discounted since some blood is getting through anyway.

Can you please comment?

Hi everyone, recently Costumenational has been in communication with a Dr. Flanagan who worked on the blood flow in the spine and skull very extensivly at a similar time to Dr. Schelling.
The work of these to men compliments and in my veiw, explains some of the missing detail in Dr. Zamboni's work.
PLEASE read all of this man's work on his web site and it may have answers for the re-stenosis issues as well as many other, as yet unconnected aspects of CCSVI.
http://uprightdoctor.wordpress.com/
The site has allot of information that is in laymans terms, for a rational person like me it gives some meaning to CCSVI that is missing.
Enjoy.
Dr. Scalafani this is even more important for you in your search for answers!!!!!!!!!!!!!!!!

i do not think that hypertension leads to narrowed veins

some semantics are necessary:
i differentiate narrowing that may be caused by many things, some of which are not permanent or abnormal from stenosis which implies to me a fixed narrowing. This is very important concept. Valves that do not open because they are malformed lead to stenoses. Scar tissue or atherosclerosis causes stenosis of arteries and dialysis grafts. Narrowing might be due to the fact that there is little blood filling a vein or due to a higher pressure structure like the carotid artery indenting it. If you fill the vein it distends from a physiological narrowing but will not if it is malformed vein.

This is a difficult perceptual concept and does lead to confusion. Sorry but true. and you are not alone in this confusion. Many doctors also are confused



sorry, i do not



i think that there are very very few people who are indeed fully experienced in ccsvi or liberation. I would include myself among them. Dr. Zamboni would consider anyone who has not performed 50 procedures to still needing experience.

thus your wife is a pioneer

good luck

zeureka , love you too

but i am not going into politics!

it has nothing to do with the medicine here

mildly prominent external jugular veins......hmmmm, could this be an underestimation of the collateral flow by a radiologist not thinking much about that? Could the "mild" have been "significant"?

Love these shorter questions!

one of the causes of easy bruising is fragile veins, or capillary fragility too. but there are many other causes of easy bruisability.

i do not think that there is much of a problem of bruising from a venogram. bruising often is more likely to be caused by accidental or inadvertent needle puncture of a small artery near the vein. Venous fragility is not likely to be a problem. but some of the other causes of easy bruisability are. your doctor may do some blood test to determine whether other things are causing the bruisability are present




symptoms of hypercoagulability include embolism, clotting, DVT, pulmonary embolism to name a few. hypercoagulable patients are at risk of thrombosis of their angioplasty

i think we need to encourage science and data collection, regardless of where and who does the procedure. Dr. Zamboni has created a registry so we can capture as much data as possible