This Is MS Multiple Sclerosis Community: Knowledge & Support

slow down, cece, the proof is in the puddin

helen, can you show us the venogram that was ultimately found to have an abnormality so we can see if I am correct in thinking that a duplication hid the stenosis?

...edited out: wrong type of duplicated IJV...

I am still impressed, Dr. Sclafani, even if Helen's IJV does not turn out to be a duplication. If it'd been my vein and my doctor, he'd have used IVUS and we'd have known for sure right away.

And I am convinced Helen has an excellent doctor also. He was able to identify the stenosis on the MRV and go back in a second time and fix it. With so many travelling patients, this is better care than nearly anyone gets; for many there would be no second procedure.

cece
what i am describing is very different. it is an incomplete duplication of 206 cm of the jugular vein centrally. it shares a common wall with the true jugular vein. and an orifice with the sublcavian/inominate

terminology strikes again!

That does explain why this

is a possible solution. There has to be a common wall before you can fenestrate the common wall.

Dr. Sclafani,

Two potential techniques or methods (without stent or surgery) are intriguing.
(1) What technique or instrument might be used to create the opening in the common wall of the vessel? (2) How might the lumen be closed via endovascular procedure?

I know this is all very hypothetical.
Thanks in advance Dr. Sclafani.

_________________
It's a paradigm shift

I'm buoyed to read the amount of discussion on this problem "possibly duplicate" vein. When I get the most recent venogram images, I will upload for further discussion. The windsock analogy kinda fits with my observations on posture (my symptoms are far worse when i sleep flat, than when i sleep on my left side). Proof will be in the puddin'.

Can you believe that my right side has worse symptoms these days than my left side (which is governed by a hypoplastic jugular...only 0.5cm in width now it's been stretched and the 0.2cm stenosis cleared).

Definitely happy with my doctor. He's conservative, but collaborative and open-minded.

H.

Dear Doctor,
I wish you a successful 2011.

I have PPMS since 2003 with Edds 7.0.
25.08.2010. I have the liberation procedure in Sofia, Tokuda Hospital. I had a very small improvements, such as excess energy and I was stable so far.
Ten days ago I felt a tremendous fall, each day worse than the previous one. Galloping.
I called Tokuda hospital and they told me to come to control and if there was restenosis, repeat the procedure.

Does it make sense to go to the control and repeat the process of liberation?
This life makes no sense, but I am very afraid of the future.

Dear Sara:

re-stenosis do happen often as far as I am aware; and tho we do not think it is 'normal' it seems to be in the actual state of the development.

Life does have a sense; cheer up; we all in this together

you can join my residency program

We might have to invent the instruments
we can poke a needle through the common wall....that is not likely to be a durable technique. We can develop a scalpel that travels on a guidewire.

closing the duplicaiton is possible but we wsould have to invent it

in good time

helen
I am not surprised. i do not think there is any correlation between side of stenosis and side of brain damage
s

if you had improvements for four months, then you should go back and have another look. All the doctors are getting better at this day by day. The doctors in Tokuda work very hard to make good results. When you have long period of PPMS, the damage is great, the likelihood of miracles is low, but slowing the beast may be worth it to you.

ok class....

Today we review an azygos vein. This vein, which drains the spinal cord via intercostal veins and lumbar veins, enters the superior vena cava at the top, the renal vein in the middle and the ascending lumbar veins at the bottom.

The findings of malformations are
1. valvular problems of fixation, stiffness and fusion
2. Webs & septations running through the ascending component of the vein
3. twists and kinks

Let's have a look at this:


1. on the left contrast media is injected at the tip of the catheter (red arrow). One notes that there is no dye flowing up toward the superior vena cava.
2. on the second image one sees that there is dye above the area of blockage (red arrows). This is flowing past the obstruction through a large feeding branch. (orange curved arrow)
3. On the third image the narrowed segment is quite obvious. For those readers who are not obvious and have real moral character, the red arrow points to the pointed narrowing.
4. Finally, the last image on the right SHOWS NO NARROWING. What could be the explanation?

Tomorrow we will continue this harrowing adventure.

This is Dr Whiplash, i am out to lunch.

I know, I know!!! I know the answer (so do you want me to answer? - I defer to the expert in this case, you of course Dr. Sclafani) ... I don't want to devalue that education and expertise you've been so kind to bring to this forum by using incorrect terminology.

I just hope you work hard and put some collective brain power together with some of these great doctor colleagues of yours (perhaps your friend who treated it the first time) ... and find a good, permanent "fix" ...

It was a pleasure sir. A true honor.

That was nice, thank you.

CCSVIhusband, I think he is interested in generating discussion, so if you can weigh in, I would not hesitate to do so. Or are you familiar with this particular azygous?

Why do the middle two images have diagonal lines across them, while the first and last don't?