DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

using port for access for liberation

Postby drsclafani » Tue Mar 16, 2010 10:15 pm

Perhaps the port could be used to access my right internal jugular, but if a wire was put in my port, it would exit the catheter into my right atrium and it would have to turn right back and trace along the catheter in my left subclavian to reach the base of my left internal jugular.


The port can be injected with contrast media but one would never try to perform a liberation procedure through the port. technically impossible
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Postby drsclafani » Tue Mar 16, 2010 10:18 pm

Do you think that low blood pressure would reduce mean transit time of blood through the brain and increase hypoperfusion?


low pressure might increase transit time and increase hypoperfusion
however the body adapts to low blood pressure by clamping down some arterial beds to protect others like the brain
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vertebral veins angioplasty

Postby drsclafani » Tue Mar 16, 2010 10:22 pm

Quote:
venogram is the gold standard for diagnosing CCSVI in IJVs and azygos you say and of course it makes sense.
What about vertebral plexous problems? Atresia, agenesis or whatever.
Would you suggest a specific test (like ct scan or MRV) just to make sure especially when venogram is not indicative for CCSVI?

I know it s early days, but given the fact that blood drains from the vertebral vains when in upright position isn't imaging of these veins also, of special importance?


I asked the same question on sunday to a certain well known investigator. awaiting an answer

these vertebral veins are pretty small. I wonder whether they would stay open after angioplasty


i cannot think of a reason why venography would not be indicated for ccsvi. the incidence of ccsvi in ms is so high and mrv does not adequately assess the azygous vein, i would perform venography on anyone.

it has been suggested that vertebral venography and angioplasty has no role. Personally I am not sure yet
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Re: using port for access for liberation

Postby weeble » Tue Mar 16, 2010 10:48 pm

drsclafani wrote:
Perhaps the port could be used to access my right internal jugular, but if a wire was put in my port, it would exit the catheter into my right atrium and it would have to turn right back and trace along the catheter in my left subclavian to reach the base of my left internal jugular.


The port can be injected with contrast media but one would never try to perform a liberation procedure through the port. technically impossible

Thank you for your reply. The lightbulb just went on in my head, of course you could not place a sheath, guide wires and balloon catheters in my port regardless of it being in an inconvenient location. You would destroy my poor port.
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Re: vertebral veins angioplasty

Postby costumenastional » Wed Mar 17, 2010 2:50 am

drsclafani wrote:
i cannot think of a reason why venography would not be indicated for ccsvi. the incidence of ccsvi in ms is so high and mrv does not adequately assess the azygous vein, i would perform venography on anyone.


Thank you Doctor.

You answered to my question, and of course you should perform venogram on anyone by all means!
I was trying to say that venogram cannot access those tiny vertebral veins, so if a venogram doesnt lead to a ccsvi diagnosis this doesnt mean that someone has no vein problems. Maybe he should undergo other tests also.

I meant
Indicative of: Means that doppler saw a stenosis problem.
And not
Indicated for: Means that something should be done.

Sorry for my english.

Thank you again.
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vertebral veins

Postby drsclafani » Wed Mar 17, 2010 5:50 am

ou answered to my question, and of course you should perform venogram on anyone by all means!
I was trying to say that venogram cannot access those tiny vertebral veins, so if a venogram doesnt lead to a ccsvi diagnosis this doesnt mean that someone has no vein problems. Maybe he should undergo other tests also


dear costumenastional
at the present time, in a phase of discovery, all the tests should be performed to determine 1. whether a screening test adds value, is accurate and is reproducible. 2. figure out which is going to be the gold standard

the vertebral veins are not that small and the catheter can enter them

what to do is a different questoin.
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Re: vertebral veins

Postby costumenastional » Wed Mar 17, 2010 7:44 am

drsclafani wrote:
the vertebral veins are not that small and the catheter can enter them

what to do is a different questoin.


Exactly...

I didnt have a clue that vertebral veins can be accessed by catheter. This sounds promising!!! Lets hope noone will have to go that far though...

It all comes down to brave patients and even braver doctors. Please, keep trying to help us Dr Sclafani. This may turn up to be the discovery of the century. But even if it doesn't, we ll know we did the best we could.

There are a billion questions i could shoot you with at this point. But i can see that you will try to find the answers anyway and i am extremely happy. I wish time was not so critical...

Good luck with your work, i hope more like you join our fight VERY SOON.
Last edited by costumenastional on Wed Mar 17, 2010 7:58 am, edited 1 time in total.
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Postby tzootsi » Wed Mar 17, 2010 7:56 am

Dr Sclafani,

My wife is awaiting a call from our local IR to setup an appointment for an angioplasty. She has already had a doppler to confirm a problem in her left jugular. However, since she found out that this procedure involves going thru the heart she has become very apprehensive about having the procedure done. Other than her mild ms, my wife is in excellent health, and bikes an hour a day. However her father died at age 27 of a coronary, which is the cause of her concern. Are there any risks to the heart in this procedure?
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membranes in veins and non-fonctional jugular valves

Postby petebou » Wed Mar 17, 2010 8:01 am

Dear Dr Sclafani,

Thank you to take the time to answer our questions: your input is highly appreciated.

When angioplasty is performed on veins to correct inverted (or sticky-faulty-valves) or to remove membranes from the lumen of these, are there any debris released and if so, what is their fate?

A few TIMsers reported accessory nerve damage after stent placement high up in the IJVs: is this unavoidable ? Is balloon angioplasty safer for interventions high up there with regards to accessory nerve damage? What are the probabilities for the vein to stay open without stent placement in this location?
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Postby Mutley » Wed Mar 17, 2010 9:29 am

Dear Dr Sclafani,

No questions. I just wanted to say a massive thanks for taking the time to answer questions and spend time with us on this forum. Your input is certainly very much appreciated by everyone here.

Thanks again, and very best wishes!
Mutley goes to Poland 1st symptom was Optic Neuritis in 1998, DX RRMS Jan 2001, DX SPMS 2007. Last EDSS by doctor 7.5
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Postby prairie » Wed Mar 17, 2010 1:22 pm

Dr. Sclafani, I don't know how you find the time to reply to questions but it is appreciated by MS patients and us caregivers.

Thank you
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Question regarding treatment in U.S. versus Poland

Postby CathyRabbit » Wed Mar 17, 2010 2:40 pm

Dear Dr. Sclafani,

I have a huge decision to make. I have just received dates to have the liberation procedure done in Poland in April, but I have also met with a vascular surgeon in the States who can perform the treatment. I'm booked to have an MRV March 22nd, and the treatment a week or two after that. Obviously, it's alot more expensive to go to Poland, but the doctors there, (Dr. Simka) have been dealing with this since October and they want me to come back in 6 months to make sure everything is okay still. Is this the sort of procedure where I shouldn't worry about the money and go to the top doctors or should I save myself some money and go to the States which is only a 2 hour drive for us? This decision is causing me alot of stress and I have to decide by Monday!! Any insight you might be able to give me is greatly appreciated! I think it is absolutely amazing that you are taking time to answer peoples questions here, I'm sure you are very busy and now you are going to be swamped with requests, so we all truly appreciate it.

Cathy
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vertebral veins

Postby drsclafani » Wed Mar 17, 2010 6:14 pm

drsclafani wrote:


the vertebral veins are not that small and the catheter can enter them

what to do is a different questoin.


Exactly...

I didnt have a clue that vertebral veins can be accessed by catheter. This sounds promising!!! Lets hope noone will have to go that far though...


who said it hasnt been done? I did it twice today.
both verts were abnormal.
but what to do is a different question :D
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valve debris

Postby drsclafani » Wed Mar 17, 2010 6:29 pm

When angioplasty is performed on veins to correct inverted (or sticky-faulty-valves) or to remove membranes from the lumen of these, are there any debris released and if so, what is their fate?


The valves are connected to the wall of the vein. The angioplasty is trying to stretch and shear the attachments to the wall but it is unlikely that a valve or web or membrane or septum could be completely detached. If it did detatch, it would go with the flow. Where would that be?

The flow would be into the right atrium of the heart, through the right ventricle of the heart and lodge in the pulmonary arteries that cause gas exchange in the lungs. The amount of tissue that might would be minor and would not have significant effect on lung or heart function.
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Postby ozarkcanoer » Wed Mar 17, 2010 6:30 pm

DrSclafani,

I just want to thank you for coming here and talking with us ! You have no idea how much it means to us that you would take the time to answer our questions.

ozarkcanoer
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