Nunzio wrote:Hi Dr Sclafani,
sorry for the long post above; it took me a while to translate it.
I found very interesting to see what other doctors are doing specially if they have good results.
He made a point, also stressed by you, that the main cause of CCSVI is the valve at the base of the Jugular vein and that gentle dilation doesn't work.
You need to break the annulus.
i think that unnecessarily breaking of annulus can cause troubles with thrombosis. I imagine the valves floating in the vein like a sail on a mast that has broken.
So, if the valve leaflets are fused, would it not be better to perform an angioplasty that does not disrupt the annulus? I am using the IVUS and the angiography to evaluate the effectiveness of the venoplasty. If valvulostomy doesnt work, then pop away and perform an annuloplasty.
A nuance of Dr. Luppatelli is that he is using kissing balloons to increase the diameter. Using smaller balloons and doubling up, allows higher pressure (LaPlace's law, Cece) but i do not think that they can attain the pressures of the Atlas balloon, that can generate pressures of more than 40 Atm.
The other point that I have not seen mentioned before is that he performs doppler during angiography and that helps with artifact and false positive negative of both procedures.
yes i agree a useful adjunct.
The last point was that people with "normal" doppler or venography can benefit from balloon angioplasty anyway.
Your comments will be much appreciated.
it is hard to find a normal, these days
This past week a patient seemed to have a normal vein but with further analysis and gentle dilatation, it became clear that there was something amiss and both jugulars were dilated, hopefully with something good to come.