First I thought that the RIJV has a narrow annulus where the vein gets real thin in a very small segment and that is why the long part above is stenosed, but then souldn't there be a bulge above the narrow annulus? As far as I know they dilated the valve and the vein with a small balloon (6x20mm) but they did not break the annulus. So a few weeks later the lower part got restenosed (1cm) then a week ago I got another Doppler and the IR saw the whole full section got back where it was. I guess this would be an elastic recoil. However, the second time the IR told me that he sees some drifting piece there. If there is a narrow annulus, souldn't be enough to break that and then the vein sould get normal? Of course, if there is no thickening of the wall.
i am sorry, Liberation, in truth, the images that you show are so bad that one cannot really make accurate comments about them. There do appear to be segmental narrowings (?hypoplasia) but the area of the valve is not visible at all. Also you state that a 6x20 balloon was used. seems rather short, possibly rather thin. Might i guess that your IR was a cardiologist? just a guess and with no bias intended.
you cannot tell wall thickness from a venogram. A venogram only shows the inner part of the vein, a "lumenogram"
As for the two other veins I do not see major obstacles.
Liberation, i dont see any "major" obstacle either....the problem is I don't think that i see anything there. You have to accept that what you are showing us does not meet standards. One cannot make ANY comments at all. And what is "MAJOR"? That is still under debate.
Dr Sinan told me he would dilate the valves there. I am not sure if saw specific problem there or he always do that. As far as I know he always enters the veins with a balloon to see whether he encounters any problem there. Would ivus be a better way exploring these problems? Would a problem be better identified with ivus or entering by balloon would have some merits?
i prefer NOT to inflate a balloon until I have found some reason to inflate it. Inflating balloons to find lesions is something many physicians do. It can damage intima. That is one of the reasons that I use IVUS which is less traumatic and more accurate in so many ways than inflating a balloon.
That is true that the upper parts are not indicated in the images. Could it be that they did not see those parts?
I think we should always try to see the ENTIRE vein, and, ideally, see the connection between the dural sinuses in the head and the jugular veins in the neck. Just last week i had a case of segmental hypoplasia which did not show reflux into the head. I sent the patient for a BRAIN MRV (not MRV of neck) and it showed clearly a number of dural sinus stenoses.
On the other hand if my recollection is right, Dr Cumming just said a day before that using an extra large balloons in the upper part of the IJVs can cause big problems as it did a full occlusion with Winni's IJV. Could it be? What should be done if those parts are stenosed? Are there valves in those segments that can cause the problems or there is a vein problem?
perhaps you are misunderstanding dr cumming
I agree that one should not use extra large balloons in the upper IJV because it will be a mis-sizing and ballooning may cause more harm that good WITH A BALLOON THAT IS TOO LARGE. Doesnt mean that using a properly sized balloon cannot improve flow in the vein.
If I understand correctly mostly valves are the cause of stenosis.
I try to get the MRV images that were prepared half a year before my operation those should be much better quaility.
ok. but perhaps your scan of your venogram is the problem. do you have the images? or do you have paper prints?
MRV just isnt as good as venography, but perhaps that will help us all understand what you are trying to show us.
Based upon what you have said and shown us here, my opinion is that we cannot provide you with any clarity, sorry.