drsclafani wrote:You are indeed fortunate that your thrombosis was able to reverse itself while on coumadin. Often, occlusion of the jugular vein is a permanent thing. You might not have had such an outcome if this vein had been the second vein treated rather than the first one.
I think that the ultrasound examination is the best screening test. Cheap, accurate and to the point.
Now you want to know how much flow there in within the vein? I would personally want to perform a venogramto assure that the vein interpreted as the IJ, actually was the IJV. Sometimes collateral vessels get quite large and may look very much like the internal jugular.
If the vein is narrowed significantly, I would try angioplasty with the expectation that a stent might be needed.
What possibly could be causing all the thromboses that we hear about. I wonder what percentage of patient treated develop IJ thrombosis.
I know that the cases of thrombosis that i have been involved with come in two forms.1. Overdilation of veins and very high pressures in relatively normal veins. Choosing vein diameter is much more precise using IVUS. I havent had a thrombosis since changing my procedure. The other association is with thrombosis resulting from treatment of hypoplastic veins. That is the reason that I have backed off aggressive treatment of hypoplasias..
Thanks for answering my question.
I guess what you're suggesting to me is that I should have a venogram done if I'm not satisfied with the US interpretation and the results I recieved with the procedures I had done. I have a feeling that an 18mm balloon was probably bigger than what should have been used due to not having the accuracy of IVUS, thus possibly causing the thombosis that occurred. When I looked at the before and after size of the LIJ, it looked quite larger after the first procedure. I'd post them with snagit, but don't know how to.