NZer1 wrote:Hi everyone, I have a question for you all.
Has anyone who has been retreated gained more improvements on the later treatments than on the first?
I have not seen in my recall anyone who has been retreated that has had new or better improvements as though the first treatment has been the benchmark for the symptom changes and it is in my understanding we don't know if there is a halt in progression.
Can anyone say that they have had a halt in progression at this time?
nigel, if you read the first case i presented today, you will see a patient who was not treated on the first go around who had angioplasty of the left IJV and two lesions in the azygous treated by angioplasty and stenting respectively. I did not treat a nutcracker syndrome of the left kidney.
if i might be so bold as to share another case in which the patient had treatment the first time in India with some improvements that lasted a few months and then recurred. I treated her this past week.
From the angiogram you can see that the treated right and left IJV were is good shape and the azygous vein that was not treated remains normal.
in this caase i treated a nutcracker syndrome as the only treatment in the second procedure.
Here are the diagnostic venograms:
Both internal jugular veins were of normal caliber as was the azygous vein. There is an indentation on the renal vein.
A stent was placed and flow is normal now
i attach the patient's report to me:
Hi Dr. Sclafani
Thank you and your team for your excellent care on Monday, and for such an informative and inspiring session on friday.
I know I'm not due to give you an update until Aug. 18th but thought I would give you a quick 5 day update. I am doing well. I think my situation is unique because I assume that whatever benefits I receive this time around can be attributed to the stent in my renal vein and the resulting improved blood flow rather than ballooning of the jugulars or azygous, or any valve work. And I have had a few improvements over and above the improvements I had the first time.
On day 2, I noticed an improvement in my vision while driving in the taxi. I have a greater sense of depth, everything is clearer and colours are brighter. I'm so pleased to have a second improvement. After my first angioplasty it took a month before I noticed improved vision and I thought that I had kept the improvement for the past year. However, I now realize that I had lost some of my benefits and my vision is now top notch again. This is especially pleasing to me because we have just completed our retirement home with a beautiful view over the Ottawa River.
My balance has improved further. I just completed 38 steps heel to toe and stopped only because I ran out of hallway. While my balance improved considerably the first time I couldn't do more than about 7 or 8 steps without loosing my balance. I feel that my gait is also slightly improved. However, I still have the constant pain and fatigue in my legs. I am hopeful I will see further improvement in my ability to stand and walk but am mindful that my lumbar veins are not normal.
I am still periodically tired and drained from the procedure--I slept much of the first 24 hours. My torso, lower abdomen and lower back were sore for about 3 days (and are occasionally tender) and the wound bled a little bit until thursday but aside from a large bruise it seems fine now. I seem to be tolerating the pradaxa and aspirin well.
I'm wondering how many patients you have found with nutcracker syndrome and how many with May Thurners syndrome since you started looking at the renal and iliiac veins? From what I have read online it seems that nutcracker syndrome is quite rare (although perhaps it is just underdiagnosed) yet you found it in 2 patients in one day. Is this congenital or did I develop it sometime over my lifetime? Perhaps the name CCSVI should be changed to chronic venous insufficiency?
Bottom line--I'm very glad I had a second procedure, and of course am even happier with my choice of Dr. I will be in touch again on Aug. 18th
Take care and I will continue to follow you on TIMS. Thanks again,
This is a really interesting and unique test of the effect that renal vein stenosis can have on symptoms of CCSVI since no other treatment was performed and rather dramatic changes occured.