tinajo wrote:Dear Dr. Sclafani,
I have a big decision to make and I am in need of your advice.
I recently had a doppler US in Arizona with Eric Feigenbutz. I basically have oversized, floppy valves/leaflets in my IVJ.
So, I was considering travel to NY to see you- however Dr. Makris is much closer and no flying.
My questions are:
Are your discoveries shared with the other AAC doctors?
especially dilation size and length and type of anti-coagulants.
If I am treated now- and plan on staying around another 40 + years will my veins be able to hold up to future tune ups or do I risk damaging them for future improvements in treatment. I realize this is a difficult question- but I would like your thoughts on this.
Thank you for everything- I can't truly express the gratitude I feel for your willingness to make yourself available to us- I was having such anxiety over this until I discovered you on TIMS. You made it all so real to me.
We do share techniques and ideas. However each physician is his own practice and each physician ultimately decides how he will treat
moreover, the other centers currently do not use IVUS so their practices are somewhat different from mine
There has been a lot of talk lately about if multiple procedures are safe or should be avoided. Dr. Arata, who uses larger balloons and higher pressures, and Dr. Siskin, who is more gentle on the veins, have both concluded that caution is warranted before doing multiple procedures. Dr. Sclafani's answer has been that we do not yet know what the limit is. It may be unlimited. There were some nuances to his answer, it's a page or two back, it was also discussed at the AAC Patient Day.
Dr. Sclafani's strategy of using IVUS to measure the vein is more precise than other doctors' methods of eyeballing it from the flouroscopy image. Dr. Sclafani and Dr. Cumming both have shown us examples where the oval-shaped vein has a significantly different measurement when done by IVUS than when done by eyeballing. Being precise about the measurement is important because the measurement is used to choose balloon size. Too large of a balloon may damage the vein. So, his strategy may be better than that of other doctors at protecting the vein from damage, which would allow for more future procedures.
There needs to be clinical research done before we know any of this for certain. Other doctors do not discount that IVUS adds extra information, the debate is whether that extra information is worth the extra cost. When it was my own veins at stake, yes, I found it to be worth the extra cost.
I know you asked for Dr. Sclafani's thoughts and, for this portion of the question, what you got was Cece's. Sorry about that.