As I understand the procedure, the contrast dye is only sent down one side at a time; therefore, the venography of the L-IJV would not opacify the R-IJV. The Right VV (and other veins) are only visible (opacified) because they are connected by collateral veins. My guess is that there is a R-IJV that we haven't been shown (yet).
Could be. This makes me think to ask very specifically: by what route is the contrast getting from the LIJV to, say, the external jugular on the right side? My assumption had been that it went across the sinuses and, since the EJV and the VV on that side lit up, the IJV should've lit up too.
Busy busy drsclafani, come back and clarify!
Cece, I think we might have been too busy looking at the trees that we didn't see the forest because in DrS's introduction to the case, he said that there is an R-IJV:
As usual I accessed the venous circulation via the left saphenous vein. I attempted right jugular catheterization first. However after 30-40 minutes, I could not enter the right jugular vein. So i moved on to the left internal jugular vein..
Catheterization was also very difficult and I was about to give up whenI finally was able to enter the LIJV. Almost one hour had passed.
The case is interesting because the IJVs are supposed to take control away from the VVs when the patient is in the supine position during the venography, BUT both VVs opacify (darken with dye) just like the IJV which means there's a blockage (valvular stenosis) causing reflux into the VVs. A major collatoral circle involved might be the intracranial condylar venous system.
I wonder if this woman is the patient who needed to come back the next day for more work. DrS spent twice as much time trying to find/create an opening in the L-IJV valve than he spent on the R-IJV valve, so maybe he wanted another crack at the stubborn R-IJV valve. Here's a radical idea: Via the dural sinuses, find/create an opening in the R-IJV valve from above
the valve, then attempt normal venoplasty from below the valve.
Is this the first time we've seen a VV take on refluxed blood? Did the VVP receive refluxed blood, too? In CCVBP theory, the VVP is the route by which lesions are formed on the cord.