This Is MS Multiple Sclerosis Community: Knowledge & Support

Yes, a 14 mm balloon in the azygous is a big vein here too....
Why though did I have a large azygous and rapid flow but no Nutcracker....my best understanding builds on what you've said before, that my verts were well developed and flow goes from the verts to the spinal veins to the azygous, and from my xl condylar veins to the spinal veins to the azygous.

Without the ivus images, I don't think it looks like there's anything wrong with the azygous arch in the first image. Do you agree?

It's an intriguing line of thinking. But what causes the greater elasticity in the veins in men? Is it as simple as testosterone? Maybe Chaz Bono is onto something....!

I have to go now and I just got to the most interesting of the veins posted. Bluesky, we haven't heard from you, what do you think? I really appreciate seeing the hemiazygous and ovarian veins in the image and that the contrast is filling in them and what that means. I am however a doofus who is not entirely sure where the renal vein and the inferior vena cava is in the image.

edited: ok, middle image, we are seeing the renal vein with the catheter in it, and the larger light vein to the left going up must be the inferior vena cava. Were the ascending lumbars also being used as collateral veins? That's not good.

But these images of the renal vein and collaterals were taken after the azygous was treated, correct? So even after the azygous was treated, it appears that there is contrast going into the ascending lumbars? By the time you got to this part of the procedure, the patient had corrected flow in the jugulars and in the azygous. It's interesting.


mystery solved....

Ovarian vein valves! That was helpful to explain it. High flow in the wrong direction would indeed be detrimental to the function of valves meant to control flow in the opposite direction. Embolization would seal off the vein to the incoming wrong-way flow from the renal vein, allowing things to flow the right way again, even without working valves.

whew, I worked through this case, next case please!
There was a whole month without them, you know. Such hardship.

(But no pressure, much respect for your limited time, etc!)

For my right Jugular, he ended up using 20mm at 15atm after he found that an 18mm (my vein was 16mm) did not resolve a waist in the balloon. And if I am reading it right, IVUS showed that I needed a larger balloon on my left as well. 20mm at 13atm. He did note that I was on the extreme side, so I guess not common.

that data is currently being tabulated. As a guesstimate, I would say that pressures necessary to eliminate the waist and have negative test for elastic recoil in the jugular veins ranges from 5 Atmospheres to 26 atmospheres. the average would be somewhere around 14 atmospheres. In the azygous veins the pressure is much lower in the range of 5-8 atmospheres.

However if required pressures reach 18-20 atm successful COMPLETE angioplasty is not 100% successful.

I might add that pressure is not the only methodology. I do not go above 18 atm until after the fifth incomplete dilatation.

Tabulation should be finished in about one week.

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

This is certainly within the range. perhaps a bit larger than normal

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

The incidence of angioplasty injury seems pretty rare these days.

Most of the original injuries during the mis-sized era seemed to have been in women but the majority of the patients are women. so not enough data to make a statement.

actually men have larger jugulars in general but the largest jugulars i have =seen have been in women.

If the vein is obstructed, then the vein tends to dilate above the stenosis. I think that collaterals are more important than stretch in relieving obstruction and reducing reflux

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

i am skeptical that this is significant, if correct.

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

This data is also being reviewed. Preliminarily: venography looks normal in 40 per cent of the azygous valvular stenoses found by IVUS

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

in the middle image there is a stent. that is why you are not seeing the hemiazygous and the ascending lumbar vein

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

Ok, I can see the stent in the middle and last image. That is the renal vein. That means the last image is just the usual one with contrast meant to light up the ascending lumbars, which look good.

The first image, now if I follow the catheter, that must be in the renal vein where it is releasing the contrast. I wonder what vein the catheter is in to get to the renal vein and why the vein the catheter is in does not light up? But the IVC is the very light vein that goes to the left and up. And the renal is compressed by an unseen artery so its flow is diverted to the hemiazygous and ovarian veins, which is why the contrast is able to light them up. The dark cloud at the top left of the image is unimportant.

Now that I've got the layout down, wow, that is an extreme change from the first to the second image. Once the stent is in, nothing lights up but the renal vein and the IVC.

What I am taking from all of this is that, instead of pelvic congestion syndrome affecting the cerebrospinal drainage, it is the messed-up cerebrospinal drainage that has affected the pelvic veins.

!! That is exciting.

Very nice!

You've seen the abstract on IVUS presented at CIRSE, with a very small sample size but similar findings that IVUS was able to show stenoses not seen on venography?
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic17846-15.html#p175921

Another side of the coin is if there are any cases that are the opposite, where venography shows an apparent stenosis that, upon using IVUS, is not a real one. And you must be tabulating how often the venography looks normal in the jugulars too but IVUS reveals a stenosis. Is this less common in the jugulars than in the azygous?

According to these findings, it seems that IVUS must be part of the standard procedure of a venogram. Otherwise both diagnosis and treatment are incomplete.

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