This Is MS Multiple Sclerosis Community: Knowledge & Support

Were you ever checked for Nutcracker, HP? It can be diagnosed with noninvasive doppler ultrasound ( http://www.ajronline.org/content/172/1/39.abstract )
Very sorry to hear about the new lesions.

Cece, thanks, I didn't know DUS can diagnose NS. Originally, I had been thinking along the lines of webs or septums being inside the hemiazygos as a possibility for the new lesions. Although I don't seem to have any symptoms of NS, for peace of mind, I'll ask to be checked for it at my next follow-up DUS.

I might add that IVUS of the vertebral vein was exciting. It showed anatomy wonderfully and did confirm suspected abnormalities

you are correct. the vertebral is the one on the right. Why a catheter in it....in good time

I also look forward to this opportunity. i can think of a few possible planned second procedures:
1. a highly resistant stenosis requiring very high pressures might be better suited to a planned second procedure rather than going overboard.
2. a questionable dissection, leading to an early ultrasound and second procedure
3. detection of an initially unrecognized lesion that is seen in retrospect after patient leaves the proceduree
4. an overly long procedure might be suspended with anticipated return.

I have to be judicious with this because the company still needs to at least make some profit to justify continuing the program. It is a for profit company.

We also will have a half priced policy for subsequent procedures. I will try to work out a technique that uses the data from the initial IVUS so that we can avoid the cost of the IVUS.

Yes, this really excites me. Compassionate care is important to me. Having patients worry about whether they can afford repeat procedures which many will need, is heartbreaking.

An image is worth a thousand words...I would trade these twenty words for an image, if one or more were forthcoming? More please.

Cece, I forgot to mention that my next follow-up DUS will be with DrS (I saw Dr. Siskin for a follow-up DUS when I couldn't travel to NYC at the time).

DrS, I've had debilitating fatigue for over ten years, and left leg weakness (back of entire thigh) arrived with my current exacerbation. Are these enough signs of possible NS for you to order imaging of my left renal vein during my follow-up DUS? My symptom improvements (one year post-PTA) are still holding strong.

DrS,

Best wishes at the SIR conference this weekend!

Ultrasonographic Evaluation of Vertebral Venous Valves

Chi-Hsiang Choua,
A-Ching Chaoa and
Han-Hwa Hua

From the Neurovascular Section, Neurologic Institute, Veterans General Hospital-Taipei, National Yang-Ming University, Taipei, Taiwan

Address correspondence to Professor Han-Hwa Hu, Neurologic Institute, Veterans General Hospital-Taipei, Taipei 11217, Taiwan

Abstract

Summary: To date, vertebral venous valves have not been studied clinically or by sonography. This report reveals that these valves could be studied noninvasively by using sonographic techniques. Real-time sonography clearly showed the opening and closing of the two cusps of vertebral venous valves at the junction of the vertebral vein and the brachiocephalic vein, which move synchronously with the internal jugular venous valves. This is the first time the vertebral venous valves have been studied by using clinical sonography. This might provide a new point of view for evaluating the clinical significance of vertebral venous valves.
Copyright © American Society of Neuroradiology

here you go, cece.

This is my first IVUS of a vertebral vein. The medical necessity for this IVUS was the fact that the internal jugular vein in J3 had long standing occlusion secondary to an overly aggressive angioplasty of a phasic compression of the IJV as it crosses the second vertebra.

I saw some abnormality on the prior venogram and wanted to confirm my impression from the venogram that the vertebral had a valve and that it was thickened. I have read that the vertebral vein is valveless, but i think that is incorrect urban legend.



Four images
left: highest level before it turns into a vertebral plexus, which accounts for the tangles at the top of the venogram. this is in the bony canal with vertebral artery and vein nicely visible. on all four images one sees this echogenic dot (yellow arrows). I am thinking this is a web.

left middle: The vertebral artery is no longer seen. The larger common carotid artery is adjacent to this

right middle. Closer to the chest one sees the thickened valve that is immobile (curved orange arrows)

Right The vein is now entering the subclavian vein.

I performed a delicate vertebral vein angioplasty because the left IJV was occluded and not functioning.

These are perhaps my ten most memorable reports from patients. they are not typical, for most patients have slight changes, that are sometimes pregressive improvements over time, others may not even be real. Other patients have never given me a followup

I ask all my patients now to send me a monthly email on their 'Liberation Day". hopefully many will do it so i can put what i do in perspective.

of course, i have said many times, my goal is to prolong time to disability. Everything else is a joyful surprise or a frustrating disappointment.

So here is the cases i will share with you

1. i its like all of a sudden someone took off my glasses and washed all the smudges off. But i wasnt wearing glasses.

2. i was so tired that i have never stood by the family bonfire as long as my kids can remember. Now i do. A few months later i am cross country skiing with my wife in the evenings.

3. I had a patient who was a wall walker, day after the procedure he came back and stood on one leg for what seems like a long time, and then rode a bicycle two weeks later.

4. i see in technicolor

5. I am less tired

6. I can harvest the winter wheat driving the combine and walk on the uneven terrain of the mud without falliing

7. nothing has changed

8 i feel worse, my balance is not as good

9.My feet are warm now

10. everything looks sharper and clearer

dr s,
I think youre amazing...im not blowing smoke up your behind. you talk about amazing discovery and technique, but with all due respect, and i mean due, i dont read much or can i find much about the improvements, which im sure are vast, in your patients? can you please share? thank you with all the respect in the world.