dlynn wrote:Dr. Sclafani,
Are you seeing "Renal Vein Compression Syndrome" in any of your MS/CCSVI patients?
If so are you treating with stents and what is the outcome?
I have been studying the renal vein compression syndrome for about two years. I have performed venography and IVUS on all patients for almost one year.
The findings on venography are sometimes subtle, manifested by either reflux into the ascending lumbar vein, the ovarian/testicular vein, and/or the azygorenal vein, and by decreased radio-opacity of the contrast column in the area where the aorta should be.
Renal vein compressive occlusion is quite common in humans: about 25% . If symptoms are present, then it is called the nutcracker syndrome. If there no symptoms then it is called the nutcracker phenomenon. The symptoms of nutcracker syndrome include fatigue, imbalance, pelvic pain, rectal pain, hematuria, proteinuria, hypertension, pelvic variose veins, pain in the area of the ovaries, varicoceles of the testes and perianal hemorrhoids and varicosities in the upper thigh, or external genitalia. Because most patients with MS have fatigue and ccsvi, and because 2/3 of the major collateral veins take the very high renal vein flow, i generally treat patients with nutcracker syndrome in PwMS.
Because this is a compression syndrome, simple angioplasty will not be effective. I perform stenting of the renal vein in all cases.
Many of the patients i have treated have had significant improvements, although others have had no response. It is definitely impossible in most cases to separate the effects of jugular/asygous venoplasty from the effects of treatment of the nutcracker occlusions. However I have had a few patients who did not have any treatment other than the nutcracker and had resolution in the symptoms.
In keeping with the FDA warning, I should add that stenting the renal vein is an "off-label use of a stent. Complications are uncommon, but should also be mentioned: migration is a known risk, occlusions are uncommon, with patency at 3 years as high as 95%.