drsclafani wrote:in all the cases that i treat, i repeat the ivus after angioplasty. I look for residual defects, immobile valve fragments, thrombus, but i have never measured the cross sectional area of the vein before and after angioplasty. It seems so obvious that i should have, but i didnt. Something else to look at
Here's a link where a doctor, Dr. Scalise of Monza, Italy, published ivus images of a jugular before and after ccsvi venoplastyhttp://www.ccvi-online.com/emea/sites/w ... df#page=18
The pre-angioplasty measurements are 113 mm2 cross-sectional area of the vein but narrowed down to 45 mm2 at the valvular stenosis. After angioplasty, the vein measurement is 107 mm2 and at the site of stenosis it is 81 mm2. Is this a typical amount of residual valve material? Do you often see veins open all the way up 100%? I had thought the vein itself might stretch, so that the initial 113mm2 measurement might go up, but it did not.
The doctor chose a balloon based on 20% oversizing.
checking Dr. Sclafani's chart and doing math
chart = chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic10680-5550.html#p172379
math = 113 CSA could get a 12 balloon which is 144 CSA which is oversized by 27% which is close to what Dr. Scalise has described
but if you went up to a 14 balloon at 154mm2 that would be a 36% oversizing which would be ok
or up to a 16 balloon at 201mm2 would be a 78% oversizing (using percentage calculator http://www.percentagecalculator.net/
But when he says he chose a Maxi LD dilatation catheter 18 X 40 mm, I think that means an 18 balloon at 254mm2, which would be a 124% oversizing!
My attempt to resolve this is to think that he chose a balloon based on the long pink line which is the diameter of 15 mm and not based on the CSA. The vein is an oval not a circle and the other diameter is measured at 10 mm.
[other technique notes: He inflated four times at 6 atm at a maximum of 3 minutes. The pressure of 6 atm is a low pressure which is good if the balloon is overly oversized (high pressure + oversized balloon = potential vein injury collapse scarring). Three minutes is a long time to have the balloon inflated as it can cut off oxygen flow to the vein itself.]
Did I miss anything? Am I correct to think that an 18 mm balloon for a vein with a 113 mm2 CSA is not a 20% oversizing but a much higher percentage of oversizing?
A month later, the patient's EDSS had gone from 4.5 to 3.5.