Moderator's Note: Thanks to AlmostClever
for putting together this index of Dr. Sclafani's thread, "DrSclafani Answers Some Questions
." I have created links to each of the pages and made it sticky. I hope that AlmostClever will continue to update the index. Additions to the index will be updated here as they are made available. Page Question Topic Page 1
New problem in jugular
Stenosis come and go Page 2
Effects of low flow
Contact info Page 3
Venogram Page 4
Low blood pressure/mean transit time
Angioplasty debris Page 5
Angioplasty nerve damage
Venoplasty through heart
Valve problems Page 6
Collapsing veins and treatment
Ballooning solve valve probs Page 7
Flow and reflux
Spinal cord drainage
Angio and stents Page 8
New covered stent
New stent development Page 9
Blood circulation problem
Angiogram CCSVI diagnosis
Stents Page 10
Pocket in IJV
Procedure curiosity Page 11
Blood flow vs lesion location
Veins in CCSVI Page 12
Addressing stenosis prior to procedure
Restenosis cause/prevention Page 13
Too much brain drain
Restenosis prevention / Vitamin K
Cutting balloon Page 14 Page 15
Vein narrowing quantification
Vein wall weakening
Vein scenario question
Venogram learning curve
Sclafani peers Page 16
Childhood CCSVI detection Page 17
Childhood heart operation
Treating early MS'ers / CCSVI
Problems found in all patients
Seizures and angio Page 18
Collaterals and stenosis
Distending vein / collaterals Page 19
Low blood pressure
Surgical repair of stenosis Page 20
Presence/absence of valves in jugulars
Radiation and CCSVI
Bad joke about Hillary Swank (diet) Page 21
Upper narrowing significance
Post-procedure Page 22
Flying and anticoagulation
CT-V Scan vs MRV Page 23
Flying and anticoagulation
Vein scar tissue Page 24
Causes of narrowing
Radiology 101 Page 25
Femoral nerve damage during angio
Improvements? Page 26
Sclefani procedural improvements Page 27
Leiden Factor V and stents
Legal fear / procedure stalls Page 28
Elastic recoil Page 29 Page 30
MS treatment resistance
Research and procedure
Research and procedure
Research and procedure Page 31
Iron theory Page 32
Neuro participation w/ Sclefani
Treatment complication comparison Page 33
Neuro recruitment Page 34
Controls Page 35 Page 36
Only 7 years of proof…
Insurance economics Page 37
Iron theory Page 38 Page 39
Umbilical cord question
Diagnosis/procedure codes Page 40
A new inspiration/gratification Page 41
Congenital/non-congenital causes Page 42
Only 1 jugular vein
Hippocrates Oath (modern) Page 43
Crappy vein syndrome and MS
Invisible "missing" jugulars
Red feet Page 44
How to help Dr. S
Physical therapy Page 45
Student interest? Page 46
Pregnancy and blood volume
Chiro neck manipulation Page 47
High EDSS question
Azygous MRI imaging
Carotid artery rubbing, sleepiness
Legs after treatment
Contact info Page 48
Fatigue vs Sleepiness
Zamboni pathological reflux definition/paper
Duplicity and drainage of critical areas
MS and multiple diseases/conditions Page 49
The power of suggestion…
Catheter Venography with IVUS Page 50
Stents and Chiros
Dyes and ReactionsPage 51
Kuwait comments / Letter to Dr. Sinan
Response from Dr. Sinan
Upcoming trial description
Get on a list!Page 52
Pressure and reflux
Normal, Anomaly, abnormality
Seek testing quality
Screening vs definitive testing
IJV, collagen, connective tissue
Throbbing neck veins
CCSVI and Tinnitus
Relax after stentsPage 53
Vertebral vein reflux/getting 2nd opinons
Getting IRB approval
Transcranial magnetic stimulation
RiciPage 54 Page 55
Local NYC IR interest
Nunzio showing offPage 56
Zivadinov's Iron Deposition
Blood Thinners and Ballooning
Ballon Angioplasty Trial Obstacles
Aspirin and Venogram
Ultrasound and Intracranial Veins
Dr. S plans to treat!
Some veins too small to balloon, verts and collaterals...Page 57 Page 58
Must test invasively
Stents more or less permanent
Can venous issues develop from trauma?
Hospital practicesPage 59
IRB approval = hospital go ahead
CCSVI is hospital issue, not US DHHSPage 60
Restenosis as a controlPage 61
Visible external malformations
Questions for your surgeon
Sleeping position question
CCSVI Patient Registry?Page 62
Which docs have the best experience?Page 63
QUIT CALLING IT SURGERY!!!
Neurovasomotor problems in extremeties
Continue immunosuppressing drugs just prior to procedure?
To stent or not to stent?Page 64
Doesn't IRB know Liberation is safe?
Beyond azygous and jugular?
Why does CCSVI warrant treatment? Proving it…
Spinal cord MS
Restenosis? Go right back to venogram…Page 65
Hotels near Dr. SPage 66
Guessing/Waiting is the hardest part!
Improvements by MS type
Artery vs Vein ballooning/stenting
Jugular stent design
Stenosis size/location treatmentPage 67
Azygous learning curve
The Elusive AzygousPage 68
Is lesion & stenosis location related?
CCSVI Tests and Descriptions
Venograms missing abnormalities
No Jugs required!?!?Page 69 Page 70
Variation of CCSVI abnormalities
Scan entire body?Page 71
Missing jug cases
Dr. S.'s IRB draft
Advice for Newbie IR'sPage 72
Trials and TrickulationsPage 73
Catherization thru inguinal (and heart) vs brachial vein
"Acute congestive plethora of the head"
Neuro's evaluations needed
Trial compromisePage 74
CCSVI Literature for docs scarce
Neuro interviewing before & after Lib Pro
Ethical trial? How?
EDSS 8.5++Page 75
It's more of a safety study…
Brain trauma and angio safe?
"No treatment" is the Control
Venography detection rates higher
more Trial talk…Page 76
Pesky Placebo & Unquantifiables
A Rewarding Journey Has BegunPage 77
Trials - Safety First!Page 78 Page 79 Page 80
Doc S. - Back after these messages…Page 81
Patient and Statistic Significance
"ndwannabe" casePage 82
Insurance money, Training and Seminars
Patients and Controls
What are we treating?
Scanning is moot - Liberate!
Buffalo Study advice
Membraneous issues seen?
Predicting restenosisPage 83 Page 84
MSQLI (MS Quality of Life Inventory)
Total MRV (MR arteriogram)Page 85
Starting with the big veins…
Measuring Cerebral Oxygenation
MS - not one size fits all…
Why study the neck only?
Study response of all symptoms…
Exclude MS family members as controlsPage 86
Why scrutinize studies?Page 87
Ultrasound protocol question
Specific studies later on…
MRV and Baclofen Pump
Focus on treatment, outcome, learningPage 88
Diminishing control group?
Online patient assessment
"astro" case questionPage 89
Dr S - (almost) Super-Doc!
Comments on "costumenastional" images
Clotting disorder and Venogram/Angio
Comments on Dr. Freedman interview
ED (not what you think!)
Collaterals indicate outflow obstructionPage 90
Pacemaker and MRV?
How to get on Dr. S' List
Don't give advice to those who don't ask for it…
Diabetes, MRV and contrast
PPMS - too early to know…
Venogram vs MRA
CT Scan - pros and consPage 91
Dr. Dake trial question
Following/maintaining patient data
Consistency of follow-up evaluationsPage 92 Page 93 Page 94
Global data collection / Squeekycat questionnaire
Why do we need controls if it seems to work?
Science must prove it
Medical community needs convincing evidence
MRV not good enogh for Azy, use contrast in MRV
When to start exercising again?
1 vs 100 (Treatment vs Study)Page 95
Venogram test of choice!
Types of trials needed
Studies and Doctor Skill Level
"vivavie" - difficult Azy vein
"Informed Consent" requires more research
Stent size - pros/consPage 96
Dr. S. holding back?Page 97
Volunteers needed for trial consent feedback…Page 98
no test 100% accuratePage 99
No improvement in PPMS but hopefully no progression either
Extensive reflux with no blockage?
Why not perform unproven techniques if they seem to work?
Look at CCSVI patients as cohort instead of MS'ers?
Stent migration possibilities
Catheter Venograpy and Irregular Heartbeat
Doctors treat patients - not groups
Procedure not new, the group application is
Venogram - too much, too little dyePage 100
Overstretching veins/ drugs to raise, lower BP
CTOS? What is…
Switching docs after procedure
One vein problem leads to another…
Dr. Zamboni advises staying on meds after procedure
Does remission mean the stenosis went away?Page 101
Why isn't vein dilated when there is elevation in pressure?
Mostly valve problems?Page 102
Radiation / 3T MRV vs 1.5T MRV / Study length
Irregular heartbeats due to flow probs?
Hand and foot circulation improved by Jugular flow?Page 103
Any proven association between CCSVI and other venous valve problems?Page 104 Page 105
Damn A/C! That MRV sucks!
Flap, Web, Septum in veins
More on "Cutting" Balloons…
Vein healing process / Anticoagulation strategyPage 106
MR Scanners and Metal
MS is the Real Enemy
Balloon and Stent size question
Duplication of Jugular Vein
Doppler, ECU, Mrvenogrm, Cather Venography - What can be seen?
When will Dr. S resume procedures?
Treating narrowed veins based on what?Page 107 Page 108
Medicine (& Emoticon Use) is an art! Page 109
Donate blood while on anticoagulants?
Narrowed jugular, CCSVI!
What medical records/reports should I bring?
Coumadin, Heparin / To use anti-coag's or not
Doctors should document MS symptoms and defects foundPage 110
Draining the Brain
"HappyPoet" test report questions
Cutting Balloon and Dural Sinus
Fix blockage, increase vein diameter and flow?
"Patience, my patients!"
Acne and CCSVI?Page 111
Vertigo drug increase bloodflow?
Doing CCSVI (research) right…Page 112
Stent or No Stent…
Things heard in a neuro’s office…
Stent IRB in the futurePage 113
Hurry up and – wait!
Heart Flutters / Cardiac RhythmPage 114
Why do the procedure if benefits are unclear? / University providers needed
Can angio cause new stenosis?
Patients know best…
"Cheerleader" husband casePage 115Page 116Page 117
Doc’s away…Page 118
TIMS’ers making a difference!Page 119Page 120Page 121
Doc coming home…Page 122
More on Cutting Balloons…
Other imaging forms?
Color Doppler Ultrasound
Dr. S job description…Page 123
Becoming "Standard of Care"…
Need studies and data…
Always vein narrowing? MRV note
Catheter: Enter left side? Why?
Relapse after Liberation
Low/High Lesions, "Phasic"
When to use stents & Azygous ballooningPage 125
Diagnostic Only studies: wastle of money
Cutting Balloon and Bleeding?
Note on procedure cost
Dr. S Future PlansPage 126Page 127
Can illness bring back symptoms?
Procedure repetition? / Does MS type predict degree of improvement?
Can Clavicle affect Azygous vein?Page 128
Ultrasound procedure descriptionPage 129
Call me crazy…
Flair triggers / illness
Dr. S. Safety Study Description
RPMS classificationPage 130Page 131
Post-procedure outcomes/Lumbar vein
Post-procedure outcome question
Inferior vena cava / Gonadal vein
CCSVI: Worse over time or damage accumulation?
State of Imaging Study ideaPage 132
Papers brought up by IRBPage 133
Hold onto your CD’s!Page 134Page 135
Break time…Page 136
IRB Proposal DeniedPage 137Page 138Page 139 Page 140Page 141Page 142
What to do? What to do?Page 143Page 144Page 145Page 146
May-Thurner Syndrome commentPage 147
Check all Veins?
Difficulty with "Sham" Operation / Empathy
May-Thurner Disease comment
Don’t send money! (Will work for…BOOZE!)
Experience of doctors for randomized trial
Study while on DMD’s answers what?
(Glad you’re back, Doc!
IRB Proposal Points…
Belmont Commission Report: Protection of Human Research Subjects
BNAC Study and DMD’sPage 149
50/50 overall improvementPage 150
Vein measurement / comparison
Legitimate reasons to treat CCSVI itself?Page 151Page 152
Comment on Italy and CCSVI
Problem with IRB proposal…Page 153
Faulty valve, blood flow, pregnancy questions
IRB’s, Treatment clinics…
Catheter is best…
Liberation for "Fuzzy mentation"?
May Thurner, CCSVI
Doing the Procedure…Page 154Page 155
Dural Sinus, IJV Stenosis
Case Reports and Medical Journals…
Testing for CCSVI without MS diagnosis?
Why look at left Iliac and Renal veins?
Comment on news article,,,
Thyroid gland and CCSVI
Vertebral vein problems, Better esponse to second angioplasty?Page 156
Thyroid? Grave’s Disease?
Cerebral Venous Thrombosis CVT (and MS)
Can I use your images for CCSVI Imaging Atlas?Page 157
CCSVI opposition and progress…
How common is venous angioplasty?
Causes of headaches from angioplasty?
Azygous abnormalitiesPage 159
What good is this thread? Looking back…Page 160Page 161
Can azygous vein suffer if jugulars ae normal?
CCSVI Atlas / where to send images
Canadian doctor contact?
Make Money or Help Mankind? Both?
Trauma that can injure veins
Is catheter venography warranted if jugulars appear normal?
MS’er letters to no avail…
Non-MS blockage complications / Budd Chiari Syndrome
Dr. Hubbard commentPage 162
Procedure now or later? Pros and cons…
"Algis" and Taiwan
Any pre-CCSVI discussions?
It’s a personal decision…
Improvements gone after a week – what now?Page 163
Some insurance is paying for CCSVI
Procedure and stent complications?
Catheter Venogram / MR Venogram / Ultrasound
Veins and chemical trauma
High jugular stenosis repair?Page 164
"Nunzio" clarifies Mitoxantrone treatment
"Apologize only for ignorance you choose not to correct" – S. Sclafani, 7/2010
Anticoaglation (Love Thy Doctor!)Page 165
Will ballooning keep bad valve open after balloon removed?
SUNY symposium (Sclafani, Siskin, Sinan, Haacke, Salvi) July 26
What to stop taking prior to procedure?
High pressure balloon
More on SUNY SymposiumPage 166Page 167Page 168Page 169
Online CCSVI Atlas?
"LadyGazelle" Doppler image
IR – To go where no doctor has gone beforePage 170
Contrast and Iodine
Transverse Sinus Page 171
Venogram one day, procedure the next?
Lumbar and SPMS, PPMS
"Mooshell" small external jug?
Lost defib. Wire causing CCSVI/MS?
Catheter Venography / IVUS
How commonly is IVUS used?
Doc. S – no sedation, no analgesia
More on IVUS…Page 172
IVUS benefit outweigh the cost?
Can one treat an occluded inominate vein?
Is IVUS catheter reusable?
Concerns about early CCSVI treatment
Dural sinus occlusionsPage 174
If venoplasty isn’t an option, is surgery?
Second opinion – get one!
Interpreting "Johnnybaby’s" reportPage 175
Find an IR who does complete Liberation
+/- IJV CSA deltaPage 176
Risk of stroke during Liberation?
Can reflux go away gradually after Liberation?Page 177
(Holly) Dr S. Waiting List info…
Vein volume formula
Is this "Sticky Blood"?
Dr. Sclafani ASKS some questions…
Jugular vein size and flow rate
Symposium on CCSVI info…Page 178
DOPPLER DIAGNOSTIC OF CCSVI test prescription/Zamboni criteriaPage 179
Catch re-stenosis early – consider 1 month check-up
Spinal cord and CCSVI questionPage 180Page 181
Insurance and screeningPage 182
How to do follow-up / Azygous question
"LadyGazelle" casePage 183
Artery pushing jugular?Page 184Page 185Page 186
Props for Dr. Salvi / Setting up the ISNVDPage 187
CCSVI vs Cancer
Cancers around the Azygous paperPage 188
Letter to Dr. ZamboniPage 189
Veins inside the brain?
Venogram and Dural Sinuses
Risk vs Benefit, Multiple Procedures
Anals of Neurology Rebuttal
West Coast Symposium?Page 190
Talking to my Doc / Commonly treated veins (historically)
Dural Sinus, Sigmoid Sinus
Is Diabetes a contraindication to Liberation Procedure?
Vein compressionPage 191
IR’s coming up to speed
Treat in multiple visits?
Larger diameter ballooning of Azygous
Symposium Follow-Up questions
"nunzio" MRV commentPage 192
Multiple visits = Waste, more risk
Dilating Carotid impressions / Vagus nerve / Bradycardia
Lmbar veins / Doctor comfort level / Vein tear? / Trends?
Blood flow and nerve function restorationPage 193
Compression of Jugular by Carotid Bulb or Strap Muscle
(Symposium video links by "girlgeek33")Page 194
Low stenosis causes appearance of high stenosis/Dominant flow/Dural sinus thrombosis
More on 2-treatment strategy…
Ascending Lumbar Vein and small veins
Temporary feeling of "Normal"?
PPMS – especially need Azygos and Ascending Lumbar Venography!Page 195Page 196
TEE (Transesophageal Echo)
Air in veins?Page 197Page 198Page 199Page 200Page 201
Jugular ligationPage 202Page 203
"Nunzio" MRV comments - Vertebral veins
Comments on German and Swedish studies
Balloon questionsPage 204
German and Swedish studyPage 205
Stent questionPage 206
Relapse questionPage 207
More relapse theory…
Left side entry / May Thurner’s
More May Thurner
Nonthrombotic Ilizc Vein Lesion (NIVL)
Renal vein / May Thurner
CCSVI ala Zamboni
Do Sinan and Petrov use IVUS?
Talking & exposed jugulars
The Pill, steroids
Problem with jugs and verts
Repeated dilationPage 209Page 210Page 211
Iliac, Renal, Lumbar drainage
Stress, CCSVI, MS
Thrombosis, StentsPage 212
Should kill 2 birds with 1 stone!
Veins and brain drainage
Endothelial cells and permeability
Why aren’t red blood cells found in spinal fluid?
Accidents and CCSVI
5-40% has not met criteria for CCSVI
My CCSVI 1-year anniversary!Page 213Page 214
Developing a standard protocol
Stress, CCSVI, neurological symptoms
Total blockage of azygous
Stenosis, refluxPage 215
Zamboni protocol question
Azygous restenosis incidence rate
Are pulse steroids bad before angioplasty?Page 216
Post-Zamboni IR activity
May-Thurner and symptoms
Can narrow/blocked veins cause high blood pressre?
No improvement. Now what?
Jugular veins, restenosis
Numb leg after procedure
MRV after chiro adjustment?Page 218Page 219
Balloons – avoiding breakage
How high up? / Vertebral veins / High venoplasty / Balloon low may fix high stenosis
China and MSPage 220
Can hypertension cause narrowed veins?
Valves, stenosis, scar tissue, artherosclerosis
Neck mass and CCSVI, scan interpretations questionablePage 221
Bruising and venogram / Hypercoagulability
The need for a CCSVI treatment registry
Aspirin and Hypercoagulability
Neck massage / Angle for Jugular vs Vertebral vein flow?
Incision technique and scarringPage 222
Incision technique and scarring
MRV and CCSVI
Scarring underneath skin from incision
What Sonographers and Angiographers should look at:Page 224Page 225
What happens to collateral veins after Liberation?Page 226Page 227
Certification of CCSVI Treatment Centers
Azygos Vein question
A May Thurner? Image
Notes from Belfast Discussion/Debate
THANKS DRBART!Page 228
Disease duration and burden predict outcome?
Missing AzygosPage 229Page 230Page 231
MS and CCSVI
Ultrasound vs MRV to screen
Be part of a study – not necessarily a randomized trial
Comment on randomized trials
Blocked Jugular AND Vertebral veins
Separating non-MS symptoms from MSPage 232
Vertebral, Subclavian, Azygous stuff
Comments on treatment
Would you stent the first time?
Vertebral vein valvesPage 233
The need to improve Doppler
Progressive dilation, Cutting balloons
Skewing results, "Metal-mania"Page 234
2 obstructions = CCSVI
Veins – Collapsed vs Stenotic vs Narrowed
I’m here to stay!!!
We do not know whether or not CCSVI causes MS
Symptom correlation to specific vein issues?
CCSVI theory for upper spinal cord lesionsPage 235
CCSVI theory for upper spinal cord lesions
Vein wall injury
Reasons for worsening, then recovering symptoms
Felux types - Is intervention warranted in the absence of reflux?
Does balloon dilation stop blood flow?
Ballooning discomfort, flow stoppagePage 236
Iliac vein / Coumadin and clots / Blood clots after angioPage 237
Azygous and webs
Radiation and stenosis? Angio can be done how many times?
Scarring, Restenosis, "Rotor-rooting"
Valves and catheter advancement
Iliac vein, swelling
Treating one vein, checking the other for improvement?
Stenosis location and disability / Jugular vein has been dx’ed as a Vertegral!
Detecting restenosis quickly with UltrasoundPage 239
Safety first – the randomized trials…
Stent concerns / N-Acetyl Cysteine
Neck brace? / Stent issuesPage 240
Trying to set up shop…
Heated balloons?Page 241
Vit K vegetables. Clotting, Coumadin (Warfarin) dose, diet
Proving CCSVI will take time!
Contrast media risk and Saline
Traveling / Hypoxia and clotting
Finding Nemos (Neuros)
Drinking fluids and Contrast Nephropathy
Laser for clots?Page 242Page 243
Sore jugulars, follow-up with Duplex US B-Mode
Reflux – 2 kinds
Thyroid cysts and collaterals
"Comparative intent to treat study"
Dilated blood vessels and blood pressure
CCSVI likely congenitalPage 244
Blood thinner – Antiplatelet and Anticoaglation therapy / Follow-upsPage 245
Future treatment plan for ballooning
Vein size diameters – IJV/azygous/hemi-azygous/vertebral/lumbar/left iliac/IVC
Sedation and increased tolerance to meds / Stenosis correlation to which side
Trauma and azygous damage?Page 246
Valsalva, refluxPage 247
Vasalva, bulging neck veins
38% reduction of NEW lesions is normal?
Advice for people who don’t see improvementPage 248
CCSVI and Zamboni criteria
4 CCSVI Pattern Types (see Squeakycat post)Page 249
Azygous, Doppler, hemodynamic
Thyroid gland disorders
Stents and thrombosis, better angioplasty
Terminology – proximal, distal
Comment on external jugularsPage 250
Getting Color Doppler Ultrasound done
B-mode vs Doppler Ultrasound, Duplex Ultrasound
The Interventional Radiologist
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If you can't explain it simply, you don't understand it well enough. - Al Einstein