I'm starting a new thread because Dr. Sclafani said something that really captured me (and many others!) so I sent the info to Dr. Simka. From what I've read here, he appears to already know about it. Anyway after posting on Dr. Sclafani's thread I have received numerous private messages wanting to discuss it further and asking if I've heard back from Dr. Simka. The answer is no... but if and when I do, with his permission I will gladly post. I will see him on Sat. June 25th if not sooner.
I'm happy to talk privately but I don't know anything... other than what I've researched... so let's talk about it here. I appreciate the private messages because of the need to keep Dr. Sclafani's thread clear of discussions among ourselves so he doesn't have to wade thru so much. This is what Dr. Sclafani said on page 127 (or was it 128? oh well close enough) and you can read the responses afterward on his thread. The emphasis in bold is mine:
When I read zamboni's paper, I noted that he stated that roberto galleoti, the IR who works in ferrara, enters the left femoral vein and advances up into the azygous and the jugulars. I thought that peculiar because it is such a straighter shot up the right femoral into the jugulars and azygous. In my entire career I have entered the right side in more than 98% of procedures. (For your information catheter manipulation is always more accurate in a straight line. when the catheter has to curve, it loses some of the fine tuning.)
The paper never really explained why robbie did that. So as i watched that first procedure in ferrara, i noted that they did a venogram of the left iliac vein and then catheterized the left ascending lumbar vein and did another venogram. I aske paolo what that was all about and he told me that they were looking for narrowing of the left iliac vein (a congenital narrowing called May thurner syndrome) and then were looking for hypoplasia of the lumbar veins. They also looked for narrowing of the vein of the left kidney. The light went off! That was why they entered from the left side.
Paolo, why didnt you say so in your paper, I asked. Because the editors cut it out for space reasons!
So now i will do all my catheterization from the left femoral approach, even though I dont like to.
How can evaluating the lumbar veins be helpful? it is helpful in explaining the disease. at the current time, there is no solution to the lumbar vein narrowings (hypoplasia). But it can explain the disease. It appears that lumbar hypoplasia is associated with PPMS.
The mechanismS by which these veins affect the spine as as follows
narrowing of the renal vein and the iliac vein reduce the ways for the blood to exit the spine. in fact they may actually increase that flow. And perhaps that leads to ccsvi of the spine.
So i think that some of those who have had venograms that appear normal just havent had all the right imaging done.
Not to say that all the venograms I have seen done around the worlds would be something leonardo would have been proud of.
Now until Dr. S is able to respond to all the questions we will just be speculating here, but his thread is SO long now and this seems important.
I looked up May-Thurner Syndrome -- wow, very interesting:
http://my.clevelandclinic.org/disorders ... drome.aspx
I asked Dr. S if this syndrome might explain edema and purple discoloration in the feet. I'm not suggesting I have the syndrome but I'm curious. He's not available to post right now so I don't know any more than what you see here.
There's probably more research around here someplace.