Right side, left side question?

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Right side, left side question?

Postby selkie » Sat Aug 21, 2010 1:22 am

Hello all,

One thing I've failed to learn in my research, I understand that with May Thurners' they normally go in on the left side. But why don't they always go in on the left side?

What's the rationale for going in on the right side? When my husband had a heart catheter, they went in on the left side.

Does it have something to do with the azygos vein? Any clarification would be greatly appreciated!

TY, s.
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Postby BalsaBoy » Sat Aug 21, 2010 4:39 am

As far as I know it's easier and quicker for them to get to the jugulars through the right groin because it's a shorter route for some anatomical reason.
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Postby bluesky63 » Sat Aug 21, 2010 8:46 am

My doctor's team said they go in from the right side 90 percent of the time when they do venograms. I asked about going in from the left to check for May-Thurner. They said it's perfectly possible to check for MT from the right as well if they know that's what they're looking for. In my case, they elected to go in from the right since that's what they are most adept at, do the jugulars and azygous, and then at the end investigate for MT from the right last of all. Since I am not a vascular doctor I can't explain the anatomical details for you, but I trust this expert team, all of whom are very familiar with CCSVI and the issues involved, as well as MT.
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Postby selkie » Sat Aug 21, 2010 11:11 am

Thanks - I'd seen people talk about it but never understood the reason.
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Postby Cece » Sat Aug 21, 2010 11:15 am

If you check in Dr. Sclafani's thread index, you should be able to find him discussing right side/left side and May Thurners. It made quite a stir. He'd gone to Italy to train with Zamboni and came back with the information. It turned out that when Zamboni published his procedures, the reason why he went in on the left side (to check out the lumbar veins) got left out by the editors. Why? Because of space reasons! Painful....
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Postby selkie » Sat Aug 21, 2010 11:23 am

Cece, thank you - doesn't the azygos run the entire length of the spine? If so, shouldn't they go in on the left side per Zamboni's protocol?

Something I'm definitely going to ask about before I have the procedure (if I do, I'm getting so nervous reading about people who haven't done well, but I still am very hopeful about this procedure)
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Postby bluesky63 » Sat Aug 21, 2010 11:27 am

So Cece, I know I need to ask "the source" myself :-), but does that mean if you go in from the right you *can't* check the lumbar veins? I'm going to want a recheck at some point, and I would want to know more about this. Maybe it would make sense to do both -- if a team feels more secure about doing most of their stuff from the right, go ahead and do that stuff, then make another entry for the other issues in other locations? Or is it bad to have more than one incision?

Just rambling here . . . :-)
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Postby selkie » Sat Aug 21, 2010 11:43 am

bluesky, you mean finding the source article by Zamboni? I think that's a good idea. Esp. for people who didn't have improvements or who slide backwards, could something have been missed along that lumbar region if they went in on the right?

Will have to look thru Dr S's thread & see if he mentions it. Or ask him when he gets back from vacation.

So many of my symptoms are sensory. And my audiologist who is an expert on vertigo and proprioceptive problems (she works with neurologists & neurosurgeons as well as ENTs) said that she felt my balance problems were due to (not putting it in technical terms but as well as I could understand the explanation she gave me) a dysfunction of the spinal proprioceptive system.

I ran this by my ENT and he agreed with her.

So, I'm wondering, since that was my first presenting symptom, if that makes the azygos vein likely to have blockage? If so, I'd like them to check the lumbar veins and go in on the left - esp. if Zamboni, a vascular doctor, recommends this.

Now I'm very confused. I'll have to ask Dr. S too.
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Postby Cece » Sat Aug 21, 2010 12:23 pm

bluesky63 wrote:So Cece, I know I need to ask "the source" myself :-), but does that mean if you go in from the right you *can't* check the lumbar veins? I'm going to want a recheck at some point, and I would want to know more about this. Maybe it would make sense to do both -- if a team feels more secure about doing most of their stuff from the right, go ahead and do that stuff, then make another entry for the other issues in other locations? Or is it bad to have more than one incision?

Just rambling here . . . :-)

If your doc says that they can, then I'd believe that. Just make sure they also know to check for hypoplasia of the lumbar veins or whatever else that Dr. Zamboni checks for when he goes in from the left.

I'm sure there's a little bit of extra incision-site infection risk if they do two incisions, but it would be a minor risk. Would it be more of a equipment cost, if they pull the catheter all the way out, then would they need a new one before going in on another side?

I think asking the 'source' (I read it as meaning Dr. Sclafani) is always a good idea. :)
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Postby Cece » Sat Aug 21, 2010 12:33 pm

selkie wrote:Cece, thank you - doesn't the azygos run the entire length of the spine? If so, shouldn't they go in on the left side per Zamboni's protocol?

Something I'm definitely going to ask about before I have the procedure (if I do, I'm getting so nervous reading about people who haven't done well, but I still am very hopeful about this procedure)

The azygous can be checked regardless of which side the incision is made on. So, yeah, 'best practices' is probably to go in on the left. It's yet to be proven and if the only doc you can line up goes in on the right, it may be ok to take 'available practices' since it's needed and miss out on what's best. Tough choices.
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