Stitch stent to vein to prevent migration?

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Stitch stent to vein to prevent migration?

Postby AlmostClever » Fri Dec 03, 2010 2:26 pm

I just finished a follow-up visit with my vascular doctor!

It appears that my left IJV is only 2mm and did not respond to the previous ballooning - it recoiled.

He suggested using a stitch to anchor the stent to prevent migration.

This would require an incision in the neck as well to perform the stitch.

Any thoughts?

Thanks!

A/C
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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Postby Cece » Fri Dec 03, 2010 2:32 pm

Has he done this to anyone else's jugular, for similar or whatever reasons?

What about a repeat angioplasty using the large balloons at high pressures? These are techniques specifically aimed at defeating elastic recoil.

There is a paper coming out from Siskin (?) or another doctor that shows that stent migration has not been a concern with stenting.
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Postby AlmostClever » Fri Dec 03, 2010 2:39 pm

Cece,

Actually he has not but I am putting him in touch with Siskin to discuss jugular stenting.

I think the stitch would be more of a secondary safety measure.

A/C
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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Re: Stitch stent to vein to prevent migration?

Postby jacksonsmommy » Fri Dec 03, 2010 3:00 pm

AlmostClever wrote:I just finished a follow-up visit with my vascular doctor!

It appears that my left IJV is only 2mm and did not respond to the previous ballooning - it recoiled.

He suggested using a stitch to anchor the stent to prevent migration.

This would require an incision in the neck as well to perform the stitch.

Any thoughts?

Thanks!

A/C


This is the first I've heard of this. It is my understanding that as long as the stent is properly oversized and inserted properly that this would be unnecessary.
CCSVI procedure May 31, 2010
RRMS - Official diagnosis January 2009
MS symptoms since at least 2000 (EBV trigger 98?)
75 - 80% Resistant Stenosis in Left Jugular - Stent
Tokuda Hospital, Bulgaria (Dr. Petrov)
Immediate and substantial results!!
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Postby HappyPoet » Fri Dec 03, 2010 3:57 pm

Vascular surgeons have several ideas regarding solutions to CCSVI vein problems. I hadn't heard before about anchoring a stent with a stitch, but I have heard of a venous graft using a small patch of saphenous vein to widen a persistently stenotic IJV, a bypass using a small-medium saphenous vein segment to go around a pathological valve, and a conduit using a medium-long saphenous (?) vein section to replace a diseased or missing IJV. Also, open-neck surgery is no big deal to these guys -- they do it all the time, and I would think the opening needed to place one stitch would be very small.

Best of luck!
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Postby bluesky63 » Fri Dec 03, 2010 4:08 pm

Happy Poet, wow -- you know so many details! I am amazed at how much we've all learned. But I don't think I could use saphenous in a sentence so easily. :-)

Almost Clever, obviously you will do the best for yourself that you can. If I were in your situation I would want to know how much time I could take to evaluate the options and see if better solutions came up, because I feel like things are changing pretty quickly and better solutions might come for you.

All the best. I hope you end up with excellent symptom relief. :-)
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Postby Cece » Fri Dec 03, 2010 4:21 pm

HappyPoet, where might one find a saphenous vein and why does it make a good jugular graft, if you know?
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Postby HappyPoet » Fri Dec 03, 2010 8:05 pm

Cece wrote:HappyPoet, where might one find a saphenous vein and why does it make a good jugular graft, if you know?

What is the saphenous vein?
http://www.veindirectory.org/glossary/2 ... ein_1.html

The saphenous vein is a large superficial vein located in the leg. It starts at the groin and extends all the way to the ankle. This is called the greater saphenous vein. There is another slightly smaller vein and it starts just behind the knee and runs to the ankle. This is called the lesser saphenous vein.

In the groin the greater saphenous vein joins the major vein (femoral vein) of the leg which goes to the heart.

The saphenous vein drains blood from the superficial tissues of the leg to the groin. From the groin, the saphenous vein enters the deeper circulation and transfers blood to the femoral vein. This junction at the groin (saphenofemoral junction) is the cause of more than 90% of varicose veins. Any pressure in the groin can easily traumatize the valves in the saphenous vein at the junction and can lead to obstruction of the vein. When the vein is obstructed at the groin, it creates a back flow of blood, which leads to pooling of the blood in the leg. A classic example of a condition which does this is pregnancy.

Does the saphenous vein have branches?

Yes, the saphenous vein has numerous branches along its entire length. In the lower leg the smaller branches of the saphenous vein (collaterals) join the deep vein in the leg. When the blood starts to pool in the saphenous vein, the pressure is easily transferred to the branches, which then appear as bulging discs (varicosities).

What are important features of the saphenous vein?

The size of the saphenous is very variable in different individuals. Some have a large saphenous vein and others have a small saphenous vein. In some individuals the saphenous vein runs along the entire length of the leg. In others it divides at the groin and one branch runs on top of the thigh and the other runs on the side of the thigh. Both of these branches can be affected and become varicosed.

Does the saphenous vein have valves?

Yes, valves are "one way door-like" structures and do exist in the saphenous vein. The valves permit blood to flow one-way and close off to prevent blood from going in a reverse fashion. When these valves are damaged or defective, pooling of blood does result in the legs.

What is saphenous vein useful for?

The saphenous vein is important for:

IV cannulation: In some individuals (particularly infants, elderly and those involved in trauma), there are no veins in the arm for IV access. In these individuals, the IV is placed in the saphenous vein. The IV may be placed near the ankle or in the groin. This can be life saving in individuals with no other IV access.

Cardiac bypass: The saphenous vein is one of the most important veins for open heart surgery. It is used in more than 90% of all bypass surgeries. Without the saphenous vein, open heart surgery would indeed be very difficult.

Vascular surgery: The saphenous vein is the most important vein used by vascular surgeons for bypass. It is better than any plastic or prosthetic graft. It is very useful for bypass in the legs and arms. The saphenous vein is an excellent graft for almost every type of vascular procedure.

What disorders are associated with saphenous veins?

Varicose veins: Without the saphenous vein, there would be no varicosities in the leg. Varicose veins occur in the saphenous vein more than any other vein in the body. The saphenous vein is very superficial and prone to injury. It is also very thinned walled and does not tolerate high pressures. Any condition that causes high pressures in the vein can lead to varicose veins. Varicose veins of both the lesser and greater saphenous veins are common. The varicose veins of the greater saphenous are typically seen on the inside of the thigh and lower leg. When the lesser saphenous vein is involved, the varicosities are seen at the back of the lower leg.

Phlebitis: Anytime a blood clot occurs in a vein, it can initiate an inflammatory reaction known as phlebitis. Phlebitis of the saphenous vein is extremely common. The condition is benign and usually resolves within a few weeks.

Final Point

The saphenous vein is involved in 99% of all the varicose veins seen in females. It is a fragile vein and easily traumatized. Any condition that causes high pressures in this vein causes the valves to pull apart and leads to engorgement of the saphenous vein. This is what we call a varicose vein. In time, the blood is unable to move along the vein and remains static; leading to formation of blood clots and phlebitis. As the condition progresses, the pooled blood collects in the branches of the saphenous vein and leads to development of varicosities.
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Postby NotFound » Fri Dec 03, 2010 10:29 pm

There are two (at least the two that stood out for me, there are probably more) issues with stents:

Yes, migration - I've read about what, 2-3 cases?

Also - clot formation in / around the stent. I've seen this mentioned way more than migration.

(No, I can not provide the links to where I read about it, this will require too much searching)

Did you discuss with your doctor the possibilities of clot formation? I can imagine even greater scarring of endothelial tissue with stitching than with the usual stent insertion.
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Postby HappyPoet » Sat Dec 04, 2010 6:13 am

Hi Cece,

So sorry! I forgot to say hi to you in my post above on the saphenous vein.

I also wanted to say that I knew a bit about the vein because my father had (and survived!) quadruple bypass open heart surgery this summer, and the doctors used the saphenous vein in both legs which meant he had a real hard time afterward with swollen feet which he couldn't walk on for months until the veins repaired/regrew again in both legs (he's doing fine now). So there can be complications, especially with the elderly.

~Pam
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Postby HappyPoet » Sat Dec 04, 2010 6:28 am

NotFound wrote:There are two (at least the two that stood out for me, there are probably more) issues with stents:

Yes, migration - I've read about what, 2-3 cases?

Also - clot formation in / around the stent. I've seen this mentioned way more than migration.

(No, I can not provide the links to where I read about it, this will require too much searching)

Did you discuss with your doctor the possibilities of clot formation? I can imagine even greater scarring of endothelial tissue with stitching than with the usual stent insertion.

Hi NewFound,

Good point regarding the possibility of additional scar tissue in the IJV. Patients should ask their doctors about this possibility. I thought blood clots can happen with venoplasty as well as with stents.

~HP
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Postby NotFound » Sat Dec 04, 2010 7:30 pm

HappyPoet wrote: I thought blood clots can happen with venoplasty as well as with stents.

~HP


Absolutely. Any sheer stress to the epithelial cells will activate the clotting factors.

So this is just a matter of a degree - venoplasty (in my understanding) will in general impose relatively lesser degree of such stress when compared with stent placement.

Then, stent placement (again, the way I understand it) would provide somewhat less stress than the stitching.

The actual reaction of the body to such stresses will vary greatly among individuals, that is - somebody will have an unstoppable clotting cascade due to venoplasty, while some may "ride" the stitching trauma without much problem.

The there are other variables - how much the tissue was scratched during venoplasty, how successful (gentle if you will) was the stent placement, etc.,
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Postby AlmostClever » Sat Dec 04, 2010 7:53 pm

Thanks everyone for the input!

I do not believe a stitch would not be needed when the stent is properly sized (or over-sized, I mean).

A/C
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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