hypoplasia of the IJV

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

hypoplasia of the IJV

Postby Cece » Wed Dec 08, 2010 9:38 am

http://content.onlinejacc.org/cgi/conte ... 5.09.058v1

Volume 33, Issue 6, Pages 857-862 (June 2007)

Analysis of Internal Jugular Vein Insufficiency—A Comparison of Two Ultrasound Methods

Max Nedelmann, Daniel Teschner, Marianne Dieterich


Received 13 July 2006; received in revised form 23 November 2006; accepted 14 February 2007. published online 24 April 2007.

Abstract
Jugular venous valve insufficiency is a contributing factor to different pathologic conditions. For assessment of insufficiency, two ultrasound techniques have been developed, that are based on very different methodology (direct Doppler assessment versus air contrast ultrasound venography [ACUV]). This study was conducted to compare these two methods to improve comparability of existing studies and diagnostic accuracy in future studies. The function of 40 valves was determined in 20 individuals during a Valsalva maneuver. For direct Doppler assessment, valvular competence was assessed on basis of Doppler recordings, following recently established criteria. Valvular insufficiency in ACUV was diagnosed when reflux of an air-based echo contrast agent through the valve could be detected. With both methods, evaluation of 39 valves was accomplished (one exclusion due to hypoplasia of the corresponding vein). Both methods showed very high agreement in detection rates. All 18 valves being classified as insufficient by Doppler criteria were also insufficient in ACUV. Of 21 valves classified as competent (Doppler), one valve was rated as insufficient in ACUV due to discrete reflux of microbubbles. However, ACUV was inaccurate in evaluation of the left internal jugular vein after injection of the contrast agent into the right cubital vein. High detection rates could only be achieved when this was taken into account. This study shows that detection rates of internal jugular valve insufficiency are very similar with both methods. However, this high agreement required modification of the established protocol of ACUV.

This was posted in CCSVI Locator but again it is talking about the other form of valve insufficiency, where blood can flow through the valve but will flow back again under valsalva. (In CCSVI the blood does not flow through in the first place; it is the valve itself as an outflow obstruction that causes the reflux.)

So to me the point of interest in this abstract is the one case of hypoplasia of the IJV. THAT could be CCSVI. Here in 20 individuals a single case of one-sided hypoplasia was found. If the sample of people was randomly chosen and they were all healthy, finding even one hypoplastic IJV is higher than would be expected?

The presence of one hypoplastic IJV wouldn't guarantee CCSVI, it would depend on the results of a transcranial doppler and how the rest of the blood flow has been diverted.

However even in a healthy population, perhaps that individual would be experiencing a scientifically measureable difference in fatigue, weakness, etc?
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Re: hypoplasia of the IJV

Postby drsclafani » Thu Dec 09, 2010 7:07 am

Cece wrote:http://content.onlinejacc.org/cgi/content/full/j.jacc.2005.09.058v1

Volume 33, Issue 6, Pages 857-862 (June 2007)

Analysis of Internal Jugular Vein Insufficiency—A Comparison of Two Ultrasound Methods

Max Nedelmann, Daniel Teschner, Marianne Dieterich


Received 13 July 2006; received in revised form 23 November 2006; accepted 14 February 2007. published online 24 April 2007.

Abstract
Jugular venous valve insufficiency is a contributing factor to different pathologic conditions. For assessment of insufficiency, two ultrasound techniques have been developed, that are based on very different methodology (direct Doppler assessment versus air contrast ultrasound venography [ACUV]). This study was conducted to compare these two methods to improve comparability of existing studies and diagnostic accuracy in future studies. The function of 40 valves was determined in 20 individuals during a Valsalva maneuver. For direct Doppler assessment, valvular competence was assessed on basis of Doppler recordings, following recently established criteria. Valvular insufficiency in ACUV was diagnosed when reflux of an air-based echo contrast agent through the valve could be detected. With both methods, evaluation of 39 valves was accomplished (one exclusion due to hypoplasia of the corresponding vein). Both methods showed very high agreement in detection rates. All 18 valves being classified as insufficient by Doppler criteria were also insufficient in ACUV. Of 21 valves classified as competent (Doppler), one valve was rated as insufficient in ACUV due to discrete reflux of microbubbles. However, ACUV was inaccurate in evaluation of the left internal jugular vein after injection of the contrast agent into the right cubital vein. High detection rates could only be achieved when this was taken into account. This study shows that detection rates of internal jugular valve insufficiency are very similar with both methods. However, this high agreement required modification of the established protocol of ACUV.

This was posted in CCSVI Locator but again it is talking about the other form of valve insufficiency, where blood can flow through the valve but will flow back again under valsalva. (In CCSVI the blood does not flow through in the first place; it is the valve itself as an outflow obstruction that causes the reflux.)

So to me the point of interest in this abstract is the one case of hypoplasia of the IJV. THAT could be CCSVI. Here in 20 individuals a single case of one-sided hypoplasia was found. If the sample of people was randomly chosen and they were all healthy, finding even one hypoplastic IJV is higher than would be expected?

The presence of one hypoplastic IJV wouldn't guarantee CCSVI, it would depend on the results of a transcranial doppler and how the rest of the blood flow has been diverted.

However even in a healthy population, perhaps that individual would be experiencing a scientifically measureable difference in fatigue, weakness, etc?


it would be interesting to see what that hypoplasia actually looked like before assuming that there is agreement on hypoplasia.
alsointeresting that they fouond half the valves were incompetent. jThe two types of reflex are very different, areant they
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Postby Cece » Fri Dec 10, 2010 8:27 am

I suppose it would be no surprise if people with CCSVI have extreme hypoplasia, compared to whatever might normally be considered hypoplasia!
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Postby Cece » Sun Dec 12, 2010 12:34 am

Here is another article:
Intensive Care Med. 2001 Jan;27(1):301-5.

The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization.
Lichtenstein D, Saïfi R, Augarde R, Prin S, Schmitt JM, Page B, Pipien I, Jardin F.

Service de Réanimation Médicale, H pital Ambroise-Paré, Boulogne, France.

Abstract
OBJECTIVE: To demonstrate an asymmetry of the internal jugular veins, a finding which will have consequences for catheterization.

DESIGN: Prospective study.

SETTING: The medical ICU of a university-affiliated teaching hospital.

PATIENTS: Eighty critically ill consecutive patients.

INTERVENTION: Measurement of the cross-sectional area of the internal jugular veins. Search for an asymmetry, defined as an area at least twice that of the contralateral vein.

RESULTS: An asymmetry was noted in 62.5% of the patients. The dominant vein was the right in only 68 % of these cases. In addition, 23% of the 160 jugular internal veins had an area of 0.4 cm2 or less.
CONCLUSIONS: Using a simple technique, ultrasound identifies the dominant internal jugular vein, thus indicating the safer side before blind catheterization
http://www.ncbi.nlm.nih.gov/pubmed/11280654

How small does it have to be before it is hypoplasia?
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Re: hypoplasia of the IJV

Postby NotFound » Sun Dec 12, 2010 4:38 pm

drsclafani wrote:
it would be interesting to see what that hypoplasia actually looked like before assuming that there is agreement on hypoplasia.


Wouldn't that be rather hard to do Doctor? Hypoplasia as I understand, refers to an inadequate number of cells.

Which, it turn, results in the underdevelopment of an organ (in our case veins).

Although as you said, an agreement should be established on what is normal and what is underdeveloped :)
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Re: hypoplasia of the IJV

Postby drsclafani » Mon Dec 13, 2010 1:43 am

NotFound wrote:
drsclafani wrote:
it would be interesting to see what that hypoplasia actually looked like before assuming that there is agreement on hypoplasia.


Wouldn't that be rather hard to do Doctor? Hypoplasia as I understand, refers to an inadequate number of cells.

Which, it turn, results in the underdevelopment of an organ (in our case veins).

Although as you said, an agreement should be established on what is normal and what is underdeveloped :)


not really
we do not have to count cells we can measure diameter. hypoplasia is an underdevelopment of normal tissue or organs
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