clotted off jugulars

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.
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Liberation
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Post by Liberation »

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Liberation
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Cece
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Post by Cece »

Could the vein collapse due to an elastic recoil without scarring to a narrower position than it was originally; so the stenoses would be greater?
Yes, this is something that Dr. Siskin's office warns about, they will honor the wishes of the patient for no stents unless this very situation occurs, where after ballooning the vein immediately recoils back so it was worse than it began. Last summer in July they said it had happened only a few times. This same warning was repeated to a patient just a month or two ago, the patient mentioned it in his blog that I posted a link to in the Albany Community Care thread. I can imagine a situation where the doctor unknowingly balloons a physiological narrowing, which would return immediately to its original state, and then gets stented when no stent was needed there. If ivus were used, this would eliminate this concern for me.
I wanted to find out if there ican bee seen any abnormailities in the other two veins, but so far no anwser from dr Sclafani.
I wish you had images of your iliac vein or ascending lumbars, those are sometimes an issue for patients with ppms.
Lyon wrote:*later....I think "shorter" got into my mind due ONLY to his stated desire not to dilate normal vein.
It is definitely a goal I can agree with, whether it's achieved by shorter balloons or smaller diameter balloons or other methods currently undiscussed.
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Liberation
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Post by Liberation »

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Cece
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Post by Cece »

At least in these sorts of images, it looks to me like you are right, there is a bulge in the wall right where the stenosis is when it's ballooned:
http://webdoc.nyumc.org/nyumc/files/cv/ ... plasty.gif
(although I don't know how accurate that is plus it is an artery with plaque instead of a vein with a valve malformation, but all the images look like that):
http://tinyurl.com/4xzh3db
What does that mean?
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Liberation
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Post by Liberation »

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drsclafani
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Post by drsclafani »

Cece wrote:
Liberation wrote:Mine was treated by a really small (6mm) but dr Sclafani told me it was too long and unnecessary damages the healthy parts. Did he use longer balloons in your case bacause of the small size of the balloon? Otherwise would he use longer ones? :)
Actually length of balloon is fairly standard as far as I know. I may have miscommunicated that; someone once asked about using short balloons but they are not practical. Placement of balloon and balloon's shoulder matters too. Let's see...
How many patients has he treated since he uses ivus?
He has treated over 100 patients.
How are his results fair with his older results with giant balloons?
too soon to tell as far as I know (drsclafani, if you find this, these are yours to answer.... :)
I would like to get an appointment from him; however, I am still afraid of getting thrombosis on the plane.
Does your regular doctor have any ideas? Could you take something preventatively? At least on the way back, you'd be on Arixtra, an anticoagulant which prevents thrombosis.
My IR told me that he does not understand why others do not use ivus.
Without IVUS, imo, there is not the same certainty that everything has been found and treated appropriately. I was really glad to have it used.

Does anyone know, has Dr. Sinan been in communication with the other doctors about the concern over large balloons?
ok
i got very worried about a run of thromboses, shortly after using larger high pressure balloons. Some of these "thromboses" were not actually thromboses. They were reports by sandy mcdonald of post procedure followup ultrasounds where he used the term "block" or "no Flow" that i interpreted as being thromboses. It put me all out of whack.

but the combination of a few thromboses and these "non" thromboses scared the S**t out of me. As i critically analyzed my earlly second experience, and started to understand the nature of the stenosis, it becamse clearer that the concept of very large ballons was overstated.

I have done several things and will be doing more to address this

1. get a really accurate wall diameter by IVUS
2. start dilating to the size of the vein wall, not greater. if repeat ivus shows persistent valvular stenosis, go up in size but take care where the balloon is placed
3. i used to center the balloon on the stenosis, now i position the balloon eccentrically to place a shoulder of the balloon near the stenosis, and thus avoiding intimal damage where there is no stenosis
4. i have started trying 2 cm balloons, not as easy to work with as the 4 cm balloons, but less intimal injury
5. My anticoagulation regimen contains an antithrombin drug and i am adding an antiplatelet drug to it I may prolong therapy from 20 days to 30 days
6. I am more careful to assure myself that there is flow coming from the brain. no flow from above leads to high risk of thrombosis


So getting a beat on techniques used by treating physicians is a moving target, isnt it.

btw i havent detected a thrombosis in a long time except for the hypoplasias which everyone is finding to be really difficult and challenging.
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drsclafani
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Post by drsclafani »

LR1234 wrote:My vascular surgeon has also ligated internal jugular veins and this has not caused problems in his patients. I understand the argument is it can take years for symptoms to develop but collaterals can form and can be pretty large. (My haemotologist reckons 2 years for new veins to grow)

I may be wrong with this but my understanding is that you get scarring in the veins that then leads to the vein collapsing. Maybe the vein can collapse without scarring though???
My left jugular is scarred to the point of total occlusion but has not yet collapsed....
i had the jugular vein of my wife tied off because the sound of the jugular vein passing by her ear was so loud she could not hear. This was in the mid 1980s. she did have fatigue and some short term memory issues that have now resolved. Thankfully she did not have the problem in both ears. I might have thought to tie off both. Imagine that!

it is odd how these veins that can be tied off with iimpunity can cause so much trouble.
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