Rosegirl wrote:Hi, Dr. S.
Some studies report that about half of the treated patients have problems with valves. How many valves are there, and where are they located?
Would it make sense to test and treat valves before treating problems in other areas? For example, if opening a stuck valve makes all the collateral veins above it go away, that would minimize any trauma that might otherwise have occurred if the doctor systematically treated any problems found as they occurred.
The arrangement of valves in the body is quite variable. Typically there is 1 valve in the proximal IJ just before it joins the subclavian vein to form the inominate vein.
There has been discussion about only treating that area of the IJ first and (if I remember correctly) this is what Zamboni has advocated.
Again, this gets back to the discussion of doing enough versus doing to much. How big do we balloon and what areas do we balloon? And then trying to manage cost particullary for cash paying patients. So, its hard to only treat the proximal IJ when we see a distal IJ stenosis.
This is also one of the reasons Sal and I worry that we do not know enough to do a randomized study. We do not know the best way to do the procedure to get the best outcomes.