This is my basic understanding...I had ont procedure done in Albany that was just ballooning (14mm). I had some improvements, then declined and suspected restenosis. I then went to Pacific Interventionalists where they ballooned (22mm) and cleared out the valves in my jugular veins. So if I understand your question, the procedures are different. One deals with just the vein, the other the vein and the valve in the vein. Crude understanding, but that is what I know. Sorry for the long stoty but bottom line...not all IR's deal with the valves. Albany does not, Pacific Interventionalists does, the rest, I don't know.
javabean wrote:Almost Clever,
No improvements as far as I can tell. I did have improvements after the first procedure though, which is weird, in my opinion.
gsiskin wrote:Interesting comments. Please know that those of us in Albany treating patients are often treating valves when we perceive valve problems are present. If one practice chooses to call this procedure valve ablation and another chooses to call it angioplasty, please know that for now, we are all talking about the same thing. More often than not, I find that we are treating the area of the valves and like Dr. Sclafani, I agree that the case imaged here is clear cut in terms of a valve abnormality. The differences between sites is more with the balloon size being used. It is our feeling that for now, we are sticking with the classic conventions associated with angioplasty in almost all areas of the body. This means that we are oversizing our balloons by 10-20% relative to the size of the vein being treated. Therefore, the thought that we are not oversizing balloons is not true...we are just not oversizing them to the extent that others may be. I am not saying the one approach is better than another. I am saying that at this early time in the evolution of CCSVI, staying close to the conventions of balloon oversizing makes sense to me and that is why I perform procedures that way. Keep in mind that balloons can injure veins. We have seen it with balloons that are oversized by 10-20% so one must assume that the risk of injury is the same or greater when even larger balloons are being used.
This is just one of those questions that remain unanswered.
gsiskin wrote:I think that restenosis is an issue that almost all patients will have to address at some point. I am personally not convinced that larger balloons will make restenosis less likely so I can't really recommend that you have this repeated with a larger balloon. I know for sure that there are others out there that feel differently so you may have to wrestle with the different opinions that are out there. A repeat angioplasty may help but you should make sure that you really had a significant clinical benefit to the angioplasty before going into another procedure because there is always risk to repeat procedures. In other words, if your symptoms got a lot better after the first angioplasty then I can understand retreatment. For now, things like cutting balloons and large balloons remain outside of what Zamboni described so it would definitely be nice to see some published literature backing up that approach.
Cece wrote:This is really interesting. It makes sense to me that docs new to CCSVI might not be able to spot a valve problem or consider it as important as we are hearing from some of the more experienced docs. So maybe if we just look at the bigger names....
Dr. Hubbard & the Del Mar IRs/CA
Dr. Zamboni and Galleoti/Italy
the doctor in Seattle
(I know I've missed many!)
Does the group think Dr. Siskin does not focus on valves? He's been at this openly since May 2010, he's in tight with the East Coast docs.
Dr. Sclafani focuses on valves, Dr. Arata does. The Del Mar IRs do not? This would be the group the Hubbards go through. I don't know enough about Dr. Arslan, Haskel, or Sperling. I think Dr. Haskel is planning on a trial, not straight-up treating, so it's especially important that he is doing it right, if he's putting his techniques to the test like that, and adding or detracting from the CCSVI movement based on what his results will be. Dr. Cumming has said here that most CCSVI is in the proximal end of the IJV where the valves are, does that mean he is focusing on the valves?
A doctor can treat stenosis not knowing that the stenosis is a valve.
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