Surgical treatment of Hypoplastic Internal Jugular vein

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

Surgical treatment of Hypoplastic Internal Jugular vein

Postby Nunzio » Thu Feb 17, 2011 5:12 am

The Italians did it again.
The story is that a patient in poor condition approached Dr. Spagnolo from Monza, Italy because had already 3 angioplasty with poor success. He convinced the doctor to do a venogram which showed a totally blocked IJV.
At that point the doctor told the patient that there was nothing he could do.
The patient which was relegated to a wheelchair told the doctor he was considering terminating his life because he could not continue like that.
This forced the doctor to attempt a surgical procedure. He took the saffenous vein from the leg and double its size and use that to replace the defective Jugular vein. One week later the patient was able to leave the hospital, this time on his own two feet instead af a wheelchair.
These are the 3 video describing the procedure. you can see the patient at the beginning of the second video but it is in Italian.
http://www.primocanale.it/viewprogramma.php?id=30&servizio=2873[/url]
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

Postby Algis » Thu Feb 17, 2011 6:03 am

Monza is called "The Cathedral of Racing Gods" because of its famous track :D

Perhaps they are working on other subjects :roll:

(kidding - joke - humour)
User avatar
Algis
Family Elder
 
Posts: 783
Joined: Sat Nov 21, 2009 4:00 pm
Location: XinDian, Taiwan

Postby Cece » Thu Feb 17, 2011 6:59 am

amazing, Nunzio

I think the answer for most of us will be through the IR techniques. IRs sure can do a lot with a catheter, a balloon, and an entry vein in the groin. Many with failed angioplasties have it due to clotting. Clotting is even more likely when grafting in a vein than it is in ballooning. Another reason for failed angioplasties is inexperienced IR or underdilation - it would be a shame to go to a surgeon for a vein that could've been opened more easily and safely by an experienced CCSVI IR. Also, I have to watch the video, where was the placement of the upper graft area? I worry for anyone getting things done too close to the brain, if clotting happens then the blood flow is blocked too high for other collaterals to let it out "easily."

but with all those caveats out of the way, I am very happy for this patient and the doctor that it was a success and I look forward to the doctors figuring out which cases truly are last-resort cases for whom this technique may be needed.

Italian IRs innovate intensely, to our infatuation - HappyPoet, do the ayes (I's) (eyes) have it? By which I mean, how do I give myself a (not J, +5) type score?
Cece
Family Elder
 
Posts: 8994
Joined: Mon Jan 04, 2010 4:00 pm

Postby Nunzio » Thu Feb 17, 2011 1:32 pm

Algis wrote:Monza is called "The Cathedral of Racing Gods" because of its famous track :D

Perhaps they are working on other subjects :roll:

(kidding - joke - humour)

Monza is only few miles away from the city in which I was born (Milan). It is also well known for its park.
Cece wrote:amazing, Nunzio

but with all those caveats out of the way, I am very happy for this patient and the doctor that it was a success and I look forward to the doctors figuring out which cases truly are last-resort cases for whom this technique may be needed.


Of course this is not a procedure to be taken lightly but it is nice to know that for the few where venoplasty is not feasible, at least there is some hope
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

Postby Nunzio » Thu Feb 17, 2011 6:22 pm

This is a translation to the introduction to the video:
New hope, albeit with due caution, open to the sick with multiple sclerosis, based on the correlation between malformations of the veins and chronic degenerative disease of the nervous system. A case of healing after a reconstruction of the veins has been reported by Dr. Spagnolo Salvatore, director of the Department of Cardiac Surgery of the Policlinico di Monza, during the ceremony which was held at Palazzo De Nobili.
The case in question concerns a boy of Reggio Calabria, with multiple sclerosis and is now paralyzed, which has regained the use of his legs after surgery to reconstruct the veins function by Dr. Salvatore Spagnolo.
"To see this young man regain movement of his legs was an unforgettable experience for me. " This comment by Dr. Spagnolo who did not let the opportunity pass to emphasize that "this new technique must be confirmed and studied, before we can talk of turning point in the treatment of multiple sclerosis. " Dr. Spagnolo, accompanied by the Chairman of the Committee on Culture and the Deputy Mayor Antonio Alcide Lodari Argirò, the mayor, Rosario Olivo, offered a plate that mimics the emblem of the city. "Salvatore Spagnolo - said the mayor - is one of those who honor our country Calabria in Italy and worldwide. We are proud of him and his human and professional should be an example for all the guys who study medicine. "Antonella Scalzi
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

more can be achieved

Postby hwebb » Sat Feb 19, 2011 1:52 pm

Cece,

I have a hypoplasmic vein, and here is what was acheived with angioplasty:

[img][img]http://farm6.static.flickr.com/5164/5353475537_9ea1edc0d5.jpg[/img]
left_jug_before_after by anatomical, on Flickr[/img]

A huge differene in appearance, and also in symptoms. However, the "final" vein I'm left with is still inadequate. My head still feels tight as blood flow is still impaired. My brain will continue to be degraded if I decide I'm "satisfied" to leave it like this and don't pursue further treatment options.

Zamboni himself said that angioplasty is not really a solution (as it gives temporary results). Given the amount of push back he received just recommending angioplasty to PwMS..it's clear he would've gotten nowhere if he initially had've recommended a more invasive yet permanent solution to deal with the malformed jugulars. He's a smart man.

There is literature going back decades showing jugular bypass and jugular replacement surgeries. As this surgical option hasn't been common in the past - it'll need to be optimised before rolling out to a large patient group like PwMS.

As a young woman with CCSVI - reading of this surgery gives me great hope.

Helen
User avatar
hwebb
Family Elder
 
Posts: 356
Joined: Thu Nov 26, 2009 4:00 pm
Location: Melbourne, Australia

Re: more can be achieved

Postby drsclafani » Sat Feb 19, 2011 2:23 pm

hwebb wrote:Cece,

I have a hypoplasmic vein, and here is what was acheived with angioplasty:

[img][img]http://farm6.static.flickr.com/5164/5353475537_9ea1edc0d5.jpg[/img]
left_jug_before_after by anatomical, on Flickr[/img]

A huge differene in appearance, and also in symptoms. However, the "final" vein I'm left with is still inadequate. My head still feels tight as blood flow is still impaired. My brain will continue to be degraded if I decide I'm "satisfied" to leave it like this and don't pursue further treatment options.

Zamboni himself said that angioplasty is not really a solution (as it gives temporary results). Given the amount of push back he received just recommending angioplasty to PwMS..it's clear he would've gotten nowhere if he initially had've recommended a more invasive yet permanent solution to deal with the malformed jugulars. He's a smart man.

There is literature going back decades showing jugular bypass and jugular replacement surgeries. As this surgical option hasn't been common in the past - it'll need to be optimised before rolling out to a large patient group like PwMS.

As a young woman with CCSVI - reading of this surgery gives me great hope.

Helen


With the creation of arteriovenous fistulas for hemodialysis, sometimes the veins do not dilate as normally happens when an artery is connected to a vein. A procedure called maturation is performed. This is a sequentiala periodic dilatation from small to large over weeks.

i will be attempting this in an ms patient in the near future.

there are distinct differences in conditions that make this less likely to be successful in ccsvi, namely the vein is not under high pressure.

we will see what happens
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby Cece » Sat Feb 19, 2011 5:06 pm

That's a beautiful change from the before to the after image, Helen, and I see what you're saying where the upper vein is still too small.

Needled said to me about us all being works in progress, I like that line, it applies quite often.

I wonder if your other jugular and the azygous are optimized; all the doctors are so new at this. Maybe a too small vein on one side would function ok if everything else were as wide as it could get.

I wonder too what the success rate of venous grafts elsewhere in the body is. I want 100% success, when it comes to us, and I know that's not possible.

Can't wait to hear how the progressive maturation works out, Dr. Sclafani. Would love for that to be a good solution for hypoplasia.
Cece
Family Elder
 
Posts: 8994
Joined: Mon Jan 04, 2010 4:00 pm

Postby Nunzio » Sun Feb 20, 2011 6:52 am

This is a picture of my hypoplastic Right IJV.
You can see that the 1.6 mm. catheter completely occupy the diameter of the vein and when contrast is injected it can only go upward into my brain and out a collateral.
Image

My post op after an 8 mm ballooning is better but there are still collaterals and some of the contrast still goes toward my brain.
Image
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

Postby dania » Sun Feb 20, 2011 9:46 am

Gives me hope after 5 failed angioplasty procedures. All my veins are now totally blocked. Last 3 attempts the doctor were unable to get into any vein.
User avatar
dania
Family Elder
 
Posts: 1088
Joined: Wed May 12, 2010 3:00 pm
Location: St Lazare Quebec

Postby Nunzio » Mon Feb 21, 2011 3:51 pm

dania wrote:Gives me hope after 5 failed angioplasty procedures. All my veins are now totally blocked. Last 3 attempts the doctor were unable to get into any vein.

Yes Dania, you would be a candidate for this procedure since you know angioplasty cannot be performed, assuming you are getting worse.
Below is the link to some picture of the second open sky procedure performed by Dr.Spagnolo.
https://www.facebook.com/photo.php?fbid=130183357051921&set=o.139997017782&theater
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

Postby dania » Mon Feb 21, 2011 4:09 pm

Nunzio wrote:
dania wrote:Gives me hope after 5 failed angioplasty procedures. All my veins are now totally blocked. Last 3 attempts the doctor were unable to get into any vein.

Yes Dania, you would be a candidate for this procedure since you know angioplasty cannot be performed, assuming you are getting worse.
Below is the link to some picture of the second open sky procedure performed by Dr.Spagnolo.
https://www.facebook.com/photo.php?fbid=130183357051921&set=o.139997017782&theater

Thanks. I am desperately searching for a doctor who can do this. And I am getting much worse. No longer autonomous. And I live alone. I find myself choking and unable to expell whatever it is due to the severe MS hug. Cannot get a full breath of air anymore. I know that this will be the cause of my death if nothing is done.
User avatar
dania
Family Elder
 
Posts: 1088
Joined: Wed May 12, 2010 3:00 pm
Location: St Lazare Quebec

Postby Donnchadh » Mon Feb 21, 2011 5:17 pm

Dr. Sclafani on an emergency basis?

Donnchadh
Kitty says, "Take that, you stenosis!"

Got MS?.....Get Liberated!
User avatar
Donnchadh
Family Elder
 
Posts: 513
Joined: Sat Jan 23, 2010 4:00 pm

Postby Cece » Mon Feb 21, 2011 5:45 pm

I pm'd the suggestion of Dr. Mehta, as he is a vascular surgeon and she is looking for someone to do a venous graft. With a hypercoaguability disorder, the risks may be greater but that would be something to discuss with the doctor and a hematologist.

Dania, wishing you the best.
Cece
Family Elder
 
Posts: 8994
Joined: Mon Jan 04, 2010 4:00 pm

Postby dania » Mon Feb 21, 2011 5:50 pm

Cece wrote:I pm'd the suggestion of Dr. Mehta, as he is a vascular surgeon and she is looking for someone to do a venous graft. With a hypercoaguability disorder, the risks may be greater but that would be something to discuss with the doctor and a hematologist.

Dania, wishing you the best.

Do you know how I can get in touch with Dr Mehta?
User avatar
dania
Family Elder
 
Posts: 1088
Joined: Wed May 12, 2010 3:00 pm
Location: St Lazare Quebec

Next

Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service