I need another MRV and if L IJV good above clot, Bypass time

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

I need another MRV and if L IJV good above clot, Bypass time

Postby daytrader » Sat Apr 16, 2011 12:38 pm

My Doc agreed to do a bypass if the vein above the clot is good. We can't tell on the ultrasound cuz there is no flow there. I sure hope it is good. This time if I clot up we will be back in there A.S.A.P.. I will post once I know. I am waiting on the MRV date as this all just happened yesterday. I know there are many in my position and ready to have hope again.
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Postby Cece » Sat Apr 16, 2011 2:08 pm

Is your doctor in contact with Dr. Zamboni? He has done 10 jugular vein bypasses or reconstructions as I've heard it called. Maybe Dr. Zamboni can offer suggestions on what he's learned from this series. Also is your doctor in contact with Dr. Mehta? He has shown interest in doing grafts; I am not sure if Dr. Mehta has done one yet, I don't think so because I think we would've heard if he had.

How old is your clot? Is your doctor a vascular surgeon? Before your vein clotted, did you have improvements (so there is something known that you may gain back from this bypass)? Has your doctor ever done a jugular bypass before? What about similiar procedures with similiar veins? Sorry for all the questions. If this works, there will be others wanting the name of your doctor! I am a nervous nellie of sorts! Here's hoping the vein above the clot is good so you can have this as an option!!
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Re: I need another MRV and if L IJV good above clot, Bypass

Postby drsclafani » Tue Apr 19, 2011 9:01 pm

daytrader wrote:My Doc agreed to do a bypass if the vein above the clot is good. We can't tell on the ultrasound cuz there is no flow there. I sure hope it is good. This time if I clot up we will be back in there A.S.A.P.. I will post once I know. I am waiting on the MRV date as this all just happened yesterday. I know there are many in my position and ready to have hope again.


we have not summarized the causes of occlusions

I can think of a variety of scenarios for clotting

1. hypercoagulability,include hughes syndrome, protein deficiencies
2. inadequate anticoagulation after the procedure
3.excessive dilatation leading to disruption of the wall and thrombosis acutely
4. treatment of a hypoplasia.
5. More downstreat stenoses, such as of the inominate vein
6. tandem stenoses with incomplete treatment of the upper vein. I had a windsock above a valvular stenosis. It would not open despite nearly 40 Atm of pressure. Unfortunately, the lower valvular stenosis, simple as it was, thrombosed, or perhaps the windsock thrombosed.
7. dural sinus stenosis or occlusion of the junction of the IJV and the dural sinus. Might be chiari, might be a malalignment syndrome at the skull base, might be hypoplasia of the foramen where the vein comes out of the skull

So it is good that you are getting an MRV. make sure you get one of the neck, but also one of the head to look for intracranial outflow problems.

also make sure you are tested for all the hypercoagulable states. Also make sure you are not on BC pills or smoke or take anything that will make you hypercoagulable.

Also make sure that there are no downstream obstructions that will impede flow of the IJV graft.

I wish you luck. I am pessimistic about these surgeries.
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Postby irv73 » Thu May 19, 2011 9:28 am

daytrader, or anyone else for that matter. Just a curiosity, but where might your doctor be harvesting this vein to graft in your jugular? After my second venoplasty my stenosised jugular veins collapsed so much that just a trickle of blood drains through them.
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Postby Cece » Thu May 19, 2011 11:28 am

I've heard it's the saphenous vein in the leg that's most likely to be used but would be very curious to hear back from daytrader. I am assuming that his doctor is in Florida as well, this would be a new doctor willing to do a jugular bypass.
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