Opinions of medical professionals on CCSVI

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

Opinions of medical professionals on CCSVI

Postby griff » Tue May 10, 2011 7:19 am

I am just wondering what happened to those threads that I saw here a few hours ago about discussing the pros and cons on CCSVI. ...I guess this is not the Big Pharma conspiracy...

http://www.cirse.org/files/File/CIRSE_CCSVI_final.pdf

There are currently several centres actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. However, it must be stated that no randomised trial data are available to back the theory behind the treatment or to support its use. There are also no RCTs currently in progress. Therefore, the basis for this treatment rests on anecdotal evidence and successful testimonies by patients. It is for these reasons that CIRSE feels that this is not a sound basis to currently offer this new treatment, which has not yet been part of a RCT.
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The core of this new theory is the CCSVI syndrome, or the abnormal venous drainage from the brain. However, venous drainage from the head has an impressive anatomic variation, which is not very well catalogued in most textbooks. Also valves can be present at a variety of sites in the head and neck veins. Interventional Radiologists who practise para-thyroid sampling are well aware of the huge variety in venous anatomy. Besides the huge variation in normal venous anatomy the jugular veins have some natural narrowing at two sites and the azygous vein, prominent in the CCSVI theory, does not drain the brain at all. The azygous can clearly drain the spinal cord but not solely, as there are many intercostal venous collaterals which fulfil the same function. In addition, the fact that this imaging is done in the supine position will have a great influence on blood flow and image interpretation. There have recently been randomised studies comparing socalled venous stenoses in patients with and without MS (3-4). Both studies show that there is no difference in the prevalence of venous stenoses between the two groups. This seems to be a very strong argument against the existence of CCSVI. However, physicians performing CCSVI treatment point out that these studies were not performed according to the specific Venous Hemodynamic Insufficiency Severity Score (VHISS) criteria. The other part of the theory is that the venous outflow obstruction needs to be treated. However, if there is a real haemodynamic venous outflow obstruction, there should also be a pressure gradient and this gradient should disappear after successful balloon dilatation. It has been shown, and confirmed by those who perform balloon dilatation for CCSVI, that over the so-called stenosis there is never a measurable pressure gradient. Those who perform this treatment argue that it is not the pressure gradient but the change in outflow pattern, caused by this stenosis, that is the pathological entity.
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Re: Opinions of medical professionals on CCSVI

Postby NHE » Wed May 11, 2011 5:17 am

Besides the huge variation in normal venous anatomy the jugular veins have some natural narrowing at two sites and the azygous vein, prominent in the CCSVI theory, does not drain the brain at all.


This is of no surprise. Why do the authors choose to make this one of their arguing points?

The azygous can clearly drain the spinal cord but not solely, as there are many intercostal venous collaterals which fulfil the same function.


I believe that collateral veins have been shown to often be inadequate.

In addition, the fact that this imaging is done in the supine position will have a great influence on blood flow and image interpretation.


Imaging via ultrasound compares blood flow in both the sitting and supine positions. This is the only way a delta cross sectional area (dCSA) can be determined. It is one of Dr. Zamboni's diagnostic criteria.

There have recently been randomised studies comparing socalled venous stenoses in patients with and without MS (3-4). Both studies show that there is no difference in the prevalence of venous stenoses between the two groups. This seems to be a very strong argument against the existence of CCSVI.


The work done at BNAC has shown an increased prevalence in MS patients.

However, if there is a real haemodynamic venous outflow obstruction, there should also be a pressure gradient and this gradient should disappear after successful balloon dilatation. It has been shown, and confirmed by those who perform balloon dilatation for CCSVI, that over the so-called stenosis there is never a measurable pressure gradient.


If I remember correctly, Dr. Dake did show a mild pressure gradient across stenoses which disappeared after angioplasty in some of his early patients.


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Re: Opinions of medical professionals on CCSVI

Postby Cece » Wed May 11, 2011 6:14 am

NHE wrote:
Besides the huge variation in normal venous anatomy the jugular veins have some natural narrowing at two sites and the azygous vein, prominent in the CCSVI theory, does not drain the brain at all.


This is of no surprise. Why do the authors choose to make this one of their arguing points?

My circulation was so bad, my azygous did help drain my brain, according to Dr. Sclafani.
www.thisisms.com/ftopicp-153823.html#153823
These images show a very tight stenosis of almost 100%. There are vertebral collaterals seen. These vertebral collaterals can drain through the vertebral veins into the subclavian vein but because of chronic obstruction some of this drainage can travel through the vertebral plexuses that are continuous down the spine. So some of the drainage goes from the plexuses into the intercostal and lumbar veins and out into the azygous system.
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Re: Opinions of medical professionals on CCSVI

Postby griff » Fri May 13, 2011 6:36 am

NHE wrote:
The azygous can clearly drain the spinal cord but not solely, as there are many intercostal venous collaterals which fulfil the same function.


I believe that collateral veins have been shown to often be inadequate.

NHE


How was it shown that it is inadequate? Why is that when one of the ISVs is fully tied off, the the there is no problem at all, but when two IJVs are slightly stenosed then there is a problem according to dr Z?


There have recently been randomised studies comparing socalled venous stenoses in patients with and without MS (3-4). Both studies show that there is no difference in the prevalence of venous stenoses between the two groups. This seems to be a very strong argument against the existence of CCSVI.


The work done at BNAC has shown an increased prevalence in MS patients.



If you accept BNAC study then it is hard to say that CCSVI is a major contributor to MS.


My circulation was so bad, my azygous did help drain my brain, according to Dr. Sclafani.


how much do we really know about our vein system? CCSVI theory seems so simple. How come the very same IRs who are doing CCSVI operations today did not raise any issue of stenosed IJVs, azygos, etc. before. As far as I know even dr S tied off IJV before.
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