Venous research from the 1970s in those with paraplegia

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

Venous research from the 1970s in those with paraplegia

Postby cheerleader » Sat Jun 04, 2011 9:55 am

for those not on Facebook. Some older research....

Thanks to Mylène Therrien for the following info on research from the 1970s on demyelination of the spine due to venous hypertension and malformations in the veins surrounding the spine. The 80 patients tested and treated in these studies had paraplegia and myeolapthies of the spine. They were treated for venous stenosis in the 1970s. Dr. Zamboni has referenced this research in his publications, but I hadn't seen these abstracts or understood the history.
Here are the abstracts and links I found from the info given in her posting:

Acta Radiol Suppl. 1976;347:395-401.
[Intraspinal venous hypertension due to multiple anomalies in the caval system. A major cause of myelopathies].
[Article in French]
Aboulker J, Aubin ML, Leriche H, Guiraudon G, Ancri D, Metzger J.
Abstract
Increased venous intraspinal pressure is described as a venous system disease, resulting in numerous unexplained paraplegias and tetraplegias. The chronic venous stasis in the intraspinal plexuses, into which the circulation of the spinal cord is drained, is due to the association of multiple abnormalities (stenoses, compressions, thromboses) on the major pathways of the caval and azygos system. The abnormalities, most of which are not known, are demonstrated by a special procedure, the cavo-spinal phlebography, and some of them are subjected to surgery.
PMID:
207125 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/207125

Acta Radiol Suppl. 1976;347:415-7.
[Cavo-spinal phlebography in myelopathies. Stenoses of internal jugular and azygos veins, venous compressions and thromboses].
[Article in French]
Leriche H, Aubin ML, Aboulker J.
Abstract
Increased intraspinal venous pressure, resulting according to ABOULKER in numerous spastic paraplegias and quadriplegias is due to multiple venous abnormalities demonstrated by cavo-spinal phlebography. The most frequent are stenoses of the internal jugular veins, the left renal, the left iliac veins, the azygos veins and compressions of the innominate venous trunks. These abnormalities cause a permanent stasis in the intraspinal plexuses through excessive supply or insufficient drainage. Out of 80 patients, 60 per cent had at least 2 abnormalities, 38 per cent at least 3 abnormalities.
PMID:
207127 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/207127

Acta Radiol Suppl. 1976;347:403-13.
[Cavo-spinal phlebography in myelopathies of venous origin. Application of the method in 115 cases].
[Article in French]
Aubin ML, Leriche H, Aboulker J, Ernest C, Ecoiffier J, Metzger J.
Abstract
The intraspinal venous stasis, described by ABOULKER as the cause of numerous myelopathies, is due to the addition of multiple venous abnormalities, demonstrated by cavospinal phlebography. The venae cavae and their major affluents and the prespinal system (lumbar and ascending lumbar veins, azygos, hemi-azygos, right superior intercostal and vertebral veins) are explored by catheterization. Cavo-spinal phlebography reveals multiple obstacles and the resulting stasis in the intraspinal plexus.
http://www.ncbi.nlm.nih.gov/pubmed/207126

------------------------------------------------------

The following quote is Mylene writing about her conversation with Dr. Garel, the IR who performed these procedures, and her translations from the research, originally written in French.
----------------------------------------------

I spent 45 minutes on the phone with Dr.Garel from St-Justine Hosptial who was the IR who did the catheterization under Dr.Aboulker's study in the 70's. Interestingly enough. the results and the outcome of that experiemental treatment were exactly what Zamboni is finding. Here is a part of his work, translated from French to English from me. Note that : First : You should know that I do not know when to use the word " stenoses " vs " stenosis"

The basis for surgical indication : To whom was surgery proposed ?

Any patients who had a major cause of spinal cord problems of unknown origin resulting in progressive disabilities for whom no other therapeutic alternatives were available to them and whose cavo-spinal phlebography examination revealed multiple abnormalities of the major pathways of the caval and azygous system.

Note that it was a new and an experimental procedure proposed and well-explained to the patients at the time ( in the 1970's). Only those whose paraplegia were progressing and regularly worsening were offered the surgery.

Aboulker and al., were investigating the multiple abnormalities ( stenosis-compression-thrombosis) which reduce or block the circulation in the large veins of the caval system, resulting in spinal venous stasis as a result of excessive supply and inadequate drainage. That would result in impairment in function of the cord, just like any organ when return circulation is chronically impaired.

HERE ARE THE RESULTS of the cavo-spinal phlebography done on 80 patients who experienced unexplained spastic paraplegias and quadraplegias.

Out of the 80 patients, only 21 patients had the left renal vein investigated.

INTERESTINGLY ENOUGH, ABNORMALITIES WERE FOUND AT ALL LEVELS OF THE VENOUS SYSTEM. The left primitive iliac vein was found to be among the most frequent abnormalities observed. The other ones were stenoses of the IJVs, the left renal vein, the azygous veins and the compressions of the innominate venous trunks.

Out of the 80 patients, 60% had at least 2 abnormalities and 38% had at least 3.

FREQUENCY OF THE ABNORMALITIES:

LUMBAR LEVEL:

ILIAC VEIN
- left primitive iliac vein showed recanalized old thrombus in 5% of the patients.
- 48% of the patients showed a stenosis of the left primitive iliac vein.
(Note that an upstream stasis were always found with those obstructions.)
- 34% of the patients had an abnormality of the intraspinal dorsal and lumbar plexuses and an abnormality of the azygous system as well..

RENAL VEIN: - Note that only 21 patients out of 80 patients had their left renal vein investigated.
-47,6% of those 21 patients had a compression of their left renal vein.
-30% of the 21 patients had an abnormality in the intraspinal dorsal and lumbar plexuses and in the azygous system

DORSAL AND AZYGOUS LEVEL:

-12% of the patients had either a stenosis or a compression of the arch of the azygous ( " crosse de l'azygos ") and hemiazygous. Those abnormalities resulted in all those cases in a distal stasis in the intraspinal plexus.

AT THE CERVICAL LEVEL:

-A venous abnormality at the cervical level was found in 77% of the 80 patients.
- 65% of the 80 patients had a stenosis of the IJV ( again here , don't know when to use stenosis or stenose)
( 16% = bilateral stenosis ; 49% = unilateral stenosis where 33% were mainly found on the left side whereas 16% were found on the right side).
-12% were found to have a bone or arterial compression of the innominate venous trunks.

ALL PATIENTS WHO HAD AN ABNORMALITY AT THE CERVICAL LEVEL ( IJV stenosis or compression of the innominate venous trunks) HAD AN ABNORMAL SUPPLY OF THE CERVICAL INTRASPINAL PLEXUS WITH GENERALLY IMPORTANT DILATATION OF THE VERTEBRAL VEINS.

SUMMARY:

Out of the 80 patients :

-15% had a normal venous cavo-spinal phlebography.
-25% had one abnormality
-21% had 2 abnormalities
-26% had 3 abnormalities
-12% had 4 and more abnormalities.

Note that those percentages are lower (less important ) than reality because the roots (" les racines") of the azygous were seen only 41 times out of 80 and because the left renal vein was investigated in only 21 patients out of 80 patients. So when the roots of the azygous and the renal vein were investigated, abnormalities were found in 50% of the cases ( one time out of two).

TO CONCLUDE:

PERMANENT STASIS IN THE INTRASPINAL PLEXUSES THROUGH EXCESSIVE SUPPLY OR INSUFFICIENT DRAINAGE CAUSED BY ABNORMALITIES WERE FOUND AS FOLLOW:

- Out of 80 patients, 60% had at least 2 abnormalities whereas 38% had at least 3 abnormalities.
--------------------------------------------------------------

thanks, Mylène . I'm floored. This is not new...
The researcher, Jose Aboulker (1920-2009) was a pioneer of neurosurgery and neurology in France and a renowned anti-Nazi partisan.
http://resources.metapress.com/pdf-prev ... ze=largest

wow.
Joan
Last edited by cheerleader on Sat Jun 04, 2011 1:33 pm, edited 1 time in total.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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nice one

Postby ppicklee » Sat Jun 04, 2011 12:49 pm

nice find Cheerleader
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Re: nice one

Postby frodo » Sat Jun 04, 2011 4:40 pm

just curiosity. Is MS officially considered a myelopathy?
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Re: nice one

Postby scorpion » Sat Jun 04, 2011 5:04 pm

frodo wrote:just curiosity. Is MS officially considered a myelopathy?
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Postby cheerleader » Sat Jun 04, 2011 5:54 pm

Frodo and Scorp--

Myelopathy is a non-specific word for spinal injury. When it is due to trauma, it is called spinal cord injury. When it is due to inflammation, it is called myelitis. So, yes, MS is a type of myelopathy, it's a "demylinating myelopathy" (say that 10 times fast)....but I'd assume if these patients had an MS diagnosis, it would have been mentioned. But we don't know yet. Hopefully Dr. Garel will clarify.

This research is from 1976...before MRI was used to determine demyelinating lesions on the spinal tissue or in the brain. The Poser Criteria for diagnosis of MS came about in 1983, and that included demyelination.

These 80 patients all had "paraplegia" (did that include MS?)...I have some Canadian friends in contact with Dr. Garel, who are trying to see if he'll speak on the record regarding these studies and the findings. He's been very helpful so far.

In any event...it's been a fascinating day. More to come,
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Cece » Sat Jun 04, 2011 7:23 pm

I don't understand why nothing came of this or of Dr. Schelling's work in the 80s. To be so close....
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Postby ThisIsMA » Sun Jun 05, 2011 7:42 am

I wonder what percentage of the people in this study improved (or stopped getting worse)? Wouldn't it be interesting to track these people down and see who is still alive and how they have done? Also to find out what percentage of them were later diagnosed with MS!
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Postby cheerleader » Sun Jun 05, 2011 7:13 pm

Cece wrote:I don't understand why nothing came of this or of Dr. Schelling's work in the 80s. To be so close....


Cece--I think in this instance it was probably a combo of lack of funding for research and the problem with restenosis in venous low flow situations. It will be interesting to get the full papers translated. Mylene has told me that the results were very much like Dr. Zamboni's...

The thing is, if venous stenosis is key, there will be more interest becasue there is now more monetary incentive. More IRs practicing, better blood thinning alternatives, venous stents in development...it's a different time than 1976. as soon as I get the full papers, will post,
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby EJC » Mon Jun 06, 2011 12:41 am

Cece wrote:I don't understand why nothing came of this or of Dr. Schelling's work in the 80s. To be so close....


More than likely, technology.

It seems scanning and understanding many of the subtle changes in the venos system are terrible difficult to find and only now with IVUS etc have we really begun to have the equipment available to find the problems.

At least thats my theory.
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