Second Annual CCSVI update Symposium

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

Re: Responses to questions asked of me during hte conference

Postby Cece » Tue Jul 19, 2011 6:55 am

DrSnyder wrote:We use IVUS in our practice mostly to get a look at renal arteries before stenting or to know where to punch holes (fenestrate) an aortic dissection to allow flow back into the true lumen

What instrument do you use for the fenestration? The concept of fenestration has come up in CCSVI discussion because some patients have jugular duplication. The second lumen swells with flow and compresses the first lumen, creating an outflow obstruction. One possibility of how to treat this would be to fenestrate. If you have experience with fenestration in the aorta, what would be the extra challenges with attempting fenestration in a jugular? Is there an instrument that is the right size?
I will begin using it on any MS patients that we treat to document cross sectional area before and after treatment.

An excellent use for IVUS....
Essentially, MS has danced in and around everyone I know and love. There by the grace of god go I. If I can do anything to help move this treatment forward, I am in in IN!

I recognise this as that passion that Dr. Sclafani was saying Dr. Zivadinov and Montel have, that Dr. Sclafani himself has, and that CCSVI tends to inspire in people, at least around here. In in IN! When you know how bad MS is, any chance of improvement or cessation of progression is amazing.
And again, I DO apologize for the picture. I knew I should have ordered wallet size instead of portrait size. I Will figure out how to get that fixed.

I am beginning to think IRs, as a group, are unusually witty. This made me laugh. ;)
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Thank you! HappyPoet, NHE and SqueakyCat!

Postby DrSnyder » Tue Jul 19, 2011 9:41 am

First of all, a huge thankyou to HappyPoet, NHE and of course SqueakyCat who actually downloaded my photo and resized it for me. I seriously had just said outloud after reading the FAQ's page, "Well, now whatthe hell do I do? Where can I put this picture?" Enter SquekyCat to the rescue!
Thanks! That was awesome - I mean, good kitty..good kitty!

In regards to Cece's fenestration question - We use that term to mean we are cutting or poking holes from one side of a membrane to another. In the Aorta this works because the blood is flowing down one pipe with a membrane (the inner lining of the vessel or intima) that has dissected off the wall. The blood is still contained in the outer tube by the muscular layer and outer layer of the vessel.

In a duplicated system there would be two separate vessels running in parallel. So to cut from one to another would mean we would have to go outside the outer vessel walss to get ourt of the first and again to get into the second. Absent seewing the two together, I don't think it would be a good idea as we couldn't control the leaking outside the vessels.

We use different long needles or even glidewires in a catheter to poke through the membrane. Then a small balloon goes in over the wire and the hole is enlarged when the balloon is inflated.

Easy and fun...

In a duplcated systemt I would try to ensure that both are as open as possible and I would check pressure gradients to see if there was fluidic evidence of obstruction.
Gregory B. Snyder, MD DABR Vascular and Interventional Radiology University of Minnesota Hospital & Clinics Mayo B-228C Mayo Memorial Building 420 Delaware Street SE Minneapolis, MN 55455 <br /><br />
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Postby esta » Tue Jul 19, 2011 10:16 am

Dr. SNYDER, JUST WANT TO REITERATE A THOUSAND THANK YOU'S!!!!!!!!
not being anywhere near NY, this was a total gem to read.
plus, all of you who did go, and your input also was so informative, this has been an amazing read, from start,to finish. well, by no means finished...
PPMS. Liberated Katowice, Poland
06/05/10 angioplasty RJV-re-stenodsed
26/08/10 stent RJV
28/12/10 follow-up ultrasound intimal hyperplasia
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Postby Cece » Tue Jul 19, 2011 11:38 am

Interesting! I meant something more along the lines of "an incomplete duplication of 206 cm of the jugular vein centrally. it shares a common wall with the true jugular vein. and an orifice with the sublcavian/inominate".

(quoting Dr. Sclafani from a previous fenestration discussion: www.thisisms.com/ftopic-10680-4320-days0-orderasc-.html )
DrSnyder wrote:We use different long needles or even glidewires in a catheter to poke through the membrane. Then a small balloon goes in over the wire and the hole is enlarged when the balloon is inflated.

If there is a common wall, that would take care of the leakage concern. But I am thinking that the structure of the common wall is stronger or harder to fenestrate than a membrane. Once there is a hole, the balloon can actually go into the hole and be used to enlarge it? This all just caught my attention in your summary and I was curious to hear what you thought! Thanks!
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2nd CCSVI

Postby ttucker3 » Tue Jul 19, 2011 11:47 am

Dr. Snyder

Thanks for the quick summations. I was also at this meeting and echo your sentiments. WRT your question about Doppler angle, I suspect that physicists and radar engineers understand that if the Doppler angle is zero then the measured velocity is also zero. I have wondered for some time if the Zamboni criteria of zero flow (1 of 5 critera ) and the intial 2008 tests which showed 100% CCSVI and MS correlation weren't a result of getting an automatic 1 check mark because a zero Doppler was unknowingly used in many cases. More advanced ultrasound sensors use a phased array sensor head that designs out the possibility of zero Doppler and the most recent tests may, as a result, be more accurate.

WRT Clive Beggs we have shared similar thoughts and you might find my Youtube prsesentation reinforces some of his hypotheses. See:

http://www.youtube.com/watch?v=WriNVSNy6Qw

http://www.youtube.com/watch?v=g07XPAA_80E

http://www.youtube.com/watch?v=ABRD5P8YO1U

Trev. Tucker
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Postby Cece » Tue Jul 19, 2011 12:03 pm

Dr. Tucker, welcome.
I have wondered for some time if the Zamboni criteria of zero flow (1 of 5 critera ) and the intial 2008 tests which showed 100% CCSVI and MS correlation weren't a result of getting an automatic 1 check mark because a zero Doppler was unknowingly used in many cases.

!!
That could be the explanation.
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Postby 1eye » Tue Jul 19, 2011 3:30 pm

http://www.med-ed.virginia.edu/courses/ ... dex4a.html

The zero angle provides a maximum signal because the blood is either coming directly at you or away from you. But it would be tricky to do. At exactly 90 degrees, which would be easy to do, the signal would disappear altogether. I don't think he had such a problem as you describe. If you did, you might see a stenosis you could make disappear by varying the angle *anywhere* you placed the probe. Moving the probe lengthwise along the vein would have the same effect as long as you held the same angle exactly. The supposed mistaken stenosis would be very long.

You might train yourself to make stenoses seem to be there that actually aren't, but you would have to be very smooth to make it look like you were scanning a vein.
"Try - Just A Little Bit Harder" - Janis Joplin
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'MS' is over - if you want it
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Postby CureOrBust » Wed Jul 20, 2011 4:07 am

DrSnider wrote: Dr. Salvi showed a picture of someone with sever edema in the lower extremities that looked just like venous stasis and claimed that they had a complete reduction in the LEG swelling after jugular treatments for CCSVI. This seems hard to explain and I would have liked to see any data to support this.
Not as obvious, but before my two treatments (both jugular, at different points) I used to get a severely painful leg thing, that originally started out as a superficial thrombosis; however in the last couple of years, the swollen vein was not visible. Since the treatments, this has not happened once. It was getting worse and more frequent, and was starting to occur once every 3 months or so before treatment. They found nothing using ultrasound of my leg. Truly painful, now a memory...please.
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