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Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency

Imperial College CCSVI Investigation Group:, A Thapar *, T R A Lane * , V Pandey *, J Shalhoub *, O Malik , M Ellis *, I J Franklin * , R Nicholas * and A H Davies *
* Imperial College London; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK

Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units.

Posted: Fri Nov 19, 2010 4:31 pm Post subject:
I got the removal of the clot via the dr hooking it out. He felt it was too risky to use thrombolysis in that location and also there is a huge risk of bleeding elsewhere in the system.

He only managed to get a small amount of flow back into the vein as it was so inflammed, he considered putting in a stent to keep it open but decided it against it as he was worried about it coming loose if the clots stuck to the walls of the veins started to dissolve, also he felt the stents currently used do not last as long as they should.

I was treated in Bulgaria, I did report my health issues to them on numerous occasions. I called the dr and nurses in over 8 times that night complaining of breathing difficulties and pain. In the end I requested an oxygen mask. They did and ECG and concluded I was fine. They made me feel like I was imagining the problem and kept repeating nothing was wrong.

I then just wanted to get home to be treated asap especially as I felt unsupervised and ignored.

A+E in the UK is very good in these situations. They have an obligation to help you, so when I walked in complaining of breathing difficulties, pain and told them what I had done they admitted me, put me straight on heparin IV and did all the necessary tests. There was a massive debate on whether to treat the clot as usually they leave jugular vein clots but they felt it was severe enough to treat (ear to collar bone clot that would never dissolve on its own). I am so thankful to them for trying.

I will go back to UK hospital for a doppler at some point to check the neck but it does feel clotted just by the feeling of pressure, it could be scar tissue now though that is giving me that sensation. My dr wants doesn't really want me to have another doppler for a while as knowing maybe worse than not knowing as I am on blood thinners and there are no options to treat it again whatever the results.

Usually fully anticoagulated means having an INR between 2 and 3. We still do not have a standardized method of treatment. I asked Dr Siskin what size balloons he uses and he said it depends on the size of the person's vein. I took that to mean that there is a variation of size between patients.
There is so much we do not know. And unfortunately, we only learn from making mistakes.

So Dr. Siskin's answer is a good one.

Usually fully anticoagulated means having an INR between 2 and 3. We still do not have a standardized method of treatment. I asked Dr Siskin what size balloons he uses and he said it depends on the size of the person's vein. I took that to mean that there is a variation of size between patients.
There is so much we do not know. And unfortunately, we only learn from making mistakes.

i hope i am posting this in the right spot.
i had ccsvi treatment in april.
in the last few weeks i am feeling tighness on the right side, like pressure. it gets intense, especially when bending over, or lying down with head propped even slightly. when just sitting, i feel just a slight discomfort and tenderness. also one lymph node on that side in back is swollen. i go back for followup Aug 30

what are the symptoms of a clot?

thx

And doing an ultrasound will only show you have something there but they cannot tell exactly what it is.