Professor Paulo Zamboni has obviously given this area much thought and has filed a patent for a device called a valvulotome. He feels this will be the most effective way of dealing with abnormal valves without damaging the vessel wall but on further questioning it became clear that there is no suitable valvulotomes available at present which are the right size for use in the jugular veins. This type of device is designed to permanently damage the valves without damaging the surrounding veins. It has been used in cardiology to remove the valves of the saphenous veins used in cardiac grafting.
It is thought that permanent disruption of the valves using balloons alone is not possible at present and that over aggressive high pressure ballooning may risk venous damage.
The use of stents in the neck veins has been one solution to this problem but it has become clear that this approach is associated with increased complications. Professor Simka in Katowice has reported that the use of stents in his unit has dropped from 50% of patients to only 5%.
Dr Ivo Petrov in Bulgaria has performed over 1300 CCSVI procedures
Dr Salvatore Sclafani from New York pointed out that the veins are totally dependent on the venous blood for their nutrients and therefore this flow should not be disrupted for any significant period of time. Overenthusiastic and aggressive use of balloon catheters to disrupt valves could be damaging to the veins in the long term if the oxygen supply is reduced by the very procedure which is aimed at restoring normal flow. Current practice in the UK is similar to other centres where the valves and other intraluminal obstructions are treated with a combination of balloons, cutting wires, cutting balloons and particularly double balloons.
BadCopy wrote:Is it easy for a IR or other doctor to see if your valves are an issue? What is the process to make that determination?
I am interested in the idea that the valves may be causing, or at least significantly contributing to, CCSVI. My question is, what determines if the valve is causing a problem. I am not sure I want to jump forward to the point of just removing them before being sure they ate a part of the problem. I have seen what appears to be a large correlation between people that had agressive ballooning at the valves and a longer amount of time their symptoms were reduced.
I guess what I am saying is that the valve issue makes sense and would definately explain the experience I have had with CCSVI. But how do docs determine what a good or bad valve is and if it needs to be dealt with? Or is it a process of elimination?
By the way I have not been following for a while, so if some of this is old news please let me know. I am very interested in the valve issue because I have suspected that it is a player in my situation for some time.
Treating the valves and other intraluminal abnormalities is therefore a central issue in the treatment of CCSVI and one that all the treatment centres in the world are dealing with. A balance has to be struck however, between aggressively treating the valves with high pressure balloons to reduce venous hypertension, and the possibility of vein damage. Excessive pressure could cause scarring and possibly further venous problems.
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