Jugulars and azygous (et al ?)

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

Jugulars and azygous (et al ?)

Postby yeadonscience » Tue Nov 15, 2011 1:44 pm

There is currently much debate about the requirement for the liberation of veins other than the jugulars and azygous. How often is liberation required other than the big two. Is CCSVI a condition of only these two veins.
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Re: Jugulars and azygous (et al ?)

Postby cheerleader » Tue Nov 15, 2011 1:51 pm

yeadonscience wrote:There is currently much debate about the requirement for the liberation of veins other than the jugulars and azygous. How often is liberation required other than the big two. Is CCSVI a condition of only these two veins.


Hi yeadon and welcome--
Dr. Zamboni discovered and defined CCSVI as being related to the azygos and jugular veins. Here he describes how blockage can impact other veins in the intraspinal system:

At the craniocervical level, anterior sources of intraspinal system arise from basal plexus and IPS (Schaller, 2004; Chaynes, 2003). A posterior communicating venous drainage exists with occipital sinus, which may be relevant in cases of lateral sinus hypoplasia (Schaller 2004). The system communicates with deep thoracic and lumbar veins, intercostal veins, AZY, and hemiazygous veins, as well as with the inferior vena cava. Particularly, the collateral circle between the AZY and the inferior vena cava, via the left renal vein is particularly relevant in course of CCSVI. The AZY in the MS group was obstructed in 86% of cases. Most cases involved membranous obstruction of the junction with the superior vena cava, twisting, or, less frequently, septum and atresia (Zamboni et al., 2009a). In such cases, descending venography documented a reflux flow along the AZY system, which re-enters into the caval system through the hemiazygous-lumbar anastomosis with the left renal vein (Fig. 2)


Dr. Zamboni believes that the problems noted in these other veins are due to collateral circulation, not truncular malformations in these veins. This is an important distinction he makes. Therefore, treating the other stenotic veins would not get to the route of the problem...the azygos vein.
Other researchers may differ in their opinions, but Dr. Zamboni is the one who has spent the most time on this problem. His research should always be considered. Treating venous stenosis, rather than the malformation (like the azygos web), isn't always successful.

Here's the full paper on collateral circulation:
http://www.benthamscience.com/cnr/opena ... boniII.pdf

cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Jugulars and azygous (et al ?)

Postby Cece » Tue Nov 15, 2011 3:06 pm

I have to disagree that this quote means anything other than that the renal vein can serve as a collateral when the azygous is blocked. Dr. Zamboni is not addressing the situation of when the renal vein is blocked and the azygous serves as a collateral. I believe this will all be discussed at the ISNVD conference in February.

I do not think Dr. Zamboni has offered a public opinion on the renal vein however he was the one who initiated the "go in on the left" so as to check the left iliac vein for May Thurner. Dr. Sclafani observed this when he visited Italy in June of 2010 and, upon asking, found out that Dr. Zamboni/Dr. Galleoti had always gone in on the left to check the iliac vein but it had been cut from the paper by the editor for space reasons! I feel I need to repeat that. For space reasons! When it is of great importance. Dr. Zamboni thought that May Thurner syndrome (in which the left iliac vein is constricted by the left iliac artery and the flow that would've gone through the left iliac vein ends up collateraling back through the hemiazyous/azygous system) is worth checking for and treating if found.
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Re: Jugulars and azygous (et al ?)

Postby cheerleader » Tue Nov 15, 2011 3:42 pm

Cece wrote:I do not think Dr. Zamboni has offered a public opinion on the renal vein however he was the one who initiated the "go in on the left" so as to check the left iliac vein for May Thurner. Dr. Sclafani observed this when he visited Italy in June of 2010 and, upon asking, found out that Dr. Zamboni/Dr. Galleoti had always gone in on the left to check the iliac vein but it had been cut from the paper by the editor for space reasons! .


Absolutely right, Cece...Dr. Zamboni went in thru the left side, and Marie Rhodes has written about this many times.
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic17750.html

But CCSVI Syndrome, as defined by Dr. Zamboni, is his "public opinion". It is published research. CCSVI was found in 5 criteria in the azygos and jugular veins....not the renal or lumbar veins, although Dr. Zamboni did suggest investigating those areas for potential problems. The implications of the renal vein have not been published yet, with the exception of the mention in the paper I linked above on collateral circulation. I believe it's important to reference what has been published when new folks come on here looking for answers. Obviously, things may change in the new year, as new papers are peer-reviewed and published.
Hope that explains more on why I answered the way I did.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Jugulars and azygous (et al ?)

Postby Cece » Tue Nov 15, 2011 4:15 pm

Stenosis in the renal or iliac vein would not be considered CCSVI. It would be a second flow disorder (nutcracker or may thurner syndrome) that could complicate the first flow disorder (CCSVI).

Dr. Zamboni has not weighed in on the effects of renal or iliac vein stenosis on the azygous, which is not the same as having come out against it.

There can be truncular malformations in the renal vein, such as webbing, but it is primarily a compression issue (the vein is compressed by the aorta), as is May Thurner syndrome (the vein is compressed by the left iliac artery). Treatment is a stent.

Yeadonscience was right about there being much debate on this subject, even among ourselves! Let's see...how often is liberation required other than the big three (left jugular, right jugular and azygous)? This would depend on which doctor you see. Dr. McGuckin finds renal stenosis in 70% of pwMS. This seems high to me. Dr. Arata checked 50 patients and found only one renal stenosis that did not, in his opinion, affect flow or require treating. This seems low to me. It's been suggested that renal and iliac stenosis are no more common in MS patients than in healthy population. The incidence in the healthy population has to be available somewhere, but I haven't got the figures handy.

In Dr. Sclafani's thread, he showed us a case study of a patient with a severely blocked subclavian vein. (Jugulars flow into the subclavian.) It would be unusual to have a subclavian vein blockage; this was due to damage from a chemotherapy port. It contributed to the obstruction of outflow, so I'd say that this was part of the CCSVI picture for this patient even though it was neither a jugular nor an azygous.

Cheer and I may disagree but she has my utmost respect, and it always improves a conversation on CCSVI to quote the research!

There are many issues which we discuss which do not have a basis in the research yet. Is it ok for IRs to tear the annulus? What anticoagulation is best? How many veins should be checked? Patient care is underway even though these answers are not yet in.
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Re: Jugulars and azygous (et al ?)

Postby Cece » Tue Nov 15, 2011 4:32 pm

psst yeadonscience please post again or I will think you were scared off! 8O
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Re: Jugulars and azygous (et al ?)

Postby Cece » Fri Nov 18, 2011 2:31 pm

bump
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