Venous hypertensive myelopathy caused by narrowing of ascending lumbar vein
Li Pan, Lianting Ma, Jie Gong, Zhe Yu, Xinyuan Zhang, Jun Li, Qihong Wang
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Command, People's Liberation Army, Wuhan 430070, China.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2002; 40(10):752-4.
OBJECTIVE: To assess the diagnosis and treatment of venous hypertensive myelopathy (VHM) caused by narrowing of the ascending lumbar vein. METHOD: The data from 3 patients with VHM caused by narrowing of the ascending lumbar vein were analyzed retrospectively. RESULTS: Once the narrowed site of the lumbar ascending vein was determined by myelographic or angiographic technique, an undetachable balloon was introduced and advanced to the proximal part of the narrowed segment. Satisfactory results were obtained in these patients. CONCLUSION: Narrowing of the ascending lumbar vein is one of the causes for VHM, and endovascular balloon angioplasty is an optimal treatment.
Not all IRs image the ascending lumbar veins in CCSVI, but some do. My own ascending lumbars looked good. But my understanding from Dr. Zamboni's work was that he imaged the ascending lumbars just to let the patient know if there is a problem there, but he did not attempt treatment, and he also found a greater likelihood of ascending lumbar abnormalities in primary progressive patients.
But look at this! In patients with venous hypertensive myelopathy, their narrowed ascending lumbar veins were treated with nothing other than endovascular balloon angioplasty, with satisfactory results.
This would not work for anyone with agenesis of the ascending lumbars, but it might for patients with narrowed lumbar veins. This is a very small study but a very interesting one.