Which Veins?

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

Which Veins?

Postby JCB » Wed Apr 04, 2012 1:08 pm

Besides the Internal Jugular and Azygous, which veins should be looked at?
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Re: Which Veins?

Postby Cece » Wed Apr 04, 2012 2:41 pm

It's uncertain. Possibly the dural sinuses, ascending lumbars, renal vein, iliac vein, vertebral veins, and/or the innominate vein. I think Dr. McGuckin checks out the superior vena cava.

Of all the ones listed, the renal vein seems to be the most important, because a compression of the renal vein causes the high 500 ml/min flow to go into the ascending lumbar and hemiazygous vein, which slows down the cerebrospinal drainage.

Next in importance would be the innominate vein, because that's what the jugulars flow into, and while we rarely hear about a blockage there, there have been a few.

Next most important from the list would be the dural sinuses, in order to check that the vein that appears to be the jugular truly is the jugular (because only the jugular goes all the way to the jugular bulb to the sinuses).

Next would be the iliac vein, because a May thurner compression can be treated, but Dr. Sclafani recently said something about the iliac vein not playing much of a role in CCSVI.

Vertebral veins and ascending lumbars are least on my list, because it would be rare to treat a vertebral vein, and the ascending lumbars are sometimes ill-formed or hyperplastic too-small and not treatable. If it can't be treated, ok, it's good to know about it, but that's all.

Hope that helps! Are you thinking of getting more veins looked at?
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Re: Which Veins?

Postby JCB » Wed Apr 04, 2012 2:57 pm

Thanks for the info.

My right jugular is starting to narrow again. I can say it has been the best 7 months I have had in quite a few years. I still feel pretty good. I am just wondering if there is stenosis in other veins, how it could potentially affect the jugular flow.
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Re: Which Veins?

Postby MsMezza » Mon Apr 09, 2012 5:22 am

I've a query - I have a retro-aortic left renal vein that was incidently found during a scan for a possible "celiac axis stenosis" even though I didn't exhibit signs of post-prandial pain.. has this been seen in CCSVI before?

*Left IJV - 2 x stenoses
*Right IJV - 1 x stenosis
*Retro-aortic left renal vein
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Re: Which Veins?

Postby Cece » Mon Apr 09, 2012 8:01 am

Yes, although retro-aortic is less common than nutcracker compression of the renal vein. Was it treated? A renal stenosis causes a lot of blood flow (500 ml/min) to be diverted into the ascending lumbars and hemiazygous vein which slows down the cerebrospinal drainage and can in itself cause CCSVI symptoms such as cogfog, vision issues, weakness and fatigue. (Not all of that is proven. But it is the argument in favor of treating renal stenoses. If I had one, I would have had it treated.)
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Re: Which Veins?

Postby drsclafani » Mon Apr 09, 2012 5:24 pm

MsMezza wrote:I've a query - I have a retro-aortic left renal vein that was incidently found during a scan for a possible "celiac axis stenosis" even though I didn't exhibit signs of post-prandial pain.. has this been seen in CCSVI before?

*Left IJV - 2 x stenoses
*Right IJV - 1 x stenosis
*Retro-aortic left renal vein

There are several nutcracker syndromes: an anterior nutcracker which compresses the left renal vein between the abdominal aorta and the superior mesenteric artery is the most common. A posterior nutcracker which compresses a retroaortic renal vein between the aorta and the lumbar vertebra is much less common. A rare nutcracker occurs when the gonadal vein wraps aound the renal vein
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com
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Re: Which Veins?

Postby Cece » Mon Apr 09, 2012 5:35 pm

So retroaortic is considered a nutcracker syndrome as well! That makes the discussion simpler. Though I am wondering, MsMezza, if your doctor chose to treat (and if so, was it ballooned or stented and did you feel any difference)?

There are several posters here at TiMS who have had their renal vein treated. Here's previous posts on nutcracker: https://www.google.com/search?q=thisism ... 11&bih=830
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Re: Which Veins?

Postby MsMezza » Mon Apr 09, 2012 6:42 pm

Nope, nobody chose to treat it merely because I forgot I had it, however I asked one surgeon (I've seen 2) if they've seen any iliac or renal vein abnormalities and bluntly said he's never checked. :S

I can't justify another $bundle of cash$ just to have it looked at when the visualised segments on ultrasound look fine.

Oh, I have the Aorta/SMA Nutcracker Syndrome =] At least SOMETHING in my body is typical

**ah bugger, just realised i have all indications of Pelvic Congestion Syndrome, too - looks as though it's time to get 'cracking' on treatment (Pardon the pun) :lol:
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Re: Which Veins?

Postby drsclafani » Tue Apr 10, 2012 3:48 am

MsMezza wrote:Nope, nobody chose to treat it merely because I forgot I had it, however I asked one surgeon (I've seen 2) if they've seen any iliac or renal vein abnormalities and bluntly said he's never checked. :S

I can't justify another $bundle of cash$ just to have it looked at when the visualised segments on ultrasound look fine.

Oh, I have the Aorta/SMA Nutcracker Syndrome =] At least SOMETHING in my body is typical

**ah bugger, just realised i have all indications of Pelvic Congestion Syndrome, too - looks as though it's time to get 'cracking' on treatment (Pardon the pun) :lol:

It is rather disturbing when the patient must be their own diagnostician
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Re: Which Veins?

Postby MsMezza » Tue Apr 10, 2012 5:17 am

It's just a bad joke, I'm stayin' put. Aussie humour.
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Re: Which Veins?

Postby Luvsadonut » Tue Apr 10, 2012 8:48 am

I was under the impression sinus veins werent too important for CCSVI, when I was a kid I had very heavy daily nosebleeds which was due to a missing valve at the top of my nose. I had my nose cauterized 5-6 times which effectively fused the vein together. Would anybody know if that wuold create issues in the sinus veins areas, which could then have a knock-on effect to CCSVI?

thanks
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Re: Which Veins?

Postby Cece » Tue Apr 10, 2012 11:34 am

I don't think so, Luvs. Here's an image of the veins of the nose: http://en.wikipedia.org/wiki/File:Gray557.png
I thought the facial veins drained into the external jugular but here it says the common facial vein drains into the IJV! http://en.wikipedia.org/wiki/Common_facial_vein
Discussion of sinuses in CCSVI is often about the venous sinuses, which drain directly from the brain and into the internal jugulars. When in real life we mention sinuses, we're often talking about the air-filled sinuses by the nose. http://www.meddean.luc.edu/lumen/meded/ ... nframe.htm
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All Stenoses are Important

Postby MarkW » Wed Apr 11, 2012 1:50 am

No interventionalist has demonstrated that leaving stenoses is a good idea, so my simple advice:
- have as many veins checked as possible (see Cece's list above and read DrS's thread)
- have all stenotic valves, webs, septums treated with a balloon correctly sized using IVUS.
It would help if you post if your Interventionalist finds a stenosis in an 'unusual' vein and other findings (even negative findings).
These are real clinical findings.
MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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