is preprocedure MRV standard for other venous diseases?

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is preprocedure MRV standard for other venous diseases?

Postby Cece » Thu May 31, 2012 10:22 am

Here's a statement by Dr. Arata over on facebook:
Despite the apparent anecdotal basis of the FDA warning cannot be dismissed. If you consider having or performing the CCSVI procedure safety must be the primary concern. The literature demonstrated that pre-procedure imaging improves the safety and reduces the duration of many procedures. MRV is unparalleled in is ability to provide a venous roadmap before a CCSVI procedure. High quality imaging also contributes to safety during the procedure. Intravascular ultrasound (IVUS) provides the most detailed intra-procedure images.

We are of the opinion that if the CCSVI procedure is going to be performed with maximal safety in mind the treating physician must know the anatomy beforehand. This is best accomplished with an MRV. In an effort to ensure utmost patient safety all patients undergoing the CCSVI procedure at Synergy will have a pre-procedure MRV and have intra-procedure IVUS.

The claim is that preprocedure imaging provides a roadmap and improves safety. The preprocedure imaging of an MRV comes at a cost to the patient of about $2000. The doctor states that preprocedure imaging improves safety in other diseases. I wonder if these other diseases are venous diseases, and if the proprocedure imaging of choice is an MRV? Does a person getting treated for Budd Chairi or Superior Vena Cava syndrome get an MRV first? Even if they do, is it for diagnostic purposes or is it for information to use during the procedure?

MarkW, you can add Synergy to the list now of doctors using IVUS in every procedure.
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Re: is preprocedure MRV standard for other venous diseases?

Postby cheerleader » Sat Jun 02, 2012 6:20 pm

I'm sure the answer to your question depends on who you ask, Cece...but for many, the answer is yes.

Magnetic resonance venography (MRV) has emerged as an effective imaging tool for the evaluation of diseases of the veins of the abdomen, pelvis, thorax, and extremities. Although duplex sonography is often the first modality for the evaluation of the venous system, it is hindered by acoustic access, especially in the evaluation of the deep veins of the pelvis, thorax, and the calf. MRV plays an important clinical role in the evaluation of venous disease, and in some clinical instances, such as evaluation of the pelvic veins, it has become the test of choice. Advances in local coils, gradient systems, and other system hardware and software have enabled faster scanning, reduced artifacts, increased signal-to-noise, and reduced examination times. Comprehensive examinations of the entire venous system can be performed in < 30 minutes. The clinical applications of MRV include diagnosis of deep venous thrombosis, for which MRV is the “new gold standard,” evaluation of chest and upper extremity veins for venous access, differentiating bland from tumor thrombus, diagnosis of superior vena caval syndrome, identification of superior vena caval invasion or encasement by lung or mediastinal tumors, diagnosis of the Budd-Chiari syndrome, diagnosis of caval anomalies such as persistent left superior vena cava and interrupted inferior vena cava, and identification of the presence and cause of obstruction or occlusion of the brachiocephalic, subclavian, and jugular veins. ... raphy.html
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
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Re: is preprocedure MRV standard for other venous diseases?

Postby Cece » Sat Jun 02, 2012 7:32 pm

Here a discussion of pelvic congestion syndrome refers to the MRV as roadmap: ... estion.pdf
and another mention of MRV as roadmap: ... sp?id=2573
Dr. McLafferty shared many images such as May Thurner Syndrome, right internal jugular vein stenosis, etc…
[...]Why should you do a CTV/MRV prior to direct venography?
Pre-intervention ‘Road map’
Thorough evaluation
Guide approach to access
Guide therapy plan
Duplex may fail (Abdomen/pelvis) (Wounds, obesity, edema)

Diagnosing venous malformations
Can diagnose/quantify compression syndromes
Degree of compression
Cause of compression
Extent of thrombus
Identify other pathology
Your finding may change next treatment step

Interesting about the use of MRV to diagnose compressions.
The MRV may be useful but is it $2000 out-of-pocket useful if intravascular ultrasound and venogram are going to be used as part of the procedure anyway.
Of course I am still shocked at the price our Canadian friends are paying for travel and procedure, and sometimes multiple procedures.
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