It's interesting to think that, if we were able to have venogram/ivus/treatment done while upright, then that would show the alternative flow routes. If there is valvular stenosis of the vertebral veins present, this would be more easily seen when upright, if flow is increased in the vertebral veins when upright. Verts are not currently treated in CCSVI but it makes sense that they would be of importance and, since valves are present in the verts, the valves can be malformed there as well. We often have more than one thing wrong inside our veins: bilateral jugular stenosis, jugular and azygous stenosis, jugular and azygous stenosis and nutcracker sydrome. Why not jugular and azygous and vertebral vein stenosis?