Internal Jugular Veins Outflow in Patients with Multiple Sclerosis: A Catheter Venography Study
Pierfrancesco Veroux, MDemail address, Alessia Giaquinta, MD, Debora Perricone, MD, Lorenzo Lupo, MD,
Flavia Gentile, MD, Carla Virgilio, MD, Anna Carbonaro, MD, Concetta De Pasquale, MD,
Massimiliano Veroux, MD, PhD
Received 26 April 2013; received in revised form 28 August 2013; accepted 29 August 2013. published online 24 October 2013.
To investigate an examiner-independent catheter venography protocol that could be used to reliably diagnose venous outflow abnormalities in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency and to determine whether venous angioplasty is effective in the treatment of these abnormalities.
Materials and Methods
A total of 313 patients with MS and 12 patients with end-stage renal disease underwent echo-color Doppler sonography and catheter venography of the internal jugular veins (IJVs) to evaluate contrast medium clearance time. In patients with venous outflow anomalies, balloon angioplasty of the IJVs was performed.
A contrast medium clearance time cutoff value of 4 seconds or less provided the maximal combination of sensitivity and specificity for the right IJV (sensitivity, 73.4%; specificity, 100%) and left IJV (sensitivity, 91.4%; specificity, 100%). IJVs with a clearance time between 4.1 and 6 seconds had moderate delayed flow (MDF), and IJVs with a clearance time longer than 6 seconds had severe delayed flow (SDF); 89% of patients showed MDF/SDF through at least one IJV, 79% showed MDF/SDF through both IJVs, and only 5% showed normal flow in both IJVs. Balloon angioplasty was immediately able to improve flow in at least one IJV in 69% of patients, but venous flow was normalized in both veins in only 37% of patients; SDF persisted after angioplasty in 32% of patients.
There is a high prevalence of abnormal delayed flow through IJVs in patients with MS. Venous angioplasty was effective in only a minority of patients with SDF.
Abbreviations: CCSVI, chronic cerebrospinal venous insufficiency, ESRD, end-stage renal disease, IJV, internal jugular vein, MDF, moderate delayed flow, MS, multiple sclerosis, PP, primary progressive, PTA, percutaneous transluminal angioplasty, ROC, receiver operating characteristic, RR, relapsing–remitting, SDF, severe delayed flow, SP, secondary progressive