IJV Outflow in Patients with MS: A Catheter Venography Study

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

IJV Outflow in Patients with MS: A Catheter Venography Study

Postby ThisIsMA » Sun Nov 24, 2013 12:35 am

Have these CCSVI study results from Italy already been posted here? They were published on October 24th, 2013 in the "Journal of Vascular and Interventional Radiology". Here is the study abstract:

http://www.jvir.org/article/S1051-0443%2813%2901393-6/abstract

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.

Abstract

Purpose
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.

Results
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.

Conclusions
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
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Re: IJV Outflow in Patients with MS: A Catheter Venography S

Postby ThisIsMA » Sun Nov 24, 2013 6:10 am

I guess insomnia has some usefulness...

Here is an article published in Italian on a website called "Mediterranews" about the study I posted the abstract to above. It seems to provide more detail than the abstract. I used the "Google Translate" website to translate the text into English. Here is a link to the original article in Italian:

http://mediterranews.org/2013/11/sclerosi-multipla-nuove-evidenze-scientifiche-sul-legame-tra-ccsvi-e-sm/

Here is the translated text of the article:

Multiple Sclerosis: new scientific evidence on the link between CCSVI and MS
Published on November 05 2013 / / Health This article was written by Alexander Rasman

Increasing evidence of the link between multiple sclerosis and outflow of blood from the brain to the heart, ie between MS and chronic cerebrospinal venous insufficiency ( CCSVI) , venous disease discovered by Prof. Paolo Zamboni (University of Ferrara) , strongly present in MS patients .

The free medical research goes on.

A study from one of the major centers of the Italian treatment of CCSVI , just published on the website of the scientific journal Journal of Vascular and Interventional Radiology , shows that in MS patients , blood flow to the internal jugular veins ( IJVs ) more slowly than in healthy people . The title of the research is : " Runoff from the internal jugular veins in patients with multiple sclerosis: a study using catheter venography ."

This study unequivocally demonstrates two things:

1) - a high prevalence of abnormal delayed flow through the internal jugular veins ( IJVs ) in patients with MS ( the contrast comes from the jugular veins usually in less than 4 seconds , the CCSVI time is always longer and thicker exceeds 6 seconds) ;

2) - that venous angioplasty and ' effective only in a minority of patients with severe delayed flow (SDF) .

Researchers at the University of Catania, coordinated by prof. Pierfrancesco Veroux , has investigated a protocol with catheter venography independent examiner , which could be used to reliably diagnose abnormalities of venous drainage in patients with multiple sclerosis (MS ) and chronic cerebrospinal venous insufficiency and to determine whether venous angioplasty is effective in the treatment of these anomalies . This is another important aspect of the study of Catania : the implementation of a new standardized diagnostic method , which will facilitate the interpretation of the test and the control of the outcome after endovascular procedures for CCSVI.

Were subjected to Doppler ultrasound and catheter venography of the internal jugular veins of a total of 313 patients with MS and 12 with end-stage renal disease , to evaluate the average time of clearance (transit) of the contrast medium . In patients with abnormalities of venous outflow was performed angioplasty of the internal jugular veins .

A value of 4 seconds of mean time to complete outflow from the vein of the contrast medium , discriminated with high specificity and sensitivity of subjects with MS and runoff anomalies ( diagnosed with ECD and catheter venography ) in subjects (MS and others) without abnormalities runoff .

The internal jugular veins with a time of clearence between 4.1 and 6 seconds delay had a moderate flow (MDF), and those with a time of clearance of more than 6 seconds had a severe delayed flow (SDF ), 89% of patients showed a delayed flow medium or severe ( MDF / SDF) through at least one jugular , 79 % showed moderate to severe delayed flow through both jugular veins , and only 5 % showed normal flow in both IJVs .

The balloon angioplasty was able to immediately improve the flow in at least one jugular in 69% of patients , but the venous flow has been normalized in both the veins in only 37 % of patients. A serious delayed flow (SDF) persisted after angioplasty in 32% of patients.

At the end of the study, according to the authors , there is a high prevalence of abnormal delayed flow through the internal jugular veins in patients with MS. The venous angioplasty was effective only in a minority of patients with severe delayed flow (SDF) .

Source: http://www.jvir.org/article/S1051-04432 ... 6/abstract

Rome / Bologna , November 5, 2013

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Re: IJV Outflow in Patients with MS: A Catheter Venography S

Postby ThisIsMA » Sun Nov 24, 2013 6:36 am

Reading through the article from Mediterranews I just posted above, I was struck by how much this quote:

The balloon angioplasty was able to immediately improve the flow in at least one jugular in 69% of patients , but the venous flow has been normalized in both the veins in only 37 % of patients. A serious delayed flow (SDF) persisted after angioplasty in 32% of patients.

is similar to the often repeated statement that CCSVI angioplasty results in great improvement for 1/3 or patients, small improvements for 1/3 of patients, and no improvement for the remaining 1/3 of patients.

The normalized venous flow in both IJVs of 37% of patients could correlate with the 1/3 who see substantial improvements. The people who see small improvements might be those who end up with improved flow in only one IJV. I think this would be the 69% figure of those who see improvements in at least one IJV, minus the 37% figure of those who see improved flow in both IJVs, which equals 32% as the number who end up with improved flow in 1 IJV. Lastly, an additional 32% of people are listed as having post angiplasty persistent impaired flow in both IJVs. These people could correlate to those who see no benefit from angioplasty.

Unfortunately I don't have access to the study, just the abstract from the study. If someone else can access the study (its available online but its not free) at the link I provided to the abstract in my first post in this thread, it would be interesting to learn more.
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