J Cardiovasc Surg (Torino). 2013 Oct 24. [Epub ahead of print]
Efficacy and safety of cutting balloons for the treatment of obstructive lesions in the internal jugular veins.
Kazibudzki M, Latacz P, Ludyga T, Simka M.
Aim: In this technical note we present the results of endovascular treatment for chronic cerebrospinal venous insufficiency with the use of cutting balloons, with focus on feasibility and safety of these endovascular devices. Methods: We used cutting balloons during 70 procedures in 65 multiple sclerosis patients presenting with strictures of the internal jugular veins, primarily at the level of jugular valves. These devices were used only in selected cases, following unsuccessful standard balloon angioplasty, and on condition that commercially available devices could be applied (currently they are maximally 8 mm in diameter). Results: In all cases the perioperative course was uneventful, with no serious adverse events. Immediate technical success rate was 94.3%. In four cases (5.7%) cutting-balloon angioplasty alone was unsuccessful and stents were implanted. Primary, assisted primary and secondary patency rates after 6 months were: 94%, 98.5%, and 98.5%, respectively. Follow-up has revealed that out of the remaining 66 angioplasties four procedures failed (failure rate: 6.1%): in two patients stents were implanted, in one patient successful redo cutting-balloon angioplasty was performed, while in another case the treated segment of jugular vein totally occluded and was not feasible to reopen endovascularly. Conclusion: Cutting balloons can be safely used for the management of stenosed internal jugular veins. These devices can replace stents in the majority of cases, especially if standard balloon angioplasty is insufficient to restore proper outflow. However, the use of cutting balloons in this particular venous territory is limited by the fact that currently only small diameter devices are available.
vesta wrote:Hello Donnchadh: I was sorry to learn your angioplasty didn't succeed and hope the next one - with the cutting balloon - does finally "liberate" you. I haven't followed your history from the outset, was it an accident that triggered off all these problems? If you've already discussed the issue, where do I turn to find it? It's frustrating to know how advanced surgery is in so many areas but somehow work on the neck veins seems in its infancy.
vesta wrote:Thanks Donnchadh: How frustrating to think that opening a two inch section of the IJV could change your life so dramatically. Did the fall cause the bone spurs to develop, and do you think the accident and vein compression cause the fibrous tissue to develop in the vein? I'll be following your treatment hoping for your complete recovery. Vesta
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