Normal) Exemplification of normal extracranial venous outflow direction. In
particular, the black arrows depict the drainage of the IJV system into the
SVC, and of the vertebral plexus (Vplex) outward from the spinal cord into the
azygous system (AZY).
• Type A (30%): This pattern is characterized by a steno-obstruction of the
proximal azygous, associated with a closed stenosis of one of the two IJVs
(red crosses). Reflux is always present, under all postural conditions, in
the stenosed IJV (red arrow), with a compensatory controlateral IJV that
appears with an ample CSA. Reflux in the DCVs was detected by the
means of TCCS in 60% of cases. In the azygous vein the reflux has an
effect as far as the lumbar veins, being able to re-enter the caval circle
either through the system of the hemiazygous vein- left renal vein, or by
rising again inside the rachis.
• Type B (38%): This pattern is characterized by significant stenoses of both
IJVs and the proximal azygous (red crosses). Reflux is present in all three
venous segments (red arrows). Cerebral venous outflow for overcoming
the IJVs stenosis re-enters the heart mainly through cervical collateral
circles (Fig. 1b); for the hampered azygous vein outflow, the collateral
circles include again the intra-rachidian pathway (Fig.3), or the system of
• Type C (14%): This pattern is characterized by bilateral stenosis in both
IJVs, with a normal azygous system (red crosses). Reflux (red arrows)
occurs in the IJVs but not in the VVs, with cervical or intracranial collateral
circles that shunt blood towards the superior vena cava or the azygous
vein system, respectively. The resulting overload of the azygous system is
depicted by black bold arrows.
• Type D (18%): In this pattern the azygous system was constantly affected
in various segments (red crosses), resulting in a forced venous drainage
towards the intrarachidian circles in an upward direction (red arrows)
(Fig.3). The vertebral veins appeared to be refluent, and the intracranial
collateral circles seek to gain the IJVs, as confirmed by reflux detection in
DCVs in 90% of cases. At times, the IJVs were also affected (6 cases,
50%), causing an additional obstruction in these patients.
But I will investigate it further, until the team of Dr Zamboni themselves conclude that I have no vascular issues.
It is wrong to assume that all vascular people everywhere can do this no sweat like it has no learning curve to it at all...everything has a learning curve and part of that is belief that it is "there".
In addition, it should be stated that not all abnormalities, which are found in venographic examination can also be visualized with sonography.
Unfortunately, while scanning of internal jugular and vertebral veins has not been difficult for examiner skilled in a routine ultrasound vascular testing, like the assessment of carotid and vertebral arteries, the
transcranial evaluation of cerebral veins has appeared to require special skills and more sophisticated software of the ultrasonographic system used (1,8,11).
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