I can clarify a little bit here
while in Dake's patients balloon dilation is less successful initially so he uses stents
This is an anatomy issue, a stenosis can be caused by a lot of things. In the case where the tissue OUTSIDE the vein is pressing it shut, and that tissue is muscle or fat, if you blow up a balloon inside the vein, all you get is a temporary moving of the tissue. Press your finger into your arm; does the arm tissue stay pressed down? Of course it does not, a balloon dilatation when that is the kind of tissue pressing on the vein is not going to work. If you put a stent in then it can resist the tissue pressure and keep the vein open. Those of us with stents in the high jugs have this.
For other kinds of stenosis, for example if there is a buildup of tissue INSIDE the vein you can nip that out...Zamboni does a lot of that it seems. You could possibly also balloon it. You could put a stent in that location as well. That's why vascular docs go to school for so long....
Sometimes if it is congenital tissue, which some of it appears to be (based on Bologna notes) then it may grow back even if removed thus needing a repair repeat. In that situation where such a repair did not last I understand that Zamboni is using stents too.
while Dake doesn't see malformations in the azygos veins in any patients.
Actually, Dr D has treated a number of azygos veins as well as at least one brachiocephalic that he discovered that the person elected not to repair. He has not seen as many azygos proportionally as Dr Zamboni has. This is a mystery to me, obviously more can be learned.
The diagnostics are different in that one is focusing on flux abnormalities (Zamboni), while the other is focusing on malformations
Yes true! But please note that Dr Zamboni and Dr Dake BOTH do venograms at surgery so have the same data to look at at that point. Before surgery we have had trouble getting useful dopplers in the US so the diagnostic to see "IF" a person has a venous abnormality or not has been MRV and MRI or CT scan with contrast. Rad is right that MRV/MRI focuses on the tissue and doppler focus on flow...
Frankly the CT uses high, possibly concerning, amounts of x ray radiation but is priced at around 1,000, but the MRV MRI is at a shocking 8,000 dollars-- neither of these are reasonable for long term follow up and monitoring. so we NEED dopplers here too. My insurance refused my repeat MRV. I had to get a CT, my 4th one this year. If I need to recheck my blood flow, say in a month because I felt dizzy or something
Apparently Jacobs is planning on training people. (Bologna notes).
My initial dopplers at the university near me were 500 dollars. If we can get the expertise needed at our local sonographers we'll be in better shape
I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...
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