Known Risks/Complications of Angioplasty and Venous Stenting

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

Re: Azygos stenting on follow-up procedure

Postby CCSVIhusband » Tue Nov 09, 2010 4:12 pm

jfhcrgvr wrote:My DW, SPMS since 1992, had her first angioplasty done on August 18th in Orange County, California. Immediately post-procedure, she reported overall reduction of spacticity throughout her body, and demonstrated this by elongating her legs to full extension and flattening out her knees, something she had not been able to do for quite some time. Very noticable was the return of fluidity to her speech and a dramatic reduction in her word-calling deficit. Those dramatic improvements have waned since her procedure and her knees are now bent in their former default position, making it difficult for her to make any progress in her ability to walk in physical therapy.

Other improvements that followed her procedure have remained, however. These include: (1) elimination of a headache; (2) improved sense of smell; (3) return of sensation to her feet; (3) almost complete elimination of a daily hiccuping jag and vast reduction in its duration when it does occur; (5) return of sensation to a formerly numb fingertip; and (6) elimination of cerebellar ataxia.

Her azygous vein was very blocked throughout its length, with many of the occlusions being webs. One section of the azygous was so curved that the IR was unable to baloon it becuase of the lack of availability of the proper configuration of catheter in inventory.

The angiogram images show successful widening of the IJVs, the return of normal flow there and the inactivation of flow through peripherals, but the azygous does not appear to have had any lasting change once the balloon was removed.

Now we are talking about a second procedure, not only to address the area that could not be treated the first time, but also to try once more to open up any veins that have restenosed, such as the azygous. There is much discussion in this thread about IJV stenting, but what about the azygous?

We would like to hear from anyone who has undergone stenting of their azygous vein. In addition to replying here, you may reach us at egbokmom2000@yahoo.com and/or stevenh_hirsch@yahoo.com, or at Steven Harvey Hirsch on FB.

Thank you all for your support and assistance!

Steven


I don't know if you can ... but reach out to Rose2 ... she had an azygous stent (and to quote her) "best thing ever" ... you can read her testimony in threads throughout the CCSVI forum, as well as in the tracking thread stickied at the top of the page.
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Postby Issy » Wed Nov 17, 2010 9:29 am

:roll: HELLO CCSVIers. I'M A CANADIAN WAITING TO HAVE THE PROCEDURE DONE SOME TIME IN 2011. I WAS WATCHING THE NIGHTLY NEWS (CBC THE NATIONAL ) AND THERE WAS A STORY OF A MAN WHO RECEVED THE PROCEDURE WITH A STENT, AND HAD GREAT RESULTS FOR 9 WEEKS. HE THEN FOUND OUT THAT HE HAD A BLOOD CLOT AT THE STENT LOCATION. HE WAS AMAZED TO THEN REALIZE THAT THE CANADIAN "INTERVENTAL RADIOLOGISTS" COULD NOT OR WOULD NOT HELP HIM? DUE TO THE CURRENT STATUS OF THE "CCSVI PROCEDURE" IN CANADA, DOCTORS WILL NOT HELP PATIENTS UNLESS IT IS AN EMERGENCY!!?? SO, IF WE HAVE ANY COMPLICATIONS AFTER THE PROCEDURE, I GUESS WE HAVE TO GO BACK TO THE DOCTOR WHO PERFORMED THE INITIAL TREATMENT! IS THIS THE EXPEREINCE THAT OTHER CCSVI'ers WITH PROBLEMS HAVE HAD??
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Postby vivavie » Wed Nov 17, 2010 9:45 am

That is exactly what happen to me after Poland. Now I have an IR in the states - 7hrs drive is "local" for me and necessary since I had more than one complication...

Be prepared, it is not a one shot deal. You should also have your GP on board to follow you blood thinner regimen if required.

Good luck!
S
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Postby gsiskin » Mon Feb 07, 2011 2:51 pm

In response to this thread, I wanted you to know that this is a presentation we will be making at the SIR meeting in March.

TITLE: Safety of outpatient endovascular treatment of the internal jugular and azygos veins for Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Multiple Sclerosis: a retrospective analysis

AUTHORS: Mandato, Kenneth; Hegener, Paul; Siskin, Gary; Englander, Meridith; Garla, Sreeivas; Herr, Allen
Albany Medical Center, Albany, NY, United States.

Purpose: To evaluate the safety of outpatient endovascular treatment of the internal jugular and azygos veins in MS patients with CCSVI.

Materials and Methods: A retrospective analysis of MS patients with CCSVI undergoing endovascular treatment of the internal jugular and/or azygos veins was performed to identify and describe the adverse events occurring within 30 days.

Results: Over 7 months, 247 procedures were performed in 231 patients. The mean patient age was 48.2 years (range: 25.7-70.2 years); 63.7% were female and 36.3% were male. 49.0% (121/247) of the procedures were performed in a hospital and 51.0% (126/247) were performed in the office setting. 92.7% (229/247) were primary procedures while 7.3% (18/247) were secondary due to restenosis. For patients treated primarily, 86.5% (198/229) underwent angioplasty and 11.4% (26/229) underwent stent placement of at least one vessel; the remaining 5 patients were not treated. Of the 18 patients treated due to restenosis, 50% underwent angioplasty and 50% underwent stent placement. After 99.2% (245/247) of the procedures, patients were discharged within 3 hours. A post-procedure, transient headache was reported in 8.5% (21/247); this persisted beyond 30 days in 1 patient. Neck pain was reported in 15.8% of patients (39/247); 53.8% (21/39) of these patients underwent stent placement. 1.7% (4/231) of patients were retreated within 30 days due to symptomatic restenosis. Sustained cardiac arrhythmias were observed in 3 patients during the procedure with 2/3 patients requiring hospital admission. One of these patients, who underwent a complex procedure for in-stent thrombosis, required a prolonged hospitalization due to a stress-induced cardiomyopathy.

Conclusion: Endovascular treatment of CCSVI in MS patients is a safe procedure when performed on an outpatient basis. Cardiac monitoring is essential to permit detection and rapid treatment of patients with procedure-induced arrhythmias. Post-procedure ultrasound is recommended to detect venous thrombosis. In addition, consideration should be given to performing complex re-interventions in a hospital given the complication risk in this sub-population of patients.
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Postby vivavie » Mon Feb 07, 2011 4:06 pm

1st: Bravo Dr Siskin and your team!
Wow! incredible everything that happen in one year!

Q: In all of those treated anybody (%) worse than pre-procedure?
I know I am even after stent stenosis, jug collapse and thrombosis corrected - I was not treated by you.

Has your 1/3,1/3,1/3 results changed since your July presentation in NY?

Thank you
S
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Postby newlywed4ever » Mon Feb 07, 2011 4:09 pm

Thanks so much for sharing, Dr Siskin! Great info/stats here. Keep on keeping us informed!
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@ Dr. Siskin

Postby leetz » Fri Mar 11, 2011 4:54 pm

Amazing....many thank's for all you have done and continue to do!!! I just knew it! Lee say's Thank you Dr. Siskin! See you soon!
GOD BLESS.... CCSVI treatment Dr. Siskin great doc....symptom's improved for about 3 week's (gait, balance, spasticity) now back to square 1...
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Re: Known Risks/Complications of Angioplasty and Venous Sten

Postby zjac020 » Mon Mar 23, 2015 3:17 pm

Im hoping to have the CCSVI procedure carried out in either April or May, hopefully with Dr Tommaso Lupattelli at the GVM Sanita clinic (also called the ICC - Instituto Clinico Cardiologo) in Rome, Italy.

I just wanted to ask what the current state of the risks are given now the number of years experience with the procedure. Are the risks less? Are the results better?

I know i can only gauge subjective opinions, but they are also useful to me!

Thanks,
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Re: Azygos stenting on follow-up procedure

Postby MarcF » Wed Jan 13, 2016 8:23 am

jfhcrgvr wrote:My DW, SPMS since 1992, had her first angioplasty done on August 18th in Orange County, California. Immediately post-procedure, she reported overall reduction of spacticity throughout her body, and demonstrated this by elongating her legs to full extension and flattening out her knees, something she had not been able to do for quite some time. Very noticable was the return of fluidity to her speech and a dramatic reduction in her word-calling deficit. Those dramatic improvements have waned since her procedure and her knees are now bent in their former default position, making it difficult for her to make any progress in her ability to walk in physical therapy.

Other improvements that followed her procedure have remained, however. These include: (1) elimination of a headache; (2) improved sense of smell; (3) return of sensation to her feet; (3) almost complete elimination of a daily hiccuping jag and vast reduction in its duration when it does occur; (5) return of sensation to a formerly numb fingertip; and (6) elimination of cerebellar ataxia.

Her azygous vein was very blocked throughout its length, with many of the occlusions being webs. One section of the azygous was so curved that the IR was unable to baloon it becuase of the lack of availability of the proper configuration of catheter in inventory.

The angiogram images show successful widening of the IJVs, the return of normal flow there and the inactivation of flow through peripherals, but the azygous does not appear to have had any lasting change once the balloon was removed.

Now we are talking about a second procedure, not only to address the area that could not be treated the first time, but also to try once more to open up any veins that have restenosed, such as the azygous. There is much discussion in this thread about IJV stenting, but what about the azygous?

We would like to hear from anyone who has undergone stenting of their azygous vein. In addition to replying here, you may reach us at egbokmom2000@yahoo.com and/or stevenh_hirsch@yahoo.com, or at Steven Harvey Hirsch on FB.

Thank you all for your support and assistance!

Steven


Hi

I was treated in Rome by Team brain flow. I'm very happy with the result!! Dr Lupattelli is a very experienced doctor with the greatest experience in the world. He has treated more than 2000 azygous without and with stent.

you can find information here: www.ccsvi.net.

good luck! :-D :-D :-D
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Re: Known Risks/Complications of Angioplasty and Venous Sten

Postby MarcF » Wed Jan 13, 2016 8:39 am

I found the abstract here. http://www.pagepressjournals.org/index. ... /view/5398



PERCUTANEOUS TRASLUMINAL ANGIOPLASTY OF AZYGOUS VEIN IN PATIENTS WITH MULTIPLE SCLEROSIS AND CHRONIC CEREBRO SPINAL VENOUS INSUFFICIENCY. A SINGLE CENTER EXPERIENCE
11112 T. Lupattelli, G. Bellagamba, E. Righi, C. Muratori, G. Noce,
P. Onorati,1 C. Babiloni3
1Istituto Clinico Cardiologico, GVM Sanità, Casalpalocco (RM); 2IRCCS SDN Foundation, Naples; 3Department of Physiology and Pharmacology, La Sapienza University, Rome, Italy

Background: Chronic cerebrospinal venous insufficiency (CCSVI) is a recently discovered syndrome mainly due to stenoses of internal jugular (IJV) and/or azygos veins (AZ). The aim of the present study is to retrospectively evaluate technical success after PTA±stenting in a cohort of patients with multiple sclerosis (MS) and CCSVI. Methods: From September 2010 to October 2014 a total of 2435 MS patients (1391 females) underwent selective venography from a left common femoral vein access, followed by balloon angioplasty±stent- ing at the same session. All the patients had previously been evaluat- ed for CCSVI with Color Doppler Ultrasound at different Institutes. Left common iliac, ascending lumbar, vertebral and internal giugular veins as well as azygos territory were selectively studied in all cases. Interventional treatment was performed whenever achievement of an improved flow through the AZ was deemed possible. Endovascular treatment was carried out as an outpatient procedure in all patients. Results: Selective venography of the AZ was performed in 2433 patients. Two patients showed no evidence of AZ vein despite several attempts at finding it. Percutaneous trasluminal angioplasty±stenting of the affected AZ was performed in 2119 (87.1%) patients. Balloon angioplasty alone was performed in 2095 cases (98.9%) whereas additional stent placement was required in 24 patients (1.1%). The decision to implant a stent was taken following 3 unsuccesfull attempts at dilating the vein (23 cases) or following a vein rupture occurring at the time of balloon dilatation (1 case). In all 23 patients with unsuccessful AZ dilatation a severe kinking of the vessel was noted at confirmation angiography. Balloon angioplasty alone showed improvement of the venous drainage >30% in 1849 out of 2119 (87.2%) whereas stenting proved to be successful in 21 out 23 patients (91.3%).
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