When I asked a reputable interventional radiologist in the Montreal area if angioplasty was safe for CCSVI, he was not too reasssuring. He said that if you dilate a vein there is a significant risk of restenosis (which we already know is about 50% in IJV's) but also a risk that the restenosis gets worse than it was initially. Do you think this is true. If so, what would the magnitude of this risk be? If this is truly the case I might have second thoughts.
The second part to my question is how often can we do angio on the same vein? Can we repeat the procedure regularly, for eg every 6 months if it restenoses. This might be costly, but something that I would be willing to endure and pay for if it could keep my MS progression at bay.
Restenosis occured in 50% of Dr Zamboni's patients in the report. It is difficult to say what this means becasue he did not tell us details of what types of problems had recurrent narrowing.
This is a different entity that that for which angioplasty is usually used and we should not correlate the outcomes of two different entities. While it is true that veins tend to restenose with other reasons for veonplasty, the narrowings of ccsvi are very different in pathology. These abnormal veins have all kinds of bizarre narrowings unlike anything i routine deal with. Only time will tell.
The second part of the question is not how simple would it be to repeat the venograms. It is really how much time do we want to use to provide surveillance of failing vein angioplasty when there are so many patients needing definitive treatment. Using Venography to followup is going to clog up the treatment assembly line.
Look, I am coming around to thinking that venography is really the way to assess, not mri and not ultrasound. If vein problems are present in 60-90% of patients, how can you not test with the gold standard test. The reason i am doing these other tests is to determine whether US or MRV can be used as a screening test for followup checks, not to determine whether venography needs to be performed.
Perhaps a bit radical, but I am an angiographer, not an imager.