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Squeakycat wrote:Dr Sclafani,

In the opposition to CCSVI, much is made of the fact that the venous system is very flexible and adaptive and anatomic anomalies are not uncommon. If there is a blockage, blood finds a new path through collaterals which are there at the ready for just this reason. Things may not be normal, but there is no reason to treat.

How do we counter this argument that the nature of CCSVI is in fact different AND problematic and therefore warrants treatment?

Zeureka wrote:

monik_77 wrote:Dear Dr. Scaflani,

Eveybody is seeing the yugular and the azygos veins in MS patients, but I have a question, in the studies developed until now, the rest of the veins of the body in MS patients were cheked and were corroborated that are normal or not???? because I think that should be necessary to see in MS patients that only these veins have the problems or determinate that is a vascular problem that also affect to more veins in the body.

Cheers,

Monica.

Monik, it's certainly an interesting question and would also be interested in Dr Sclafani's views. I have been in touch with Dr Schelling on this and he replied to me mid March in German. Here the answer translated in English as much as I can:

"In the case of extensive spinal cord damages the conventional phlebography of neck veins and the azygos vein might not be sufficient to illustrate all critical venous passages. Should there be anomalies of lumbal veins ("Lumbalvenen") or their connections to the lower veins ("Hohlvenen"), it would be required to perform a widening of phlebography which is currently not yet performed in the standard MS protocols. According to Prof Haake work is underway to develop MRV of venous spinal cord/vertebral column drainages, but the results are unfortunately not yet satisfactory."

This was mid March, so maybe there has been some progress on this since then? Dr Sclafani would be interesting, if you have maybe heard anything on this research of potential stenosis in other vein drainages? Can damages in the vertebral column in your view have anything to do with the veins that are currently checked in the standard procedure (jugular/azygos)? Understand that a stenosis in the jugular vein could rather be responsible for brain damage caused by reflux (in form of "Dawson-Finger" and "Steiner-Spritzer" as Schelling explained to me). But the azygos, could that have an impact on myelin damage in the spinal cord/vertebral column?

The quicker we can gather this data, the faster we should be able to get a number of centers up and running to treat the 2.5 million requiring treatment for their vascular problems.

Although perhaps not an ideal tool, Google Docs provides some basic tools for collecting the data and restricting access in a way that probably meets HIPPA requirements for protection of patient privacy and Google Sites provides a quick and dirty web presence for managing the data collection. Happy to volunteer to build both if this makes sense.

Cece wrote:Dr. S, you have a striking level of commitment...I am here because my foot drop and ON have been acting up this week and I have been resting them off...and resting...and resting...(conveniently with my laptop)...but I am pretty sure you could be off playing golf...if you are not yet tired of hearing thank you, here it is again: thank you

hoodyup wrote:Hi, Dr. Sclafani.

About 2 weeks my wife had her right IJV balloned in 3 places and experienced some drastic improvements for about a week, then she reverted to her previous state. We are going to have to schedule another MRV and repeat the process again.

Question #1 If you were treating a suspected restenosis would you repeat this scan or just go for another venogram?

Question #2 Our IR, who is a 30+ year surgeon says he is reluctant to stent jugulars. I was wondering if you had any advice for other vascular surgeons or would be open to sharing "trade secrets" with other IR's regarding placement of stents in jugulars. I'm sure it would be on a case by case basis as patients veins are all different. I could PM you with his contact info if you are willing to consult with him.

Thanks,
Andrew

Squeakycat wrote:Dr. S,

Rather than a choice of descriptions, do you think this one covers it:

CCSVI treatment is:

PERCUTANEOUS VENOPLASTY,
A MINIMALLY INVASIVE PROCEDURE PERFORMED UNDER LOCAL ANESTHESIA


Again, I think words matter, but it is very important that we use the right ones to maintain accuracy as well as a favorable spin.

Wikipedia... percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed (typically with the use of a scalpel).

The percutaneous approach is commonly used in vascular procedures. This involves a needle catheter getting access to a blood vessel, followed by the introduction of a wire through the lumen (pathway) of the needle. It is over this wire that other catheters can be placed into the blood vessel. This technique is known as the modified Seldinger technique.

More generally, "percutaneous" can mean 'through the skin'. An example would be percutaneous drug absorption from topical medications. More often, percutaneous is typically used in reference to placement of medical devices using a needle stick approach.

In general, percutaneous refers to the access modality of a medical procedure, whereby a medical device is introduced into a patient's blood vessel via a needle stick. This is commonly known as the "Seldinger Technique" Seldinger technique named after Dr. Sven Ivar Seldinger. The technique involves placing a needle through the skin and into a blood vessel, such as an artery or vein, until bleedback is achieved. This is followed by introduction of a flexible "introducer guide wire" to define the pathway through the skin and into the passageway or "lumen" of the blood vessel. The needle is then exchanged for an "introducer sheath" which is a small tube that is advanced over the introducer guide wire and into the blood vessel. The introducer guide wire is removed, and exchanged for a catheter or other medical device to be used to delivering medication or implatation of a medical implant uch as a filter or a stent into the blood vessel.

The benefit of a percutaneous access is in the ease of introducing devices into the patient without the use of large cut downs, which can be painful and in some cases can bleed out or become infected. A percutaneous access requires only a very small hole thorugh the skin, which seals easily, and heals very quickly compared to a surgical cut down.

Percutaneous access and procedures almost exclusively refer to catheter procedures such as PTA ballooning, stent delivery, filter delivery, cardiac ablation, and peripheral or neurovascular catheter procedures

Karenems wrote:THIS VIDEO WAS TAKEN 2 DAYS AGO.



LESS THAN 24 HOURS AFTER CCSVI LIBERATION SURGERY YESTERDAY

jr5646 wrote:We should all be familiar with subcutaneous injections - under the skin (copaxone, rebif), Intramuscular IM injections - into the muscle (avonex, betaseron?) and Infusion or Intravenous IV - within a vein (Tysabri, Solu-Medrol)

I think since we do the above on a regular basis, we can easily handle PERCUTANEOUS VENOPLASTY

jr5646 wrote:We should all be familiar with subcutaneous injections - under the skin (copaxone, rebif), Intramuscular IM injections - into the muscle (avonex, betaseron?) and Infusion or Intravenous IV - within a vein (Tysabri, Solu-Medrol)

I think since we do the above on a regular basis, we can easily handle PERCUTANEOUS VENOPLASTY