OPINIONS DR ARATA & DR HEWITT
Posted: Tue Jul 05, 2011 1:02 pm
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Dr. Sclafani was just saying in another thread that azygous valves are very difficult to observe on venography but show up on IVUS. I wonder what is different about azygous valves as compared to jugular valves to make this so? Perhaps they are smaller? His solution is to use IVUS, Dr. Arata's solution is to balloon the azygous in the usual spot even when he does not see anything? This would cause intimal damage to patients who do not have azygous issues but it might keep some azygous issues from going untreated.Azygous valves can be very difficult to detect which is why we often empirically treat the azygous.
Vertebrals and lumbars cannot be treated. It's only the renals in this list that can be treated, as well as the iliac. Unless Dr. Arata is claiming a 100% success rate, there is a subset of patients who will experience restenosis after the procedure. If these patients have their collateral veins blocked as well, then they are right back where they started. I believe it is good care to treat the renals and the iliac. If the renal vein is blocked, it adds 500 ml of blood to the cerebrospinal drainage, wihch is already draining 750 ml.Additional veins such as the vertebrals, lumbars, renals etc do NOT cause CCSVI. The do serve as collateral veins. Proper treatment dictates correction of the jugular or azygous problem. NOT Venous agioplasty of Collaterals
There is no research to back this statement up, but he must be speaking from his own personal experience. Many times when a patient comes in for a repeat procedure it is because of a complication from the first procedure. If there has been clotting or intimal hyperplasia or a stent gone bad, this in itself might cause issues. Does anyone have other ideas as to why he would be observing not as good of a response in repeat procedures?Patients have to understand that their first treatment is their best opportunity for a good result. Even when going to the best physician second, third or fourth procedures will not generate as good a response as the first treatment.
Just curious. For secondary CCSVI can this be treated by angioplasty?dania wrote:Sorry. here it is.
From Dr Arata
Secondary CCSVI is a result of compression of one or all of these veins by adjacent structures.
C1 is that the top of the spine?dania wrote: Answer From Dr.Arata
For example if severe compression of both jugulars is seen at the C1 level this is increased risk of lack of response.
It might depend on what the adjacent structure is. A year ago Dr. Sclafani introduced the concept of leave-me-alone-lesions if it is the carotid artery impinging on the jugular. Not a good place for stenting or ballooning because of the carotid. Other places like in May thurners it fits the definition of this secondary CCSVI (with the iliac vein compressed between the iliac artery and the spine) and that is treated by stenting. If it's a jugular and it's a muscle compressing it, then Dr. Sclafani talked about stenting only if the patient failed to respond to a first procedure.orion98665 wrote:Just curious. For secondary CCSVI can this be treated by angioplasty?dania wrote:Sorry. here it is.
From Dr Arata
Secondary CCSVI is a result of compression of one or all of these veins by adjacent structures.
What are the options for somebody who has secondary CCSVI?
Thanks,
Bob
Anyone know if there is a minimum amount of time needed between venoplasties to allow the intima to heal? Or if intimal hyperplasia is more likely with repeat balloonings?Waiting a specified period of time, despite what happens to the ccsvi symptoms, is a simplistic and antiquated view of CCSVI. Retreatment is indicated anytime after complete relapse of ccsvi symptoms is present.
I agree with him on this. CCSVI = outflow obstructions.Flow is everything. CCSVI is not about narrow veins!
Majority? Back when my azygous did not have any issues, I questioned that because of my belief that most people with CCSVI had azygous issues, and if I recall correctly, Dr. Cumming and Dr. Sclafani both said their percentage was much lower. Maybe 25% for DrS and 10-15% for DrC? I would have to look that up again.Certainly the majority of patients have a problem with the azygos but not all.
Those are good numbers.I personally average 20 CCSVI procedures a week. I have been doing it for over a year. If not the most, certainly one of the most experienced in the world.
hypoplastic valve? Or just small valve?Additionally, rapid restenosis often occurs when the jugular valve is to small.
Is this true, that there is research showing antiplatelets to be ineffective against venous clotting? There is an additional benefit in the antiplatelet in that it may reduce intimal hyperplasia, as there is an early stage in intimal hyperplasia in which platelets glom on to the injury and release platelet-derived n. factor, which is one of the things that signal the smooth muscle cells to grow (which is what intimal hyperplasia is, a solid overgrowth of the smooth muscle cells in response to injury, and it grows inward and disrupts some flow).Anti-platelet agents, aspirin being one of them have not been shown to prevent venous clotting. This has been studied far more than ccsvi itself. The available evidence would suggest increased risk of bleeding if anything. Recommending them following treatment for ccsvi would be counter to available data.
Most pwMS with May Thurners are asymptomatic for it. This method would miss the majority of MT cases. I believe it was Dr. Siskin's interview on CCSVI Alliance where it was discussed that when he found patients with MT they were asymptomatic; this was part of his reasoning for no longer looking for it and he may have missed the point, we are not so concerned about symptoms in the leg, we are concerned about the rerouting of flow that would have gone through the iliac and instead goes through the diseased azygous.We screen patient for it and if symptoms we do venogram. Treat all US patients and ask all others if they want to be treated.
What we don't do is radiate the pelvis of patients without symptoms.
He is using the same definition of what is a symptom of CCSVI as we have talked about here (If it responds immediately to CCSVI treatment, then it is unfathomable that nerves remyelinated or the autoimmune system righted itself in minutes, therefore it is a CCSVI symptom.)Purple feet are typically the result of autonomic dysfunction. It is usually accompanied with coldness of the extremity. It is a symptom of CCSVI. When CCSVI is treated it responds.
There is no increased incidence of MT in MS. This does not matter. When it happens to occur, it impacts the flow of blood to the azygous. That is what is signicant, not whether or not it is associated with CCSVI.When isolated to the left leg it can be secondary to iliac vein compression however this is not associated with CCSVI in any way.
Enough of my friends have tried it that I will be giving it a try too. Just not this year, because I feel I've had enough radiation this year from the procedures, and UCC does require xrays? I also need a bit of a break. But next year, I'll give it a try.civickiller wrote:thanks cece
thats one reason why i try to push people to just get atleast tested for UCC misalignment, maybe then will they be able to get the ccsvi surgery and benefit from it
I disagree with myself, on second thought. 20 per week, if he is working five days a week, means four procedures a day. He may not be spending enough time on each patient.Cece wrote:Those are good numbers.I personally average 20 CCSVI procedures a week. I have been doing it for over a year. If not the most, certainly one of the most experienced in the world.