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Mike Arata Observation over the last year has lead us to the conclusion that jugular stents work very poorly. This is particularly true in the left jugular. In the past I would work aggressively to open occluded jugulars. This in part is based on a lo...ng career of treating chronic venous occlusions. Unfortunately angioplasty alone of a venous occlusion generally doesn't stay open. In case of a jugular vein neither does a stent. Getting the vein open isn't the problem...Its keeping it open. My approach now is if it opens easy then perhaps it will stay open with angioplasty.

dania wrote:Mike Arata Observation over the last year has lead us to the conclusion that jugular stents work very poorly. This is particularly true in the left jugular. In the past I would work aggressively to open occluded jugulars. This in part is based on a lo...ng career of treating chronic venous occlusions. Unfortunately angioplasty alone of a venous occlusion generally doesn't stay open. In case of a jugular vein neither does a stent. Getting the vein open isn't the problem...Its keeping it open. My approach now is if it opens easy then perhaps it will stay open with angioplasty.

thank you, Dania.

Here's another mention of the left jugular being more difficult or more prone to complications. (First mention I heard of this was on the table two weeks ago, when Dr. Sclafani was deciding whether or not to size up from the 10 balloon, with banding seen on the balloon on one hand and the fact that complications, if they happen, tend to be in the left jugular on the other hand.) Dr. Cumming weighed in on the question with his observation that it is not left or right that he sees a difference in but rather he sees more complications in the smaller vein. (Relevant because the left tends to be the smaller vein.)

So, from Dr. Arata, is he saying that aggressive angioplasty doesn't work well and jugular stents don't work well? Getting the vein open isn't the problem, it's keeping it open...that gets back to the concept of durability.