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Ok, I like that Dr. Arata was looking for renal vein stenosis, even when he was not expecting to find it. After almost a hundred patients, indeed, he found one with complete compression of the left renal vein that reversed the lumbar flow. This is the concern, not about outflow from the azygous to the renal but about inflow to the azygous from the renal vein. Check out the images.

Here's the issue. It is impossible to assess the effects of a renal stent when other veins are treated also. Nutcracker syndrome implies symptoms specific to renal vein compression. The renal vein can be compressed without symptoms being evident.

That's a quote from Dr. Arata. Wonder if he has heard about Dr. Sclafani's patient who had patent jugulars and azygous from a treatment a year prior, then had only the renal vein treated with subsequent improvements?

Dr. Siskin made the point yesterday at the global expo that the debate over whether to treat the renal vein or other veins needs to be backed up by research. I believe that Dr. Arata and Dr. Sclafani both have IRBs, are looking at the renal vein, and may be counted on to publish what they find.

edited to add: "The Arata family will be serving crow for Thanksgiving this year" (said by Dr. Arata over on the facebook page) ... first, LOL ... second, if anyone deserves a rich Thanksgiving feast, it is our CCSVI investigators. No side dishes of crow. ...third, since Dr. Arata is doing an IVUS study, if he has not conferred with Dr. Sclafani about what's seen on IVUS, maybe there is something to be learned on either side there. I remember Dr. Cumming telling me at one of my follow-up appts that IVUS goes fast, and that it's hard to know what you are seeing. This was early on in Dr. Cumming's use of IVUS in CCSVI patients, but it was news to me that even IVUS was not self-evident but that there may be a learning curve for how to read those images too.

Cece wrote:<shortened url>

Ok, I like that Dr. Arata was looking for renal vein stenosis, even when he was not expecting to find it. After almost a hundred patients, indeed, he found one with complete compression of the left renal vein that reversed the lumbar flow. This is the concern, not about outflow from the azygous to the renal but about inflow to the azygous from the renal vein. Check out the images.

Here's the issue. It is impossible to assess the effects of a renal stent when other veins are treated also. Nutcracker syndrome implies symptoms specific to renal vein compression. The renal vein can be compressed without symptoms being evident.

That's a quote from Dr. Arata. Wonder if he has heard about Dr. Sclafani's patient who had patent jugulars and azygous from a treatment a year prior, then had only the renal vein treated with subsequent improvements?

Dr. Siskin made the point yesterday at the global expo that the debate over whether to treat the renal vein or other veins needs to be backed up by research. I believe that Dr. Arata and Dr. Sclafani both have IRBs, are looking at the renal vein, and may be counted on to publish what they find.

edited to add: "The Arata family will be serving crow for Thanksgiving this year" ... first, LOL ... second, if anyone deserves a rich Thanksgiving feast, it is our CCSVI investigators. No side dishes of crow. ...third, since Dr. Arata is doing an IVUS study, if he has not conferred with Dr. Sclafani about what's seen on IVUS, maybe there is something to be learned on either side there. I remember Dr. Cumming telling me at one of my follow-up appts that IVUS goes fast, and that it's hard to know what you are seeing. This was early on in Dr. Cumming's use of IVUS in CCSVI patients, but it was news to me that even IVUS was not self-evident but that there may be a learning curve for how to read those images too.

cece

there really is a steep learning curve because most IRs do not use IVUS very often.

Recently, I had this renal vein conversation with both mike arata and gary siskin.
both were looking at the renal vein as an OUTFLOW vein for an obstructed azygous vein and not in the manner that Zamboni and I saw it: as an INFLOW vein into the cerebrospinal circultation.

Mike told me he was going to look at the renal vein some more and I am pleased that he has found a Nutcracker synddrome in less than two weeks since that conversation.

But , give dr Arata a break. He is a good man trying to do good works.

I have been hard on him.
I hope no one thinks I was saying he should eat crow...I was quoting him, and disagreeing!

the ability to change one's mind ... is something MrSuccess greatly admires in a person.

This is always based on obtaining more information.

As is the case.



MrSuccess

Is there any precedent for renal vein stenting? Sounds a little risqué.

Renal vein stenting is for the treatment of Nutcracker syndrome:
http://scholar.google.com/scholar?q=nut ... as_sdtp=on

It is a compression disorder, where a vein is compressed by another blood vessel or structure, which means that ballooning will not hold it open.

i have no idea except for good old google scholar - it does appear there is precedent:
Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): Repair by a new stenting procedure (1988)
Stenting of a renal artery stenosis achieves better relief of the obstructive lesion than balloon angioplasty (1993)
Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis (1998)
Expandable metallic stent placement for nutcracker phenomenon (1999)
Nutcracker syndrome: intravascular stenting approach (2000)
Endovascular stenting for the nutcracker phenomenon (2001)
Current trends in the diagnosis and management of renal nutcracker syndrome: a review (2006)
Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature (2006)

RogerNadd wrote:Is there any precedent for renal vein stenting? Sounds a little risqué.

If you look at the illustration Dr Zamboni uses for his explanation of ccsvi, you will see the renal vein is shown. I spoke to him about this recently as i remembered him describing this vein's importance when i first visited him. He agreed with me that it is "very important". I think that nutcracker phenomenon is common but the syndrome is less common. I believe that chronic fatigue and neurological signs and symptoms are justification to calling this the syndrome in patients with MS.

Actually, the nutcracker phenomenon sounds more risqué than renal vein stenting which merely sounds a bit risky.

Jugular wrote:Actually, the nutcracker phenomenon sounds more risqué than renal vein stenting which merely sounds a bit risky.

just to clarify: the nutcracker phenomenon occurs in an asymptomatic person. If there are symptoms, then it is the nutcracker syndrome. Symptoms include, hematuria, proteinuria, chronic fatigue, testicular varices in men, pelvic congestion in women...and, in my opinion, signs of ccsvi.

I'd looked this up in google scholar, and I wonder if in some of the articles they are mis-using the term 'nutcracker phenomenon.' There are many articles about the treatment of nutcracker phenomenon, but if it is asymptomatic, I would expect it to go untreated. (examples here http://scholar.google.com/scholar?q=nut ... as_sdtp=on )
Stenting is discussed as treatment, as is transposition of the left renal vein, which must be a surgical intervention.

Here was one titled: "Nutcracker phenomenon or nutcracker syndrome?"
http://ndt.oxfordjournals.org/content/20/9/2009.1.full

Patients with nutcracker phenomenon are usually young and slim, and the diagnosis can be made by ultrasound. There are established criteria for the diagnosis of the entrapment of the left renal vein by two-dimensional ultrasonography and Doppler sonography [2,3].

Nutcracker phenomenon, an entrapment of the left renal vein usually in the fork between the aorta and the superior mesenteric artery, was first described by de Schepper in 1972 [4]. Differentiation should be made between an asymptomatic dilatation of the left renal vein (‘nutcracker phenomenon’) and the ‘nutcracker syndrome’ presenting with gross or microscopic haematuria, orthostatic proteinuria, varicocele and hypertension.

I wondered if that meant that staying young or staying slim might keep nutcracker phenomenon from becoming nutcracker syndrome in patients with nutcracker. Staying slim is slightly easier to manage than staying young....

also this...

The nutcracker syndrome is a rare condition, but is certainly underdiagnosed. It should be considered when patients present with left flank pain and hematuria, or pelvic congestion syndrome, or both. Duplex scanning and computed tomography angiography show the compression of the LRV, but diagnosis can be confirmed by selective phlebography. Endovascular treatment by stenting was proposed and is not very invasive, but follow-up is too short to establish the role of this technique in the management of the nutcracker syndrome. To date, surgery remains the gold standard.

www.phlebolymphology.org/2009/07/nutcracker-syndrome/

It seems we are again on the forefront, as patients, in getting treated at all for CCSVI and in getting treated endovascularly instead of surgically for nutcracker syndrome.

Symptoms include, hematuria, proteinuria, chronic fatigue, testicular varices in men, pelvic congestion in women...and, in my opinion, signs of ccsvi.

I concur with your opinion.