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The Controversies on Chronic Ceribrospinal Venous Insufficiency

Published on December 24 2013 / / Health This article was written by Alexander Rasman

A review of the literature has analyzed the scientific controversy on chronic cerebrospinal venous insufficiency ( CCSVI) and its association with neurodegenerative diseases and multiple sclerosis .

Were reviewed all published studies on the prevalence of CCSVI in patients with multiple sclerosis, including studies with ultrasound and venography catheter . Were also taken into account other publications on the pathophysiological consequences of CCSVI in the brain , as well as some recent data on the pathology of the vein wall in the course of CCSVI. Finally, there were further updated safety data and pilot data on the efficacy of endovascular treatment of CCSVI .

Prevalence studies have shown great variability in the prevalence of CCSVI in patients with multiple sclerosis assessed on the basis of sonographic criteria established . This may be related to the strong operator dependence of ultrasound .
However , 12 studies , with more objective catheter venography , showed a prevalence of greater than 90 % of CCSVI in multiple sclerosis .

The hypo- global hypoperfusion of the brain and the reduced dynamics of the cerebrospinal fluid in multiple sclerosis have been shown to be related to CCSVI.

Post-mortem studies and histological supported the decision of the 2009 International Union of Phlebology (UIP) Consensus insert between CCSVI venous malformations .

Finally, the safety of balloon angioplasty of extracranial veins was certainly demonstrated , while prospective data on the potential efficacy of endovascular treatment of CCSVI claim the increase in the level of evidence proceeding with a randomized controlled trial .

Taking into account the current epidemiological data , including studies on catheter venography , the autopsy findings , the relationship between CCSVI and hypo- perfusion and cerebro -spinal fluid flow , it can be concluded that CCSVI may be finally inserted between the medical entities .

The research is still inconclusive in elucidating the role of CCSVI in the pathogenesis of neurological disorders .
The dispute between the vascular and neurological community is due to the great variability in the prevalence of CCSVI in patients with multiple sclerosis by means of ultrasound evaluation of venous insufficiency.
An evaluation of chronic cerebrospinal venous insufficiency more reproducible and objective. Finally, randomized controlled trials may clarify the role of endovascular treatment of CCSVI . ( Xagena2013 )

Zamboni P et al , 2013 Veins and lymphatics

Neuro2013

Source: http://www.sclerosionline.net/articolo/ ... le-cronica