Venous stent or not...
Posted: Sat Jun 20, 2009 10:32 am
Does the presence of stenosis all by itself indicate that repair SHOULD be done?
In legs the answer is yes............. and that is just in a leg! yeah, you need your leg but the BRAIN, I would argue, is even more important...
FOUND HERE
It also says that reflux AND obstruction together had a lot of stasis ulcers.
If you have not kept up with this information on CCSVI , just a reminder that a venous stasis ulcer has the same cytokines as an MS lesion, MMP9 upregluation TIMP1 iron deposits etc. This is why an obstruction with reflux in the neck is a big deal and a possible cause for the MS lesion.
Ok now tell me again why it is good to ignore this same type of obstruction and reflux in the head?
It is illogical to accept that a leg stenosis should be opened up with a stent based on good medical literature but it is OK to ignore a neck one with the brain being the impacted tissue because we "don't know" if it caused the brain lesions.
please add anything to this thread that supports the position that stenoses (that's plural for stenosis) should be treated for their own sake...
This ammo may help make the case to insurance companies as we go forward in absence of complete studies.
marie
In legs the answer is yes............. and that is just in a leg! yeah, you need your leg but the BRAIN, I would argue, is even more important...
FOUND HERE
I'll pick it apartVenous outflow obstruction: An underestimated contributor to chronic venous disease.Neglén P, Thrasher TL, Raju S.
River Oaks Hospital, Flowood, MS 39232, USA. neglenmd@earthlink.net
OBJECTIVE: To assess the importance of iliac venous outflow obstruction in limbs with and without concomitant deep or superficial reflux, we performed a retrospective analysis of data contemporaneously entered into a set time-stamped electronic medical records program. MATERIAL AND METHOD: Four hundred forty-seven limbs underwent iliac vein stenting of chronic, nonmalignant obstruction when greater than 50% morphologic stenosis was found at transfemoral venography or intravascular ultrasonography. Group 1 (female-male ratio, 3.4:1; left limb-right limb, 2.7:1; nonthrombotic-thrombotic, 1.8:1) included 187 stented limbs in 176 patients with absence of deep and superficial reflux as identified at erect duplex Doppler scanning. Group 2 (female-male, 1.7:1; left-right, 1.9:1, nonthrombotic-thrombotic limb, 1:2.1) included 260 limbs in 253 patients with combination obstruction and reflux. Reflux was left untreated during the observation period. Clinical outcome (ulcer healing and recurrence rate, degree of pain per visual analog scale, swelling grade) and hemodynamic effects (ambulatory venous pressure, venous refilling time, venous filling index at 90 seconds) of iliac venous stenting were assessed. RESULT: Patients with reflux and obstruction had more severe disease (clinical class 4-6, 53% in group 2 vs 24% in group 1; P <.001). Similarly, rate of active ulcer was low in limbs with obstruction only (3% vs 24%, groups 1 and 2, respectively). Mean clinical follow-up was 13 +/- 12 months (SD) in 86% of limbs. Because of the presence of reflux in group 2, venous pressure was higher, venous filling time was shorter, and venous filling index at 90 seconds increased, compared with group 1. Multisegment scores were 2.6 +/- 1.6 and 0, respectively. Of greater interest, there was no deterioration in venous hemodynamics in group 2 after stenting. There was substantial clinical improvement in both groups after stenting. Approximately half of patients were completely relieved of pain after stenting, and a third were completely relieved of swelling. In addition, 55% of ulcerated limbs healed. CONCLUSION: Iliac venous outflow obstruction appears to have an important role in clinical expression of chronic venous insufficiency, particularly in producing pain, and is easily overlooked, mainly because of diagnostic difficulty. The combination of reflux and obstruction is seen more frequently with severe clinical disease than is obstruction alone. Ulcer prevalence is clearly associated with reflux, with a low incidence in patients with obstruction alone. Removal of iliac vein outflow obstruction does not result in increased axial reflux, with clinical deterioration in limbs with combined reflux and obstruction.
PMID: 14603188 [PubMed - indexed for MEDLINE
This study is to see if it helps to repair a blockage (a stenosis) in the veins of the legs when the blockage does not show reflux -reflux meaning that the blood hit the obstruction and then swirled around in there chaotically, usually detected on doppler. They will compare people with blockage and reflux to people with JUST blockage. This study looked at data from people who had already had surgery to see what the results were after the fact. FYI it is generally considered to be more important to treat where reflux is seen, so this study is trying to answer whether treating in absence of that reflux is useful.OBJECTIVE: To assess the importance of iliac venous outflow obstruction in limbs with and without concomitant deep or superficial reflux, we performed a retrospective analysis of data contemporaneously entered into a set time-stamped electronic medical records program.
This just says that many people with blockage of greater than 50% were treated. Group one had no reflux, Group 2 did have reflux as well as the stenosis. To assess how well people did they noticed how well healing of the venous stasis ulcers occurred (ulcer=an open wound in the foot/ankle area that is caused by blocked blood flow) , how often the ulcers returned, the degree of pain they had and how swollen the leg was. They also did some technical evaluations such as checking pressure, how fast the veins refilled and how well the stents worked.MATERIAL AND METHOD: Four hundred forty-seven limbs underwent iliac vein stenting of chronic, nonmalignant obstruction when greater than 50% morphologic stenosis was found at transfemoral venography or intravascular ultrasonography. Group 1 (female-male ratio, 3.4:1; left limb-right limb, 2.7:1; nonthrombotic-thrombotic, 1.8:1) included 187 stented limbs in 176 patients with absence of deep and superficial reflux as identified at erect duplex Doppler scanning. Group 2 (female-male, 1.7:1; left-right, 1.9:1, nonthrombotic-thrombotic limb, 1:2.1) included 260 limbs in 253 patients with combination obstruction and reflux. Reflux was left untreated during the observation period. Clinical outcome (ulcer healing and recurrence rate, degree of pain per visual analog scale, swelling grade) and hemodynamic effects (ambulatory venous pressure, venous refilling time, venous filling index at 90 seconds) of iliac venous stenting were assessed.
This chunk just says that people with both reflux and stenosis had worse disease and had more ulcer issues. It also says that of special interest is the fact that these people with both obstruction and reflux actually did well after stenting and their blood flow was good.RESULT: Patients with reflux and obstruction had more severe disease (clinical class 4-6, 53% in group 2 vs 24% in group 1; P <.001). Similarly, rate of active ulcer was low in limbs with obstruction only (3% vs 24%, groups 1 and 2, respectively). Mean clinical follow-up was 13 +/- 12 months (SD) in 86% of limbs. Because of the presence of reflux in group 2, venous pressure was higher, venous filling time was shorter, and venous filling index at 90 seconds increased, compared with group 1. Multisegment scores were 2.6 +/- 1.6 and 0, respectively. Of greater interest, there was no deterioration in venous hemodynamics in group 2 after stenting.
This says it worked well and it did not cause any other kinds of problems to treat this with stents (that last sentence about axial reflux treatment; it did not cause axial reflux).There was substantial clinical improvement in both groups after stenting. Approximately half of patients were completely relieved of pain after stenting, and a third were completely relieved of swelling. In addition, 55% of ulcerated limbs healed. CONCLUSION: Iliac venous outflow obstruction appears to have an important role in clinical expression of chronic venous insufficiency, particularly in producing pain, and is easily overlooked, mainly because of diagnostic difficulty. The combination of reflux and obstruction is seen more frequently with severe clinical disease than is obstruction alone. Ulcer prevalence is clearly associated with reflux, with a low incidence in patients with obstruction alone. Removal of iliac vein outflow obstruction does not result in increased axial reflux, with clinical deterioration in limbs with combined reflux and obstruction.
It also says that reflux AND obstruction together had a lot of stasis ulcers.
If you have not kept up with this information on CCSVI , just a reminder that a venous stasis ulcer has the same cytokines as an MS lesion, MMP9 upregluation TIMP1 iron deposits etc. This is why an obstruction with reflux in the neck is a big deal and a possible cause for the MS lesion.
Ok now tell me again why it is good to ignore this same type of obstruction and reflux in the head?
It is illogical to accept that a leg stenosis should be opened up with a stent based on good medical literature but it is OK to ignore a neck one with the brain being the impacted tissue because we "don't know" if it caused the brain lesions.
please add anything to this thread that supports the position that stenoses (that's plural for stenosis) should be treated for their own sake...
This ammo may help make the case to insurance companies as we go forward in absence of complete studies.
marie