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Cece wrote:At one point during my follow-up procedure on Monday, he was expecting because of the fast flow in my extra-large azygous, that he would find a renal stenosis. Prior to the procedure, he discussed this as a possibility. Had it been found, which it was not, he would have stented the renal vein.
Unlike the jugulars which have variable flow dependent on posture, the renal vein has constant flow and the risks of clotting or complications with a stent seem to be less.
Did you read Dr. Arata's opinion that the renal and iliac veins should not be checked in the absence of symptoms, that this was somewhat akin to battery? But from a patient's perspective, whenever I hear of people who have learned they have a renal stenosis or MT, they want to know this.
Cece wrote:At one point during my follow-up procedure on Monday, he was expecting because of the fast flow in my extra-large azygous, that he would find a renal stenosis. Prior to the procedure, he discussed this as a possibility. Had it been found, which it was not, he would have stented the renal vein.
Unlike the jugulars which have variable flow dependent on posture, the renal vein has constant flow and the risks of clotting or complications with a stent seem to be less.
Did you read Dr. Arata's opinion that the renal and iliac veins should not be checked in the absence of symptoms, that this was somewhat akin to battery? But from a patient's perspective, whenever I hear of people who have learned they have a renal stenosis or MT, they want to know this.
i have been called a battery:
Eveready DuraSal
Seriously, one should look at the cerebrospinal venous circuit as continuous. it seems to me that adding considerable blood from the renal veins into this pool is part of the equation.
sorry Dr Arata was so dogmatic on this point. I wouild hate to have him quoted by the NY district Attorney to a Grand Jury
davmets2 wrote:Dr Sclafani,
I just had my 3 month ultrasound. My procedure was done in 2 stages, one week apart. While doing the second procedure for the RJV the venogram showed that the LJV that was done the week before with 18 mm balloon had restenosed and clotted. He attempted to re-balloon without any success. Had been on warifin since then (just stopped taking yesterday).
The ultrasound that I just had done yesterday showed flow in both jugulars. He couldn't tell me how much flow. He suggested another procedure with ballooning and probably a stent, but gave no guarantees that this would work or help. He told me to think about it, but the sooner I do it the better chances of success.
I guess my question would be, is there any test to show how much flow I'm getting and do you think that I should consider another procedure, possibly with a different Dr. such as yourself.
Thanks
Hi Dr. Sclafani,
I thought this was a good question. I, too, would be interested in your opinion on this question, whenever you have the time to answer. I know you are a very busy doctor.
Thanks,
CD
You are indeed fortunate that your thrombosis was able to reverse itself while on coumadin. Often, occlusion of the jugular vein is a permanent thing. You might not have had such an outcome if this vein had been the second vein treated rather than the first one.
I think that the ultrasound examination is the best screening test. Cheap, accurate and to the point.
Now you want to know how much flow there in within the vein? I would personally want to perform a venogramto assure that the vein interpreted as the IJ, actually was the IJV. Sometimes collateral vessels get quite large and may look very much like the internal jugular.
If the vein is narrowed significantly, I would try angioplasty with the expectation that a stent might be needed.
What possibly could be causing all the thromboses that we hear about. I wonder what percentage of patient treated develop IJ thrombosis.
I know that the cases of thrombosis that i have been involved with come in two forms.1. Overdilation of veins and very high pressures in relatively normal veins. Choosing vein diameter is much more precise using IVUS. I havent had a thrombosis since changing my procedure. The other association is with thrombosis resulting from treatment of hypoplastic veins. That is the reason that I have backed off aggressive treatment of hypoplasias..
I just got back from my 3 month follow up US from April 12th. It showed no flow in my LIJV. I think this probably occurred 3 weeks after my April 12th US and stopping Coumadin. The last couple months have been pretty rough...was put on solumedrol twice thinking it was an MS flare up.
Now I know it was from the vein clotting. My question is what are the chances of being able to stent this vein as this is what my doctor told me he wants to do.
1. In the "what do you want for free" department... for those of us tired of relying on the Gray's Anatomy pictures on Wikpedia (free, yes, but I can't make out some of the writing on the pictures),
(a) do you have a favorite human anatomy textbook for under $100? and
(b) what would the choice be if price wasn't a consideration?
drsclafani wrote:Seriously, one should look at the cerebrospinal venous circuit as continuous. it seems to me that adding considerable blood from the renal veins into this pool is part of the equation.
What disease or disorder are INRs treating when the stent the dural sinus? It would be interesting to tie that into current CCSVI thinking on chronic venous constriction (CCSVI) and MS.
CD wrote:
Hi Dr. Sclafani,
I thought this was a good question. I, too, would be interested in your opinion on this question, whenever you have the time to answer. I know you are a very busy doctor.
Thanks,
CD
You are indeed fortunate that your thrombosis was able to reverse itself while on coumadin. Often, occlusion of the jugular vein is a permanent thing. You might not have had such an outcome if this vein had been the second vein treated rather than the first one.
I think that the ultrasound examination is the best screening test. Cheap, accurate and to the point.
Now you want to know how much flow there in within the vein? I would personally want to perform a venogramto assure that the vein interpreted as the IJ, actually was the IJV. Sometimes collateral vessels get quite large and may look very much like the internal jugular.
If the vein is narrowed significantly, I would try angioplasty with the expectation that a stent might be needed.
What possibly could be causing all the thromboses that we hear about. I wonder what percentage of patient treated develop IJ thrombosis.
I know that the cases of thrombosis that i have been involved with come in two forms.1. Overdilation of veins and very high pressures in relatively normal veins. Choosing vein diameter is much more precise using IVUS. I havent had a thrombosis since changing my procedure. The other association is with thrombosis resulting from treatment of hypoplastic veins. That is the reason that I have backed off aggressive treatment of hypoplasias..
I just got back from my 3 month follow up US from April 12th. It showed no flow in my LIJV. I think this probably occurred 3 weeks after my April 12th US and stopping Coumadin. The last couple months have been pretty rough...was put on solumedrol twice thinking it was an MS flare up.
Now I know it was from the vein clotting. My question is what are the chances of being able to stent this vein as this is what my doctor told me he wants to do.
Thanks
recanalizing a two month old clotted vein is difficult. Likely will not be possible but worth a try. i use ultrasound to search for partially recanalized vein so i have a working channel to push through. This is not easy for me to accomplish.
Question; You are using the IVUS for several months now, do you see any difference in the percentage of improving patients?
Does the IVUS have a positive effect on that?
1. In the "what do you want for free" department... for those of us tired of relying on the Gray's Anatomy pictures on Wikpedia (free, yes, but I can't make out some of the writing on the pictures),
(a) do you have a favorite human anatomy textbook for under $100? and
(b) what would the choice be if price wasn't a consideration?
2. New avatar is ... you? Just curious.
i do not have a favorite anatomy book. i do love grays tho
the new avatar is me, a self portrait in the jungles of sulawesi at night photohunting tarsiers, the smallest primates......i sure do miss doing that stuff!!!
drsclafani wrote:Seriously, one should look at the cerebrospinal venous circuit as continuous. it seems to me that adding considerable blood from the renal veins into this pool is part of the equation.
What disease or disorder are INRs treating when the stent the dural sinus? It would be interesting to tie that into current CCSVI thinking on chronic venous constriction (CCSVI) and MS.
look up dural sinus thrombosis, dural sinus stenosis
interestingly some of the symptoms are the ones that respond most often to angioplasty in ccsvi.
Question; You are using the IVUS for several months now, do you see any difference in the percentage of improving patients?
Does the IVUS have a positive effect on that?
Robert
its not that i am using ivus for only a few months. I have always used IVUS for ccsvi
what is changing for me is my understanding of the pathology and the nuances of the approach with IVUS in my practice.
it was three months ago that i "got it!". i believe that IVUS makes my procedure more rational to me and this shows in the results
i believe i am seeing a higher percentage of patients with improvements and a reduction in thromboses and other complications
its too soon to tell whether there is better durability of the angioplasty
drsclafani wrote:it was three months ago that i "got it!". i believe that IVUS makes my procedure more rational to me and this shows in the results i believe i am seeing a higher percentage of patients with improvements and a reduction in thromboses and other complications
its too soon to tell whether there is better durability of the angioplasty
Ignoring the durability, could you put a rough number on the percentage of patients who say they notice improvements as compared to those which say they notice no change in their MS?
drsclafani wrote:it was three months ago that i "got it!". i believe that IVUS makes my procedure more rational to me and this shows in the results i believe i am seeing a higher percentage of patients with improvements and a reduction in thromboses and other complications
its too soon to tell whether there is better durability of the angioplasty
Ignoring the durability, could you put a rough number on the percentage of patients who say they notice improvements as compared to those which say they notice no change in their MS?
I think the amount of treated patients is an important factor to say thngs tha make sense....so suppose we have to wait...
