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.
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?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.
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.