new from Zamboni

[frodo]

http://www.sciencedirect.com/science/ar ... 3X16300865

[NHE]

Here's more info...


Fixing the jugular flow reduces ventricle volume and improves brain perfusion
Journal of Vascular Surgery: Venous and Lymphatic Disorders. 4:434–445, 2016.

• Objective: Increased ventricle volume and brain hypoperfusion are linked to neurodegeneration. We hypothesized that in patients with restricted jugular flow, surgical restoration may reduce brain ventricle volume, because it should improve the pressure gradient, hence promoting cerebrospinal fluid reabsorption into the venous system.
  
  Methods: The effects of restoring the jugular flow were assessed by means of a validated echocardiography with color Doppler (ECD) protocol of flow quantification, magnetic resonance venography, and single-photon emission computed tomography combined with computed tomography (SPECT-CT). The main outcome measurement was the cerebral ventricle volume blindly assessed at SPECT-CT. Secondary outcomes were brain perfusion in the whole brain and in another 12 cerebral regions. The mean follow-up of the SPECT-CT and ECD parameters was 30 days. Patency rate was subsequently monitored by means of the same ECD protocol every 3 months.
  
  Results: Among 56 patients (28 male and 28 female; mean age, 44 ± 10 years) with ECD screening positive for chronic cerebrospinal venous insufficiency due to nonmobile jugular leaflets, 15 patients were excluded from the initial cohort because they did not meet the inclusion and exclusion criteria. Of the remaining 41 patients, 27 patients (14 male, 13 female; mean age, 48 ± 7 years) underwent endophlebectomy and autologous vein patch angioplasty. Omohyoid muscle section was performed when appropriate. The control group comprised 14 patients matched by age and gender (8 male, 6 female; mean age, 44 ± 11 years) who were not treated. Comorbidity was multiple sclerosis without significant differences in relapsing remitting (RR) and secondary progressive (SP) clinical course among groups. In the control group, neither ECD nor SPECT-CT showed any significant changes at follow-up. On the contrary, in the group operated on, the collateral flow index went from 70% to 30% (P < .0003) thanks to improved flow through the internal jugular vein. Correspondingly, ventricle volume dramatically decreased in the treated group (from 34 ± 14 cm3 to 31 ± 13 cm3; P < .01). The effect was much more evident in the RR subgroup (P = .009), whereas in the SP subgroup, it was not significant. Perfusion was found to be improved in the surgical group with respect to controls, particularly in the occipital and parietal regions of the RR subgroup (P < .0001 and P = .017, respectively), but not in the SP subgroup. The probability of reducing ventricle size is increased by 13-fold (P < .03) when restoration of the jugular flow achieves a postoperative collateral flow index ≤20%. Finally, the 18-month patency rate was 74%.
  
  Conclusions: Fixing the flow in the jugulars in patients with chronic cerebrospinal venous insufficiency might significantly reduce brain ventricle volume and improve cerebral perfusion. These changes are more evident in patients in the earlier stages of neurodegenerative disease.

[ThisIsMA]

Can someone explain what they did in plain English?

I'm really having a bad case of cog fog today, so I don't have the patience to analyze this. Was it surgery, like making an incision with a knife and doing something (what?) to their jugulars? Or was it angioplasty to open the jugular veins? The fact that it was successful is very exciting, I just couldn't figure out what they did.

M.A.

[NHE]

Can someone explain what they did in plain English?

I'm really having a bad case of cog fog today, so I don't have the patience to analyze this. Was it surgery, like making an incision with a knife and doing something (what?) to their jugulars? Or was it angioplasty to open the jugular veins? The fact that it was successful is very exciting, I just couldn't figure out what they did.

Of the remaining 41 patients, 27 patients (14 male, 13 female; mean age, 48 ± 7 years) underwent endophlebectomy and autologous vein patch angioplasty. Omohyoid muscle section was performed when appropriate.

A quick google search suggests that these are surgical procedures and go beyond venoplasty.

[Cece]

Of the remaining 41 patients, 27 patients (14 male, 13 female; mean age, 48 ± 7 years) underwent endophlebectomy and autologous vein patch angioplasty. Omohyoid muscle section was performed when appropriate.

Vein patching is when the vein is surgically expanded by cutting the vein and patching in a new segment. Endophlebectomy is ... surgically shaving off the valve or clot or blockage from inside the vein without cutting the vein itself? Omohyoid muscle section is cutting a muscle that's compressing the vein from the outside, without cutting the vein itself.

So, yes, vein surgery in the case of the vein patching. Muscle surgery in the case of the omohyoid muscle section. Cutting from within the vein, but not actual surgery on the vein itself, in the case of the case of the endophlebectomy.

There was pretty good patency at 18 months too. That was the problem when people here were getting vein surgery done, the new veins seemed to take at first but didn't last. Vein patching always seemed more likely to succeed than that though.