BLOOD CLOTS AFTER ANGIOPLASTY IN JUGULAR VEIN

[dania]

A woman developed clots in a vein that did not have a stent while taking anticoagulants.

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[Cece]

Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency

Imperial College CCSVI Investigation Group:, A Thapar *, T R A Lane * , V Pandey *, J Shalhoub *, O Malik , M Ellis *, I J Franklin * , R Nicholas * and A H Davies *
* Imperial College London; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK

Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units.

It sounds like the thrombosis was treatable ('requiring open thrombectomy for symptom relief').

We need the full paper -- what is meant by fully anticoagulated, was it a true anticoagulant? Was it a valvuloplasty procedure as the majority of CCSVI cases are? Were the balloons appropriately sized?

I agree with the part highlighted. We've seen it happen. This fits with Dr. Cumming's statement when he first showed up at TIMS of being aggressive enough to get the job done but not too aggressive to injure the vein (paraphrased) and Dr. Sclafani's recent discussion of finding the right mix of being bold and gentle on the veins.

Thanks, dania, this was a good find.

[dania]

Usually fully anticoagulated means having an INR between 2 and 3. We still do not have a standardized method of treatment. I asked Dr Siskin what size balloons he uses and he said it depends on the size of the person's vein. I took that to mean that there is a variation of size between patients.
There is so much we do not know. And unfortunately, we only learn from making mistakes.

[cheerleader]

Sadly, that is one of our own on TIMS...she's been posting about this situation since coming home from Bulgaria. She was treated in London.

Posted: Fri Nov 19, 2010 4:31 pm Post subject:
I got the removal of the clot via the dr hooking it out. He felt it was too risky to use thrombolysis in that location and also there is a huge risk of bleeding elsewhere in the system.

He only managed to get a small amount of flow back into the vein as it was so inflammed, he considered putting in a stent to keep it open but decided it against it as he was worried about it coming loose if the clots stuck to the walls of the veins started to dissolve, also he felt the stents currently used do not last as long as they should.

I was treated in Bulgaria, I did report my health issues to them on numerous occasions. I called the dr and nurses in over 8 times that night complaining of breathing difficulties and pain. In the end I requested an oxygen mask. They did and ECG and concluded I was fine. They made me feel like I was imagining the problem and kept repeating nothing was wrong.

I then just wanted to get home to be treated asap especially as I felt unsupervised and ignored.

A+E in the UK is very good in these situations. They have an obligation to help you, so when I walked in complaining of breathing difficulties, pain and told them what I had done they admitted me, put me straight on heparin IV and did all the necessary tests. There was a massive debate on whether to treat the clot as usually they leave jugular vein clots but they felt it was severe enough to treat (ear to collar bone clot that would never dissolve on its own). I am so thankful to them for trying.

I will go back to UK hospital for a doppler at some point to check the neck but it does feel clotted just by the feeling of pressure, it could be scar tissue now though that is giving me that sensation. My dr wants doesn't really want me to have another doppler for a while as knowing maybe worse than not knowing as I am on blood thinners and there are no options to treat it again whatever the results.

http://www.thisisms.com/ftopicp-143345- ... lar#143345

[Cece]

Usually fully anticoagulated means having an INR between 2 and 3. We still do not have a standardized method of treatment. I asked Dr Siskin what size balloons he uses and he said it depends on the size of the person's vein. I took that to mean that there is a variation of size between patients.
There is so much we do not know. And unfortunately, we only learn from making mistakes.

We've seen a lot of learning in the last year, it's true.

Jugular vein sizes vary quite a lot between patients and even within patients. My right jugular is bigger than my left. So Dr. Siskin's answer is a good one.

Cheerleader, thanks for the heads-up. Her story was about as bad as it gets.

[pklittle]

So Dr. Siskin's answer is a good one.

Can you clarify? Where is Dr. Siskin's answer? thx

[Cece]

Usually fully anticoagulated means having an INR between 2 and 3. We still do not have a standardized method of treatment. I asked Dr Siskin what size balloons he uses and he said it depends on the size of the person's vein. I took that to mean that there is a variation of size between patients.
There is so much we do not know. And unfortunately, we only learn from making mistakes.

I was referring to this. You could say our veins vary from xxs to xxl.

XXS might be anything under 6 mm aka "hypoplastic."
XXL might be anything over 18 mm.
These are approximate.

I wish I had XXL veins....

Anyway, this is why the question of 'what size balloons do you use' does not have an easy answer. It might be better to ask how the IR determines balloon sizing (with precise measurement of the vein by IVUS being one possibility) or 'What size balloon would you use on a 150 mm vein? How about a 60 mm vein?' It is difficult asking such precise questions but it would get usable information.

[dianabee]

i hope i am posting this in the right spot.
i had ccsvi treatment in april.
in the last few weeks i am feeling tighness on the right side, like pressure. it gets intense, especially when bending over, or lying down with head propped even slightly. when just sitting, i feel just a slight discomfort and tenderness. also one lymph node on that side in back is swollen. i go back for followup Aug 30

what are the symptoms of a clot?

thx

[Cece]

I've heard it as loss of symptoms or pain in the neck. Clots can also be asymptomatic.

Glad to hear you have a follow-up soon.

[dania]

i hope i am posting this in the right spot.
i had ccsvi treatment in april.
in the last few weeks i am feeling tighness on the right side, like pressure. it gets intense, especially when bending over, or lying down with head propped even slightly. when just sitting, i feel just a slight discomfort and tenderness. also one lymph node on that side in back is swollen. i go back for followup Aug 30

what are the symptoms of a clot?

thx

Hard to say. Sounds like you have one. I had one in my stent. You just know it does not feel right. And doing an ultrasound will only show you have something there but they cannot tell exactly what it is. Good luck.
If they are clots They can be removed. Mine was cut up. Best to get it done as soon as possible as they are hard to remove when they have been there a long time.

[Cece]

And doing an ultrasound will only show you have something there but they cannot tell exactly what it is.

I've heard otherwise, although this might be true if there is scarring or if there is a stent.

Clots should be easily identified in a ballooned-only vein. They change the compressibility of the vein.