4th ARAB RADIOLOGY CONGRESS 2011
LEBANESE SOCIETY OF RADIOLOGY
28th - 30th April 2011
CCSVI IN MS. DIAGNOSIS AND MANAGEMENT
Tommaso Lupattelli (Italy)
Introduction: Chronic cerebrospinal venous insufficiency (CCSVI) is a recently discovered syndrome mainly due to stenoses of internai jugular ( IJV) and/ or azygos (AZ) veins. The aim of the present study is to retrospectively evaluate the feasibility and safety of endovascular treatment for CCSVI in a cohort of patients with multiple sclerosis (MS).
Study was of 206 MS patients.
One patient underwent selective venography alone due to no evidence of significant stenosis in the IJVs and AZ. In four additional patients the decision to carry out the interventional procedure was solely taken after selective venography which disclosed at least one significant stenosis in the IJV or AZ territory despite a negative Colour Doppler Ultrasound for CCSVI.
Only one patient failed to have any CCSVI stenoses. Four had a negative ultrasound but had stenoses upon venogrpahy.
Major complications included 1 (0,5%) severe bleeding in the groin requiring open surgery, 1 (0,5%) surgical opening of common femoral vein to remove balloon fragments and 1 (0.5%) left IJV thrombosis 28 days after discharge. Minor complications included, 3 (1,5%) procedure-related technical issues, 3 (1,5%) transient atrial fibrillation requiring a further 12 hour hospital stay, 10 (5%) slight bleeding or haematomas in the groin ( 3 requiring further hospital care the day after intervention and 3 prolonged hospital stay) two right neck haematoma (1%) both occurring the day following the procedure and one (0,5%) haemo- tympanum on the 25th day after discharge.
Discussion & Conclusion: Endovascular treatment for CCSVI appeared feasible and safe. However, a proper learning curve can dramatically lower the rate of complications. In our experience, all major complications occurred in the first 50 cases performed.
Better to be patient #51 than to be #1....