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cervocuit wrote:

drsclafani wrote:cervocuit
i will bet that homo erectus had constipation, heart disease and chronic cough. The survival of the fittest left him far behind.

Jugular hypertension is usually a reflection of problems of the heart and lungs. If right heart hypertension occurs from heart failure or emphysema, that pressure will be reflected into the jugular veins. So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

So what happens if the jugular valves are present with heart problems. the high pressure above the heart will close the valves if if works correctly. Then we have a closed system as with valve stenosis. Are heart desease and MS associated conditions ?

mo_en wrote:Hi, best wishes to all.
Dr S, i would like to bring back a question from the past that seems to have passed unanswered:
The ability of each IJVr to act as a collateral for the other depends on the patency of the confluence of sinuses between the left and right side. I've been told that underdevelopment or even absence of the confluence is commoner than one would expect. If such an obstacle was present then someone would need both her/his IJVs to remain functional in order to have adequate outflow.
Do you consider the state of the confuence of sinuses critical? Do you intend to incorporate it in your future procedures?
Thank you.

blossom wrote:dr. sclafani,

thanks for answering.

the numbness is worse and has increasingly gotten painful. this has spread across the private part and into the right leg also. i never in 20 yrs. had a symptom just pop up and then maybe lighten up like say rrms. mine were slow steady down hill ppms type. until i had the angioplasty and woke up to the numb left leg. with this spreading from the nerve getting injured "similiar to a reflex sympathetic sympathy" type condition and it were to spread more i doubt i could live with it. you as a dr. knows rsd has no cure either. i hope i'm dead wrong i'm no dr. all i know is what my body tells me and it's not good what happened. i knew going in maybe it might not help but never expected to have this outcome. i had enough going on as it was.

again i appreciate your input. and in your experience if you have heard of this happening to anyone what if anything can be done to fix it?

after 20 yrs. i can hardly move but severe pain and numbness was not an issue. i have never taken an ms med. or anything stronger than an asparin.
what a shame if this is added to this pot of misery-and all i wanted was the hope of moving again.
when doing the doppler they checked the whole left leg for flow and that was good.

drsclafani wrote:There are also ipsilateral intracranial collaterals through the emissary veins, predominantly condylar emissary veins.

Cece wrote:

drsclafani wrote:There are also ipsilateral intracranial collaterals through the emissary veins, predominantly condylar emissary veins.

I have been wondering about those condylar emissary veins, and whether, as you have suggested, in some patients they indicate a congenital malformation of the valves leading to increase as a fetus in the size of the emissary veins.

Here's an image from a patient after bilateral ligation of both jugulars, due to a cancer of the neck.
http://neurosurgery.dergisi.org/pdf/pdf_JTN_554.pdf


Are there condylar emissary veins in this image?

I think I'll pull another image from the article and ask about it too. Next post....

Cece wrote:

What do you make of this image? It's a DSA after unilateral internal and external jugular ligation on the left side. Right jugular can be seen. I think I see a vein leaving the left sinus; do you know what vein that is? Are those cerebral veins that can be seen on the left side of the brain but not the right? Does this indicate slowed drainage of the left side of the brain, as compared to the right side?

drsclafani wrote:This is the venous phase of the direct injection of the left internal carotid artery, so we are seeing drainage of the left side of the brain.

I had a case today where the IR called the condular vein the vertebral vein.

Cece wrote:

drsclafani wrote:This is the venous phase of the direct injection of the left internal carotid artery, so we are seeing drainage of the left side of the brain.

Ahhh...that explains it. I was reading too much into one side having veins showing and the other not.

I had a case today where the IR called the condular vein the vertebral vein.

Must've been a big condylar vein to be mistaken for a vertebral vein.

If you're still around, any thoughts on ISET? Did Dr. Zamboni present trial results on plethysmography? Was there discussion of IVUS? Fewer cowboy accusations?

Hope you are having an excellent January. I am coming up on my one year anniversary since CCSVI treatment. Still going strong.

Thank you for all that you have done and continue to do for us CCSVIers!

drsclafani wrote: hold on, cece. i never said those veins were not condylar veins. In fact, there are probably condylar veins there. All that density at the upper neck is more likely condylar than other collaterals. it just takes a good lateral view to see it well. I used to call these collaterals going into the vertebral veins too. But since i h ave been performing dural sinography, it is clear that they are very often condylar collaterals. I will try to post one today here and on my facebook page.

Great! I am hoping for longer times between restenoses as i am comfortable with the IVUS-based large balloon high pressure technques. Yesterday it took eleven inflations of a 14 mm balloon at 23 atmospheres to open a stenosis. That is a new boundary!

Thank you for all that you have done and continue to do for us CCSVIers!

I would like to do more treatments.

Cece wrote:

drsclafani wrote:
Great! I am hoping for longer times between restenoses as i am comfortable with the IVUS-based large balloon high pressure technques. Yesterday it took eleven inflations of a 14 mm balloon at 23 atmospheres to open a stenosis. That is a new boundary!

Wow, yes, lots of inflations at a high pressure, but without taking the balloon size up to 16 or 18.
Thank you for all that you have done and continue to do for us CCSVIers!

msfire wrote:Hi Dr S. (saint) in regards to high pressure and large balloons, I recall you using an 18mm balloon @ 18 atmospheres on my left jugular and a 22mm @ 18 atmospheres on my right. So far so good.

drsclafani wrote:Cece, i do not sweat the larger size WHEN it is necessary. This particular patient had venoplasty on the right side with an 18 mm balloon. IVUS showed that anything less on the right would have been suboptimal to me.

On the other hand, IVUS showed that 14 mm was optimal on the left side and i was loath to, but tempted, to use a 16mm when ten inflations were unsuccessful. However we got lucky and dilatation was successful on the eleventh inflation

S

But since i h ave been performing dural sinography, it is clear that they are very often condylar collaterals. I will try to post one today here and on my facebook page.