Preliminary results of preoperative diagnostics and endovascular treatment for CCSVI

Marian Simka EuroMedic Vascular and Endovascular Surgery Department Katowice Poland

• Testing for CCSVI with color Doppler sonography –since May 2009
• Testing for CCSVI with MRV –since October 2009
• Endovascular procedures for CCSVI –since October 2009 EuroMedic Katowice Poland

color Doppler sonography

• about 250 MS patients examined
• venous abnormalities found in ~95%
• most common finding: pathologic valves or membranes in the internal jugular veins (IJV)
• majority of stenoses in the middle part of IJV seemed to be secondary to pathologic valves or to result from external compression

MR venography

• about 100 MS patients examined
• most common finding: a)stenoses in middle and upper part of IJV b)signs of impaired outflow on time-of-flight imaging
• pathologic valves and membranes could be visualized only in few patients

Endovascular treatment

• 90patients operated on
• Intraoperativevenography as the key test for decision making
• Preoperative Dopplerand MRV–as a help to evaluate venous anatomy and to reveal where the problem might be situated
• Stentingonly if absolutely needed(ballooningunsuccessful) and if safe(not for areas with changeable diameter during Valsalva)

Endovascular treatment –procedures for IJV

• No obvious pathology found –3 patients (3%)
• Only balloon angioplasty –57 patients (63%) (31 patients: one IJV; 26 patients: both IJVs)
• Only stenting –19 patients (21%) (18 patients: one IJV; 1 patient: both IJVs)
• Stenting in one IJV and balloon angioplasty of the other vein –12 patients (13%)

Endovascular treatment –additional procedures

• Stenting or angioplasty of azygous vein –6 patient (7%)
• Balloon angioplasty of brachiocephalic vein –2 patients (2%)
• Redo surgeries –3 patients

Endovascular treatment –complications

• 1 minor bleeding from puncture in the goin, 2 days postop
• 1 gastrointestinal bleeding a week postop (clopidogrel?)
• transient headaches following procedure in some patients
• No major pain
• No injury to the nerves
• No problems related to stents

Endovascular treatment –failures of the treatment

• Unsuccessful stenting for hypoplastic upper IJV -1 patient
• Unsuccessful balloon angioplasty for stenosis in the middle part of IJV (probably due to external compression) –3 patients
• Minor success of balloon angioplasty for membranes in the brachiocephalic veins -2 patients

RESULTS –some preliminary impressions

• Follow-ups available only for some patients; however , most of patients reported improvements
• In general: the less disabled patients was, the bigger improvement•No improvement or recurrence of symptoms may indicate restenosis

Some interesting findings

• Within one hour postop patients' hands became warm (if cold before treatment) and faces pink (if pale before)
• Bladder control improved within one day postop
• It is difficult to explain these findings in terms of improved nerve function; rather -it is more likely that a blood-released neurotransmitter may play a role (angiotensin ??)

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