It has long been known that venous obstruction or reflux in the lower extremities can lead to chronic venous insufficiency (CVI) resulting in
persistent leg swelling, induration, dermatitis, hyperpigmentation,

and ulcers.

Patients with CVI have elevated pressure in their dilated and engorged veins, resulting in sluggish blood flow. This
slowed circulation then causes red blood cells and protein-rich fluid

to escape into the subcutaneous tissue leading to hyperpigmentation and

inflammation. Studies have shown that legs affected with CVI

have a 20-fold higher concentration of iron deposits compared to

non-affected legs; increased iron and protein can lead to a chronic

inflammatory response.

TREATING MULTIPLE SCLEROSIS

It has been more than 100 years since the first diagnosis of multiple
sclerosis (MS), an inflammatory disorder that results in demyelination

of the central nervous system. The exact underlying cause of MS remains

unknown; however, it has long been considered to be related to an

autoimmune response. According to the National MS Society, approximately

400,000 Americans are affected by MS. Symptoms typically begin in early

adulthood and include neurologic sensory and motor disturbances that

can lead to severe lifelong disability. There is no cure for MS, and

medical management provides only limited benefit.

Paolo Zamboni, a vascular surgeon at the University of Ferrara in Italy, has
recently illustrated a significant association between MS and chronic

cerebrospinal venous insufficiency (CCSVI). Zamboni and

colleagues evaluated the extracranial venous outflow from the brain in

patients with and without MS and noticed a dramatic association of

venous outflow abnormalities in patients with MS. His findings suggest

that extracranial venous stenosis in the neck veins that drain blood

from the brain (the internal jugular veins) and the vein that drains

blood from the spinal cord (the azygous vein) can result in venous

reflux and increased central nervous system venous pressures. This

process is similar to the way that CVI in the lower extremities leads to

increased venous pressures and related problems. In the case of MS, the

increased venous pressures can potentially lead to the weakening of the

blood-brain barrier and extravasation of the of the red blood cells

carrying hemoglobin with iron. The iron deposition that is seen

in patients with MS may be responsible for the inflammation that can

lead to demyelination of the neurons in the brain and spinal cord.

Zamboni and colleagues have also evaluated the safety and feasibility of
endovascular angioplasty of extracranial central veins in MS patients

with CCSVI. A study published in 2009 looked at 65 patients with CCSVI

who underwent balloon angioplasty of extracranial central vein stenosis

and were followed up for a mean of 18 months. Their findings indicate

that endovascular treatment of CCSVI had significant improvement in

clinical outcomes of MS, particularly in patients with the

relapsing-remitting type of the disease. After venous angioplasty, there

was a significant decrease in venous pressures in all treated veins and

a drop in the number of active brain lesions.

On February 10, 2010, the results of the first prospective blinded study of CVI
prevalence in MS patients showed promising results supporting the

significance of CCSVI in MS patients. This 500-patient study compared

extracranial venous outflow from the brain in MS patients and compared

it to healthy individuals and found a significantly higher incidence of

CCSVI in MS patients (62.5% vs 25.9%). These data are certainly

encouraging, and further studies with advanced imaging including

venography will be necessary to further evaluate the relationship

between CCSVI and MS.

LIBERATION STUDY

Utility of Chronic Cerebrospinal Venous Insufficiency

Percataneus Angioplastty Group Study

The Vascular Health Pavillion, Albany, NY

Investigaro: Manish Mehta, MD. MPH.

OTHER VENOUS TRIALS IN NY

The vein-related research trials described here are currently recruiting
participants or plan to do so in the near future. For information go to

clinicaltrials.gov.

Info taken from:

Deborah Hill, RN, CRC and Manish Mehta, MD, MPH

V-AWARE, The journal of the Center for Vascular Awareness

Vol 2, Isuse 1

http://vaware.org/images/stories/pdfs/VAWARE_Vol2_Issue1.pdf

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