"Driving down the side streets will never be as fast as driving down the highway" ~ Dr. Joseph Hewett commenting on collateral veins and why we need to treat CCSVI.

Dr. Hewett wanted to do the session to correct a lot of misinformation that is circulating about stents. First, he detailed a long history of using stents to correct circulatory problems, beginning in 1856 with a dentist aptly named "Dr. Stent." With angioplasty becoming commonplace after 1964, stenting eventually became associated with this procedure by 1994. In 2003, drug coated stents for arteries were developed to prevent restenosis.

Stents were used in many areas of the body, beginning with the liver and trachea before being used for arterial procedures. Many types of stents are appropriate for use in veins; in fact, stents are not designed for only one type of vessel, but are designed in terms of what they can achieve in terms of improving blood flow.

Surprisingly, Dr. Hewett said there's no proof stents keep veins open longer than angioplasty alone. This, of course, doesn't refer to situations where angioplasty failed to work in a particular location, but refers to a comparison between veins successfully treated with angioplasty versus veins successfully treated with a stent. Dr. Hewett stressed that ALL VEINS WILL RESTENOSE. It's not a matter of "if" -- it is a matter of "when." Restenosis generally occurs after 4-6 months and usually much later (12-18 months) and is a very gradual process taking many months before total restenosis happens. He said that if symptoms return before the 4-6 month period, it is a matter of undertreatment and not restenosis.

Stents should be 20% wider than the vein in which they are placed. If a stent is put in properly, it won't move (sometimes called "jumping"). Stents are not, contrary to a lot of the buzz out there surrounding CCSVI, strangers to veins -- Dr. Hewett says he has placed over 5000 venous stents over his 15 year career. For instance, May-Thurner Syndrome has been known for decades and usually requires a stent. Kidney dialysis patients also need stents in their veins because angioplasty is not effective for their needs. The main issue is whether to use a stent in the first place. If it is indicated for a number of reasons, such as blood flow and patient outcomes, it is best to use it. In terms of CCSVI, though, stent use is still quite rare.

Some issues people worry about with stents is a stent fracture. This is a very low incidence occurrence and may not actually lead to a problem for the patient. Stents may also be too small for their location and need to be fractured deliberately by widening with angioplasty. To deal with fractures, another, larger stent needs to be placed inside the smaller one to cover any exposed edges of the fractured stent. These corrections work quite well with few complications.

The azygos vein is unique in that there's only one vein providing drainage for this area of the body. Many other veins, such as the jugular veins, have backups; the azygos does not. This vein can get squished between the heart and the spine. A branch of the vein, the hemiazygos, can get squished by the aorta. Because there are no alternative veins to supply drainage, these areas often need stenting because angioplasty alone will not keep blood flowing.

Presence of a stenosis is sometimes difficult to detect and isn't strictly a visual determination. A pressure gradient of 3-5 mm of mercury before and after the blockage warrants treatment. This is a much lower pressure gradient than was traditionally thought to cause problems. Dr. Hewett describes the situation where a patient has symptoms indicating a problem with the azygos (walking, bowel, bladder), but no obvious stenoses. He recommends using balloons to assess the vein three dimensionally because a two dimensional assessment (dye) may not be sufficient to detect a stenosis. He feels the azygos is a crucial area for MS patients to have completely assessed.

However, blockages do not always need to be treated. It is necessary to look at the big picture and always try angioplasty first if symptoms are present. Sometimes leaving a vein stenosis intact is preferable because angioplasty would not significantly affect clinical outcomes for the patient and would unnecessarily damage the vein. Jugular veins are rarely, rarely stented. Dr. Hewett is now using fewer stents in this area than when he first started treating CCSVI a year ago.

In the question and answer period, Dr. Hewett stressed that we should get the fluoro time from our treatment doctors because of the potential radiation exposure. This time indicates how long we were exposed to the dye used during the procedure to assess blood flow. In the United States and Canada, it is the law to keep this time very short. Dr. Code mentioned one patient who had CCSVI treatment and had two hours of radiation exposure during the procedure, leading to all of her hair falling out. Dr. Hewett said this couldn't happen in the US or Canada because of the regulations. He didn't think patients need to be overly concerned about repeated angioplasties (meaning repeated exposure to this dye), mentioning that we probably are exposed to more radiation coming out of building materials used in our homes; however, it is important to keep this information in our medical records.

After treatment, aggressive anti-inflammatory protocols (diet, drugs) will minimize scarring and prolong treatment effects. But remember, RESTENOSIS WILL HAPPEN. (I find it curious restenosis is often cited as a reason a) not to have CCSVI treatment in the frst place, and b) evidence of a failed treatment. It is neither -- it is expected with CCSVI angioplasties as it is with all other angioplasties.)

Finally, Dr. Hewett closed with stressing the need for a lifelong commitment to monitor and treat restenosis because it will happen in every location that has been angioplastied. He said there's no difficulty if we have to have angioplasty, for instance, every three years throughout our lives to make sure our veins stay open. He left it open that a more permanent solution may be found eventually.

Thank you Dr. Hewett for, once again, delivering your expertise so capably and willingly to an eager audience!

~ Sandra  http://www.facebook.com/note.php?note_id=495642382733&id=182832983940