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Tuesday, April 19, 2011 4:00 AM | Ken Torbert Volg link

What is chronic cerebro-spinal venous insufficiency (CCSVI)?

Chronic cerebro-spinal venous insufficiency (CCSVI) is a condition which describes compromised flow of blood in the veins draining the central nervous system. This condition has been hypothesized to play a role in the cause of multiple sclerosis (MS). MS has long been recognized as a disorder affecting the central nervous system, including the spinal cord and the brain. The causes leading to MS remain unclear, and patients with MS have neurological symptoms that are often progressive. Currently there is no known cure for MS. The treatment is focused on limiting MS attacks to prevent further disability.

Researchers have recently discovered a possible association between MS and CCSVI. CCSVI occurs when the flow of blood in the veins of the chest and neck is compromised. This causes less efficient draining of blood from the brain. It is proposed that insufficient venous blood flow, in turn, promotes development of brain dysfunction, especially in MS.

What are the symptoms or consequences of CCSVI?

Proposed consequences of CCSVI syndrome include intracranial hypoxia, delayed perfusion, reduced drainage of catabolites, increased transmural pressure, and iron deposits around the cerebral veins. Iron deposition as a cause of MS received support when a relation between venous pressure and iron depositions in MS patients was found in a neuroimaging study. CCSVI itself, regardless of MS presence, is known to cause mind impairment.

How is this condition diagnosed?

Your doctor may perform several studies to further evaluate the CCSVI conditions. These tests include ultrasound, disability scale evaluation, unassisted walking evaluation, and venogram. Brief descriptions of these tests are provided below.

• Duplex Ultrasound - This is a non-invasive test which uses ultrasound to send ultrasound waves which reflects from moving red blood cells. This is done by placing a probe over your chest and neck. Ultrasound gel is placed on the skin underneath the probe to help see the vessel better. This test takes approximately 45 minutes. This ultrasound test allows the doctor to evaluate the blood flow in the veins of your neck and determine the options for treatment. These tests are routine in the evaluation of patients with blood flow disturbances in the vein.

• Expanded Disability Status Scale (EDSS) - This is a disability status scale evaluation for patients with MS. The EDSS ranges from 0 - 10 with higher scores indicating more severe disability. At each visit the scale will be done with you to determine a score.

• Unassisted Timed 25 Feet Walk (EDSS) - This is a test that will be used to assess leg and ambulation function if a patient is capable of walking. This will be done at all visits. You will be asked to walk 25 feet as quickly as possible. This will be done twice and the average time will be taken.

• Venogram - A small catheter is placed in the groin so your doctor can take images of the vein in the chest and neck, as well as perform treatment to correct the blood flow. This diagnostic test typically takes less than one hour. During that time, the doctor will make a small puncture in your groin and a catheter (narrow tube) will be inserted and advanced up into the veins in your neck (internal jugular or azygous). Dye is injected into the vein and several x-rays are taken. This test will allow the doctor to determine if you have blockage in your veins. If CCSVI is confirmed, the doctor may proceed to treatment by using a special balloon to open the narrowed jugular or azagous veins.

What is the treatment for CCSVI?

Treatment for CCSVI is an endovascular procedure to dilate the narrowed vein with a balloon, which is delivered from the groin. This procedure is done in conjunction with the diagnostic venogram. It has been shown that this procedure may reduce symptoms in MS patients that are diagnosed with CCSVI. This procedure takes less than an hour to complete. After the procedure is complete, you will be taken to the recovery area. Pressure may be applied to your groin where the catheter was removed and replaced with a bandage. You will be on bed rest for up to 2 hours. You will be sent home the same day and discharge instructions will be given to you.

Contact Information

Physicians at the Division of Vascular Surgery & Endovascular Therapy can provide diagnostic evaluation and perform appropriate treatment for this condition.

To schedule a visit with Baylor vascular surgery physicians, please contact the Baylor Clinic at (713) 798-5700.