Is CCSVI Treatment Safe?
A review of the article: ”Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe?”
by T.Ludyga, M. Kazibudzki, M. Simka, M. Hartel, M. Swierad, J. Piegza, Pl Latacz, L. Sedlak, and M. Tochowicz from Euromedic Specialist Clinics, Department of Vascular and Endovascular Surgery, Katowice, Poland and magnetic Resonance Imaging Department VOXEL, Medical University No 1, Zabrze, Poland. Published in Phlebology 2010, 25, 286-295.
All patients in the study had confirmed diagnoses of MS and CCSVI totaling 342 patients ages 15-68. The presence of CCSVI was confirmed using colour Doppler sonography and magnetic resonance (MR) venography (not gadolinium enhanced). They choose not to use gadolinium since their previous pilot study demonstrated that this imaging technique was not useful in the assessment of CCSVI. The researchers stated that Doppler and MRV were only used as screening tests and decision-making for interventions were based on standard venography as part of the endovascular procedure. They used a grading system of 4 venographic flow patterns identified in patients describing their venous problems/pathology. As contrast was injected at various levels of the vein, issues could be identified during the standard venography. This is also a change from the usual screening methods. Standard venography has long been the “Gold Standard” for CCSVI diagnosis, however, due to its invasive nature, has been reserved for pre-screened patients. It is reassuring to note that the decision-making for treating MS patients is the venography, NOT only the Doppler or MRV, as patients would be turned away and not offered treatment in some cases. We have found that the physicians we have worked with in Mexico, Belgium and India go to great lengths to rule-out CCSVI as well. This is a comforting and reassuring factor for the MS patients we work with.
Surgical intervention was planned based on testing results in 333/342 patients. 15 procedures were redone due to re-occlusion following balloon venoplasty. 357 diagnostic standard venographies were performed in total. 97% of patients received interventional procedures after testing. I think this is also an interesting point…this is a large percent of patients receiving the procedure and the procedure was either balloon venoplasty OR stenting. Almost half of the patients received stents (44.2%)! Notice their complications rates were very low at 1.2% had stent thrombosis (clot) and 2.3% had minor complications with correct placement of the stent.
“According to recently published ‘Consensus Document’ of the International Union of Phlebology on the diagnosis and treatment of venous malformations, which used the ‘Hamberg Classification’ of congenital vascular malformations, CCSVI was recognized as venous truncular lesions of obstructing characteristics that are localized in the territory of IJVs and/or AVs.” This means that patients are born with the venous abnormalities found with CCSVI. Will other professional organizations follow suit with this statement? The congenital origins of venous malformations were also described in “Embryological background of truncular venous malformation in the extracranial venous pathways as the cause of chronic cerebrospinal venous insufficiency” by B.B. Lee, J. Laredo, R. Neville in International Angiology, 29(2), pp.95-108. See my review of this article at: http://ccsvi-ms.ning.com/profiles/blogs/the-impact-of-simple-truncular . So, the question remains—what relationship do these abnormal veins have in the development of MS? Regardless, the mere presence of the abnormalities calls for surgical intervention, deemed as safe both by this study and the Society of Interventional Radiology. (Source: Society of Interventional Radiology (SIR) 36th Annual Scientific Meeting: Abstract 3. Presented March 28, 2011.)
“Recommended therapeutic interventions in proven CCSVI cases comprised angioplasty and/or stenting endovascular procedures” according to the authors…
“The expert panel recommended diagnostic procedures in suspected CCSVI cases because CCSVI comprises the lesions that obstruct outflow and drainage from vital organs (i.e. the brain and spinal cord). This statement by the authors also gives credence to the gravity of the situation in patients with probable CCSVI. Altered blood flow from patients’ brains IS a worrisome situation requiring treatment. Whether it improves symptoms or prevents disease progression, either way….blood flow needs to be restored to vital organs.
Please contact me for further info or to discuss CCSVI Treatment at: kcuenca@worldmedasssist.com or visit us at www.worldmedassist.com or read more at www.msandccsvi.com. This article is copyrighted by WorldMed Assist, but can be reproduced in its entirety as long as the reproduction credits WorldMed Assist by including the following: "source: www.worldmedassist.com ".