Guidelines for the
Management of Patients
Following Endoluminal
Vein Dilation Procedures
for the Treatment of
Multiple Sclerosis

Guidelines for the Management of Patients Following Endoluminal
Vein Dilation Procedures for the Treatment of Multiple Sclerosis
1 ) P U R P O S E S T A T EME N T
These guidelines were developed by The Ontario Multiple Sclerosis (MS) Expert Advisory Group (see Appendix A
for Membership List) to provide guidance to health care practitioners (i.e., family physicians/general practitioners,
specialists, nurse practitioners) in the province of Ontario who are providing post-operative and ongoing
follow-up care to patients with MS who have had an endoluminal vein dilation procedure for the treatment of
MS in another country and have returned to Ontario.
While some research has suggested a relationship between narrowed veins in the neck and chest and the development
of MS, this relationship has not been proven. It has also been suggested, but not proven, that endoluminal
vein dilation procedures can improve the symptoms of MS. Some patients have chosen to undergo endoluminal
vein dilation procedures outside of Canada. Typically, follow up of these patients after endoluminal vein dilation
procedures is not done by the physician who carried out the procedure. The Expert Advisory Group developed
these guidelines at the request of the Minister of Health and Long-Term Care of Ontario to address the care of
patients with MS after endoluminal vein dilation procedures. These guidelines represent a consensus opinion
based on the expertise of the members of the group, as well as the available evidence-based literature on this
subject, which is acknowledged to be of limited scope and quality.
MS patients routinely seek care from primary care physicians or nurse practitioners, and these practitioners may need
to refer patients to, or collaborate with, other health care practitioners, including physician specialists, to manage patients
with MS after endoluminal vein dilation procedures. This document is meant to guide all health care practitioners
in the province who may be involved in the care of these patients.
Practitioners should tell their patients that there are currently no evidence-based clinical guidelines for the treatment
of complications of vein dilation procedures involving the azygous or jugular veins, that they will inform
their patients if and when new information about treatment options becomes available, and that they will make
referrals to other health care practitioners as appropriate.
It must be emphasized that individual practitioners’ opinions regarding endoluminal vein dilation procedures for
the treatment of MS should have no bearing on a practitioner’s willingness to provide care for patients returning
to Ontario after endoluminal vein dilation procedures, their willingness to refer such patients to other practitioners
for care as indicated, their willingness to accept such a referral in a timely manner, or their willingness to
accept such patients as new patients (see Appendix B for applicable legislation, regulations, policies, standards, and guidelines).

For the balance of report: http://www.health.gov.on.ca/en/public/publications/ministry_reports/ms_ccvsi/ms_ccvsi_pro.pdf