World Congress of Phlebology meets in Boston; CCSVI found worldwide - facebook prikbord

The Seventeenth World Congress of the International Union of Phlebology (venous specialists) met in Boston, MA during September 8-13. http://uip2013.org

The abstracts from the presentations are now published in a medical journal. Thanks, once again, to Sandro for providing this information to me for review.

These researchers and specialists are studying the venous malformations found in CCSVI, in hopes of learning how best to treat this hemodynamic problem. While many neurologists have abandoned the theory, venous specialists understand the importance of healthy veins to tissue perfusion.

Dr. Zamboni addressed the current controversy--

Studies of prevalence show a big variability in prevalence of CCSVI in MS patients assessed by established ultrasonographic criteria. COSMO study, despite the big sample and the blinded methodology, appears to be inconclusive for 90% discrepancies between peripheral and central investigators. However, 12 studies, by the means of more objective catheter venography, show a prevalence >90% of CCSVI in MS. Global hypoperfusion of the brain, and reduced cerebralspinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies show a higher prevalence of intraluminal defects in the main extracranial veins in MS patients, as well an altered ratio type I\type III collagen in the vein wall in respect to controls. Finally, both genetics and environmental factors significantly associated to MS were identified.

Conclusions. The origin of the controversy between the vascular and the neurological community is linked to the great variability in prevalence of CCSVI in MS patients by the means of venous ultrasound assessment, known to be a methodology highly operator dependent. To the contrary, taking into ac-count the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypoperfusion and cerebrospinal fluid flow, we conclude that CCSVI can be definitively inserted among the medical entities. Research is still inconclusive in elucidating the CCSVI role in the pathogenesis of neurological disorders. The controversy between the vascular and the neurological community can be solved by the means of multimodality assessment of CCSVI. More reproducible and objective CCSVI assessment is warranted also for planning treatments, in consequence of the inherent variability ofthe causes leading to restricted venous outflow from the brain.

Other CCSVI presentations included Dr. Simka's (Poland) paper on cutting balloons in the treatment of CCSVI and improvement in quality of life for those treated.

Dr. Alessandro (Italy) presented on the incidence of CCSVI and found in his study:

Of 137 patients with MS, 127 (92.70%) were diagnosed with CCSVI while 10 patients (7.29%) did not respondto at least 2 Zamboni criteria, resulting in a negative diagnosisof CCSVI. Among 40 patients studied with selective preoperative venography and positive to CCSVI, all had venous anomalies of the internal jugular veins and 19 patients (50%) hadvenous anomalies of the azygos vein.

Dr. Zamboni also submitted his study on how CCSVI utlizes the collateral network of veins, with a new ultrasound model used to calculate outflow thru collaterals.

A team of researchers from the Medical Education Center in Buenos Aires Argentina diagnosed 19 pwMS that had CCSVI, and treated all with venoplasty and evaluated them for 2 years, finding

Color doppler ultrasound depicted 15 patients with JV lesions and PHconfirmed 13 stenotic JV and 8 AV patients. Venous angioplasty was performedin 33 JV and 8 AV. Clinical neurological evaluation tests improved soon after VA with maximum effect between 6 and 12 months. After 12 to 24 months,a tendency to decrease and then to stabilize the benefits wasobserved in most patients. 8 patients presented JV restenosisbetween 1 and 12 months without major complications. Toler-ance was excellent and feasibility showed appropriate resultsin all patients.

Conclusions. Patients with associated CCSVI and MS canimprove their clinical conditions with VA that demonstrate tobe safe and with and good tolerance.

A team of vascular and neurology researchers from Bari and Taranto, Italy found nine pwMS to have CCSVI on color doppler US, which was confirmed with venoplasty. Doppler sonography has animportant value for the detection of IJV anomalies in patientswith MS, with good agreement with catheter venography (CV).

The Vascular Disease Center of Ferrara, Italy reported on omohyoid muscle entrapment in pwMS/CCSVI. Six people with entrapment were treated with muscle transection and venous angioplasty. At 1 year mean follow up the surgical procedure lead to an IJV flow improvement from a preoperative52.6+32 mL/min to a post-procedural 403.6+141.9 (p=0.0079).The mean neurological disability score (EDSS) improved from3 to 2.5.

While we hear of death knells and coffins in neurology--the academic research world of venous specialists is still discovering and uncovering CCSVI.

more to come,

Joan