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Thursday, March 28, 2013 4:05 PM | CCSVI Toronto Volg link

It 'was published in the American Journal of Neuroradiology a letter by Dr. Bavera , vascular surgeon at the University of Milan, criticizing the methodology and findings of the Australian study " Chronic Cerebrospinal Venous Insufficiency of Mystery: Identical Venographic and Ultrasound Findings in Patients with MS and Controls"published in January in the journal.

I read with interest the article entitled " The mystery of chronic venous insufficiency cerebrospinal results flebografici identical and ultrasound in patients with MS and controls "of McAuliffe and Kermode (1) published online in January in the American Journal of Neuroradiology. I therefore do not agree on the methodology is that the authors' conclusions.

It is unclear whether operators doppler had sufficient training to look for any abnormalities of the jugular vein and if in fact the research has followed the usual protocol required. The authors have cited the protocol guidelines published by seven international scientific societies (2).Furthermore, it was demonstrated that the formation is mandatory to improve the reproducibility of screening for chronic venous insufficiency cerebro spinal (CCSVI). The coefficient k found [in the study in Note 3] was significantly different comparing the interobserver variation of ultrasound operators trained to non-trained (3).

Thirty cases are not sufficient to obtain statistically significant results. Furthermore, it was demonstrated that the formation is mandatory to improve the reproducibility of screening for CCSVI. This methodology is very different from that of Zamboni and colleagues in their initial article (4). CCSVI has been proposed with a multimodal approach that combines imaging with ultrasound abnormalities achieved by catheter venography.

After 30 years of experience as a vascular surgeon and diagnostic (5), I can comment on the work of the authors, because after 1500 tests for CCSVI research, I have found abnormalities in 90% of patients with MS. Half of these were controls after venous angioplasty, all subject to venografici tests have confirmed CCSVI.

The conclusions to be made with large numbers and require time, proper training, and a learning curve, as well as the comparison dell'ecocolordoppler with the criterion standard catheter venography.

P.M. Bavera

Vascular Surgeon

University of Milan


1. McAuliffe W, Kermode AG. Chronic cerebrospinal venous insufficiency of Mystery: identical venographic and ultrasound findings in patients with MS and controls. AJNR Am J Neuroradiol January 31, 2013 [Epub ahead of print]

2. Zamboni P, S Morovic, Menegatti E, et al. Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound: recommendations for a protocol. Angiol Int 2011; 30:571-97. Erratum in: Int Angiol 2012; 31:201

3. Menegatti E, V Genoa, Tessari M, et al. The reproducibility of color Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis. Angiol Int 2010; 29:121-26

4. Zamboni P, Galeotti R, Menegatti E, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:392-99

5. Bavera PM, Agus GB, Alpini D, et al. Results from 823 consecutive duplex exams for CCSVI in a vascular center. Phlebologica Acta 2012; 13:141-48


Article translated from:

Lettera del Dott. Bavéra su AJNR a commento dello studio australiano