Report on the Hemodyn 2013 meeting. Pozzuoli, Naples 7-9 November 2013, via Alessandro Rasman
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Tijdlijnfoto'sActa Phlebologica 2013 December;14(3):81-5
Report on the Hemodyn 2013 meeting. Pozzuoli, Naples 7-9 November 2013
Kalodiki E.
Chronic cerebrospinal venous insufficiency
By Prof Clive Beggs
The congress devoted an afternoon to cerebral venous drainage and consideration of the clinical implications of constricted outflow. Prof. Zamboni, who first identified chronic cerebrospinal venous insufficiency (CCSVI) as a phenomenon associated with multiple sclerosis (MS), gave an informative lecture outlining the current state of research into CCSVI. He highlighted the methodological inconsistencies used by various researchers investigating CCSVI and suggested that some studies had reached erroneous conclusions. In support of this, he pointed to a 2013 meta-analysis of the subject by Zwischenberger et al. which demonstrated a strong correlation between CCSVI and MS, although no evidence was found that CCSVI plays a causative role in MS. He further pointed out that Beggs et al. in their 2013 paper in Alzheimer’s disease had found jugular venous reflux to be associated with structural changes in brain parenchymal volume.
The theme of heterogeneity in CCSVI research was taken up by Prof. Haacke, who highlighted that many researchers simply measured blood flow in isolated veins without considering the haemodynamics of the system as a whole, or how flow varied throughout the cardiac cycle. He showed that through hemodynamic analysis of the cerebral venous outflow, it was possible to distinguish between MS patients and healthy controls. He also expressed the opinion that CCSVI might be a good indicator of clinical outcome, with the ratio, internal jugular vein flow to arterial flow, being a particularly insightful metric. The importance of considering cerebral venous outflow as a network was further reinforced by Dr Menegatti, who presented a paper on a novel lumped-parameter model developed at the University of Ferrara, which could be used to better assist in the ultrasonic assessment of patients. Prof Iaccarino also gave an interesting presentation that showed how CT venography could make a valuable contribution in the diagnosis of CCSVI.
Prof. Beggs presented the results of a study involving a novel cervical plethysmography collar, developed by the team at the University of Ferrara. Because this technology assesses the whole cerebral drainage system, rather than any one vein, it avoids many of the limitations of existing assessment methods. The results of the study revealed a marked difference in the cerebral drainage characteristics of MS patients (diagnosed with CCSVI) compared with healthy controls, with the hydraulic resistance of the venous pathways in the MS patients, being 63.5% greater than those of the controls. Further evidence of vascular changes in MS patients was presented by Prof Mancini, who used contrast-enhanced Doppler ultrasonography to assess cerebral (blood flow) circulation times (CCT), which he reported as being significantly longer in MS patients compared with controls. However, while Mancini reported increased prevalence of CCSVI in MS patients, CCT did not appear to be prolonged in patients with MS and CCSVI compared with those who had MS but did not fulfill the criteria for CCSVI.
Overall the session revealed that, despite the controversy surrounding CCSVI, the science associated with the subject is rapidly advancing, with important new insights being gained into the association between constricted cerebral venous outflow and neurological disease.
Source: http://www.minervamedica.it/en/journals/acta-phlebologica/article.php?cod=R43Y2013N03A0081 — met Shirley Renshaw en 29 anderen.