INTERNATIONAL ANGIOLOGY Vol. 32 - Suppl. 1 to No. 5 October 2013
XVII WORLD CONGRESS OF THE INTERNATIONAL UNION OF PHLEBOLOGY Boston, September 8-13, 2013

CONTROVERSY OF THE DAY
Controversy of the Day: There is a Clear Relationship Between Multiple Sclerosis and CCSVI Which has Important Implications for Treatment
P. Zamboni
Director Vascular Disease Centre and Institute of Translational Medicine and Surgery, Dept. of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy

Aim. To analyze the actual scientific controversy on Chronic Cerebrospinal Venous Insufficiency (CCSVI) and its association with both neurodegenerative disorders and multiple sclerosis (MS).
Methods. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series, and also the press release of the recent COSMO study. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as with the recent description of CCSVI in Pathology.
Results. 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 hypo-perfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies show a higher prevalence of intraluminal defects in the main extracranial vein 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 account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion 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 of the causes leading to restricted venous outflow from the brain. https://www.facebook.com/photo.php?fbid=571421912926546&set=t.1587534396&type=1&theater


Foto's van Alessandro Rasman
INTERNATIONAL ANGIOLOGY Vol. 32 - Suppl. 1 to No. 5 October 2013
XVII WORLD CONGRESS OF THE INTERNATIONAL UNION OF PHLEBOLOGY Boston, September 8-13, 2013

CONTROVERSY OF THE DAY
Controversy of the Day: There is a Clear Relationship Between Multiple Sclerosis and CCSVI Which has Important Implications for Treatment
P. Zamboni
Director Vascular Disease Centre and Institute of Translational Medicine and Surgery, Dept. of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy

Aim. To analyze the actual scientific controversy on Chronic Cerebrospinal Venous Insufficiency (CCSVI) and its association with both neurodegenerative disorders and multiple sclerosis (MS).
Methods. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series, and also the press release of the recent COSMO study. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as with the recent description of CCSVI in Pathology.
Results. 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 hypo-perfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies show a higher prevalence of intraluminal defects in the main extracranial vein 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 account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion 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 of the causes leading to restricted venous outflow from the brain. — met Matthias Rennebaum en 23 anderen.