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Preliminary results of preoperative diagnostics and endovascular treatment for CCSVI

Marian Simka EuroMedic Vascular and Endovascular Surgery Department Katowice Poland

  • Testing for CCSVI with color Doppler sonography since May 2009
  • Testing for CCSVI with MRV since October 2009
  • Endovascular procedures for CCSVI since October 2009 EuroMedic Katowice Poland

color Doppler sonography

  • about 250 MS patients examined
  • venous abnormalities found in ~95%
  • most common finding: pathologic valves or membranes in the internal jugular veins (IJV)
  • majority of stenoses in the middle part of IJV seemed to be secondary to pathologic valves or to result from external compression

MR venography

  • about 100 MS patients examined
  • most common finding: a)stenoses in middle and upper part of IJV b)signs of impaired outflow on time-of-flight imaging
  • pathologic valves and membranes could be visualized only in few patients

Endovascular treatment

  • 90patients operated on
  • Intraoperativevenography as the key test for decision making
  • Preoperative Dopplerand MRVas a help to evaluate venous anatomy and to reveal where the problem might be situated
  • Stentingonly if absolutely needed(ballooningunsuccessful) and if safe(not for areas with changeable diameter during Valsalva)

Endovascular treatment procedures for IJV

  • No obvious pathology found 3 patients (3%)
  • Only balloon angioplasty 57 patients (63%) (31 patients: one IJV; 26 patients: both IJVs)
  • Only stenting 19 patients (21%) (18 patients: one IJV; 1 patient: both IJVs)
  • Stenting in one IJV and balloon angioplasty of the other vein 12 patients (13%)

Endovascular treatment additional procedures

  • Stenting or angioplasty of azygous vein 6 patient (7%)
  • Balloon angioplasty of brachiocephalic vein 2 patients (2%)
  • Redo surgeries 3 patients

Endovascular treatment complications

  • 1 minor bleeding from puncture in the goin, 2 days postop
  • 1 gastrointestinal bleeding a week postop (clopidogrel?)
  • transient headaches following procedure in some patients
  • No major pain
  • No injury to the nerves
  • No problems related to stents

Endovascular treatment failures of the treatment

  • Unsuccessful stenting for hypoplastic upper IJV -1 patient
  • Unsuccessful balloon angioplasty for stenosis in the middle part of IJV (probably due to external compression) 3 patients
  • Minor success of balloon angioplasty for membranes in the brachiocephalic veins -2 patients

RESULTS some preliminary impressions

  • Follow-ups available only for some patients; however , most of patients reported improvements
  • In general: the less disabled patients was, the bigger improvementNo improvement or recurrence of symptoms may indicate restenosis

Some interesting findings

  • Within one hour postop patients' hands became warm (if cold before treatment) and faces pink (if pale before)
  • Bladder control improved within one day postop
  • It is difficult to explain these findings in terms of improved nerve function; rather -it is more likely that a blood-released neurotransmitter may play a role (angiotensin ??)

Bron: PDF document