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:
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