Dr. Bernhard Juurlink, Dr. Ashton Embry, and Dr. Pietro Bavera collaborated to respond to UBC‘s study of venous angioplasty. Unfortunately, their full review exceeded the length available to be published. See their full commentary beginning in the paragraph below. Their abbreviated published commentary can be found online through the link

What Drs. Juurlink, Embry and Bavera wanted to publish:

The objective of venoplasty is to improve venous return from the brain and spinal cord; hence, it was surprising that no data were presented in the recent Traboulsee et al paper1examining the safety and efficacy of venoplasty in multiple sclerosis (MS) patients. In this trial ultrasonography was performed at 24 and 48 weeks. It should be noted that in the clinical venoplasty trial reported by Zamboni et al2only 54% of the venoplasty patients had improved venous blood flow. One might expect that only a subset of the venoplasty group in the Traboulsee et al1clinical trial had improved blood flow. Examining the ultrasonography data would not only be informative of this but may allow better interpretation of the data collected.

We note in the clinical trial by Zamboni et al2the initial examination of the data showed that there were no significant differences between the venoplasty and sham-treated groups with respect to the development of new MRI-detectable lesions. However, when the venoplasty group was divided into those with improved blood flow and those with no improved blood flow, the data showed that there were significantly fewer new lesions (P < 0.07 at 6 months and P < 0.05 at 12 months) in the venoplasty subgroup with improved venous blood flow compared to the venoplasty subgroup without improved venous blood flow3.

We note upon examining Figure 2 of the Traboulsee et al1paper the standard deviations of the data for the venoplasty-treated group is about 20% greater than for the sham-treated group. This makes us wonder if the greater variability is due to better outcomes in a small subset of the venoplasty group because of improved blood flow.

Finally, we also note a discrepancy in the reporting of data in the paper. The Results section of the Traboulsee et al1paper states that 21 sham-treated and 18 venoplasty-treated patients had at least one new MRI-detectable lesion. Yet the data presented in Table 3 clearly shows that 19 out of 52 sham-treated patients displayed new lesions while 13 out of 47 venoplasty patients displayed new lesions. Which is correct?


1. Traboulsee AL, Machan L, Girard JM, et al. Safety and efficacy of venoplasty in MS. A randomized, double-blind, sham-controlled, phase II trial. Neurology Sep 2018, 10.1212/WNL.0000000000006423; DOI:10.1212/WNL.0000000000006423
2. Zamboni P, Tesio L, Galimberti S, et al. Efficacy and safety of extracranial vein angioplasty in Multiple Sclerosis. A Randomized Clinical Trial JAMA Neurology 2018;75:35-43
3. Zamboni P, Zivadinov R. Extracranial veins in Multiple Sclerosis. Is there a role for vascular surgery? Eur J Vasc Endosurg Epub July 2018 DOI: 10.1016/j.ejvs.2018.06.028

http://n.neurology.org/content/reader-response-safety-and-efficacy-venoplasty-ms-randomized-double-blind-sham-controlled