Could autoimmune disease actually be disease of chronic venous congestion?  The immune system goes where blood goes....

From the introductory speech by Elliot M. Frohman, MD, September 2009,

The First CCSVI conference in Bologna, Italy

In the three yearss since Dr. Frohman, a neurologist and guest moderator at Dr. Zamboni's first conference, made that off-hand comment (which I quickly wrote down, astounded)--New technology, including color doppler scanning--has allowed researchers to see how slowed blood flow relates to inflammation. 

This means that there are new treatments available to help relieve symptoms.  Reducing venous congestion and aiding normalized blood flow reduces inflammation in "autoimmune" disease.  Venous congestion may well be part of the pathogenesis of these diseases.  

New research is giving us a better picture of what happens to the opthalmic vein in Graves Disease.  Graves Disease is a disease of the thyroid gland, which causes it to create too much thyroid hormone and increases inflammation and swelling in many areas of the body, including the eyes.  The cause of Graves is unknown---the labeling of this disease as autoimmune is based in theory.  

Dr. Zamboni believes that autoimmune thyroid disease might be related to increased collateral flow through the thyroid veins, caused by CCSVI.  The thyroid veins become activated as part of the collateral circle of drainage when there is chronic obstruction of the internal jugular veins in CCSVI.  And this may impact the thyroid gland and activate the immune reaction and inflammation.   But there is more research needed.  As in other situations, like CCSVI, our understanding of the impact of the veins is woefully incomplete.

CCSVI and Collateral Circulation  

Although the connection to thyroid disease is still a hypothesis, we are learning that the opthamalic vein is related to Graves Disease.

Color Doppler imaging of the superior ophthalmic vein in patients with Graves' orbitopathy before and after treatment of congestive disease

Superior ophthalmic vein flow was significantly reduced in the orbits affected with congestive Graves' orbitopathy and returned to normal following treatment. Congestion appears to be a contributing pathogenic factor in the active inflammatory stage of Graves' orbitopathy.

Treatment of GO in the acute stage is traditionally immunosuppressive (using corticosteroids or immunosuppressants), but congestive signs sometimes remain despite adequate treatment and may require orbital decompression. Persistently reduced or reversed SOV blood flow despite adequate treatment may be an indication for decompressive surgery in select patients. The current data appear to confirm this assumption, as most of our patients were in fact treated with orbital decompression.

link

Intraocular pressure and superior ophthalmic vein blood flow velocity in Graves' orbitopathy: relation with the clinical features 

Ocular pressure and superior ophthalmic vein blood flow velocity have significant association with the clinical features of Graves' orbitopathy. The decrease in SOV–BFV increases the severity of Graves' orbitopathy, and may have a role in the clinical course of dysthyroid optic neuropathy.

link  

Color Doppler imaging of the superior ophthalmic vein in different clinical forms of Graves’ orbitopathy

SOV congestion may be a contributing pathogenic factor in both congestive and fibrotic myogenic Graves’ orbitopathy.

link

If relieving venous congestion helps the vision of those with Graves Disease by preventing optic neuropathy---does it matter really which comes first--the immune process or venous congestion?  Do the people with Graves Disease need to know?  Opening veins and restoring blood flow helps people by reducing inflammation.  It works in the liver, the legs, the eyes, and the brain.

The opthalmic vein decompression treatment for Graves Disease was not randomized.  It was a surgical procedure given to only those with venous congestion, who still had slowed flow even after immune modulating or steroid treatment.   And these treating doctors didn't care which came first--the immune reaction of the venous congestion--they just know that normalizing blood flow heals tissue, and saves vision.

Joan