preliminary results of preoperative diagnostics and ... -ccsvi-1.pdf · color doppler sonography...
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Preliminary results of preoperative diagnostics
and endovascular treatment for CCSVI
Marian Simka
EuroMedic Vascular and Endovascular Surgery Department Katowice
Poland
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• 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
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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
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MR venography
• about 100 MS patients examined• most common finding:
a) stenoses in middle and upper part of IJVb) signs of impaired outflow on time-of-flight imaging
• pathologic valves and membranes could be visualized only in few patients
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signs of impaired outflow on TOF
imaging
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pathologic valves and membranes not always visible (only indirect signs: a collapse of the vein)
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Endovascular treatment
• 90 patients operated on• Intraoperative venography as the key test for
decision making• Preoperative Doppler and MRV – as a help to
evaluate venous anatomy and to reveal where the problem might be situated
• Stenting only if absolutely needed (ballooningunsuccessful) and if safe (not for areas with changeable diameter during Valsalva)
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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%)
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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
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Balloon angioplasty for membrane in brachiocephalic vein
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Stenting for stenosis of the azygous vein
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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
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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
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stenosis in area of the valve
stenosis due to compression from outside
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Stenting for stenosis in the upper IJV
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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 improvement
• No improvement or recurrence of symptoms may indicate restenosis
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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 ??)