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Rivista sulle Malattie delle Vene e dei Linfatici
Acta Phlebologica 2016 Aprile;17(1):27-32
Chronic cerebrovascular vein insufficiency: how and when jugular vein PTA can influence multiple sclerosis symptoms
Pietro M. BAVERA 1, 2
1 S. Maria Nascente Institute for Scientific Research, Don Carlo Gnocchi Foundation, Milan, Italy; 2 Medick-Up Vascular Lab, Milan, Italy
BACKGROUND: In the past five years, a series of papers have followed and investigated the possible link between chronic cerebrovascular vein insufficiency (CCSVI) and multiple sclerosis (MS). Most of these papers regarded the theory, the pathology, mechanisms and a series of anatomical dysfunctions related to brain venous outflow. It now appears that a straight correlation between a poor cerebral vein outflow and prevalently nervous symptoms is possible.
METHODS: This paper analyses and classifies the symptoms collected from 366 MS patients who initially had a CCSVI Duplex diagnosis and then autonomously decided to be treated by means of vein percutaneous transluminal angioplasty (PTA) of internal jugular veins. The symptom classification used was built on the subjects’ spontaneous descriptions and then regularly monitored for 48 months after treatment. The symptoms were: diplopia, fatigue, headache, upper limb numbness/mobility, lower limb numbness/mobility, thermic sensibility, bladder control, balance coordination, quality of sleep, vertigo, mind concentration. Frequency, severity and follow-up were not so much considered if compared with the more common Expanded Disability Status Scale.
RESULTS: On the whole, the “relapse-remitting” (RR) patients, 179 females (67.8%) and 85 (32.2%) males, were the most important observed group with significant results in all the considered disturbs. Symptom results in the “secondary-progressive” (SP) — 37 (59.7%) females and 25 (40.3%) males — and “primary-progressive” (PP) patients — 22 (55%) females and 18 (45%) males — were also important, but showed lower significance.
CONCLUSIONS: The excellent and durable results obtained in RR patients seem to suggest that venous Duplex exams and eventual outflow improvement should be considered as possible. Duplex training curve periods are recommended. Based on this experience, it appears that CCSVI Duplex evaluation could be fruitfully employed in all early situations of progressive neurologic diseases, and not only in MS.