CCSVI means chronic cerebro-spinal venous insufficiency, this being a venous pathology that has only recently been described and is still a cause of active scientific debate.
During the Union Internationale de Phlebologie Congress (Monte Carlo 2009) CCSVI was officially classified as belonging to the venous malformations group. The symptomatology and treatment of CCSVI were described. The CCSVI syndrome consists of venous anomalies, mostly localized within the internal jugular vein (vena jugularis interna) and azygos vein (vena azygos), and is characterized by narrowing, occlusion, venous valve dysfunction, and reverse blood flow (venous reflux) connected to it. These changes are often observed in patients with multiple sclerosis.
Connection between CCSVI and multiple sclerosis
According to the available medical data, more than 80% of patients with the RR (relapsing-remitting) type of MS, more than 90% of patients with the SP (secondary progressive) type and 90% of patients with the PP (primary progressive) type fulfil the criteria for CCSVI (Zamboni et al.).
The existence of cerebral venous circulation pathology was first observed in the 19th century (Rindfleish E. 1863). Venous pathology in MS patients was also noticed in the 1980s (Schelling F. 1986).
Many reports indicate the possible existence of a connection between neurological pathology (as in MS) and cerebral venous outflow. That subject is still open and has given rise to many controversies, especially the theory of venous pathology being a primary pathomechanism of autoimmune processes, and venous pathology treatment leading to the removal or amelioration of MS symptoms. Further, long-term clinical trials are required to reach straightforward and verified conclusions.
At present, due to the lack of results of scientific research conducted within the framework of clinical programmes, a connection between CCSVI and MS cannot be confirmed indubitably. Attempts at intravenous CCSVI treatment, focused on removal of vascular anomalies, are conducted at numerous medical centres. Those procedures are not considered to be an MS treatment method; however, early results indicate a substantial improvement in the neurological state of patients with MS, leading to sphincter control regulation and subsidence of headaches, balance disorders and chronic fatigue. Research results from different medical centres across the world, presented during the CCSVI Workshop on Multiple Sclerosis (Canada, 2010), bring an optimistic perspective to the “relevance” of such treatment.
Diagnostics
CCSVI is diagnosed using Doppler ultrasound of the venous system and magnetic resonance venography (MRV) procedures. Such diagnostics require the application of special research protocols and high quality equipment that enables the imaging of veins in the characteristic CCSVI region. Ultrasound and MRV results are the basis of CCSVI diagnosis, depiction of vein conditions and the possibility of intravenous treatment.
Treatment
The procedure for venous system correction is preceded by phlebography performed using special Roentgen equipment that enables detailed analysis of the venous system and the choice of the most appropriate treatment method. The procedure is performed by vein puncture in the groin, with locally administered anaesthetic, and does not require general anaesthetic. The procedure is performed under X-ray control. The vein anatomy and function are assessed during the procedure by contrast fluid administered via an intravenous catheter. During contrast fluid administration, vein narrowing can be observed on a monitor. Jugular vein narrowing that causes blood flow disturbances may be widened by special balloons, which, while being pumped, remove the narrowing.
Patients must stay under close medical supervision for at least six hours after the procedure.
A patient’s general health improvement depends on existing nervous system damage. When deciding whether to diagnose and treat CCSVI it should be remembered that endovascular treatment, as with every surgical procedure, brings with it the risk of complications.
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