Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.

Hdl Handle:
http://hdl.handle.net/10147/229145
Title:
Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.
Authors:
Reekers, J A; Lee, M J; Belli, A M; Barkhof, F
Affiliation:
Department of Radiology, AMC, University of Amsterdam, Amsterdam, The Netherlands. j.a.reekers@amc.uva.nl
Citation:
Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency. 2011, 34 (1):1-2 Cardiovasc Intervent Radiol
Journal:
Cardiovascular and interventional radiology
Issue Date:
Feb-2011
URI:
http://hdl.handle.net/10147/229145
DOI:
10.1007/s00270-010-0050-5
PubMed ID:
21136256
Additional Links:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816826/pdf/270_2010_Article_50.pdf
Abstract:
Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1]. The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the "venous hemodynamic insufficiency severity score" (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits [2]. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called "liberation treatment," and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists, who are directly approached by MS patients, contact the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no trial data are available, and there is currently no randomized controlled trial (RCT) in progress Therefore, the basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet. CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.
Item Type:
Article
Language:
en
MeSH:
Azygos Vein; Balloon Dilation; Central Nervous System Diseases; Cerebrovascular Circulation; Chronic Disease; Constriction, Pathologic; Humans; Iron; Jugular Veins; Multiple Sclerosis; Radiography, Interventional; Societies, Medical; Vascular Malformations; Venous Insufficiency
ISSN:
1432-086X

Full metadata record

DC FieldValue Language
dc.contributor.authorReekers, J Aen_GB
dc.contributor.authorLee, M Jen_GB
dc.contributor.authorBelli, A Men_GB
dc.contributor.authorBarkhof, Fen_GB
dc.date.accessioned2012-06-15T13:52:27Z-
dc.date.available2012-06-15T13:52:27Z-
dc.date.issued2011-02-
dc.identifier.citationCardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency. 2011, 34 (1):1-2 Cardiovasc Intervent Radiolen_GB
dc.identifier.issn1432-086X-
dc.identifier.pmid21136256-
dc.identifier.doi10.1007/s00270-010-0050-5-
dc.identifier.urihttp://hdl.handle.net/10147/229145-
dc.description.abstractChronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1]. The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the "venous hemodynamic insufficiency severity score" (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits [2]. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called "liberation treatment," and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists, who are directly approached by MS patients, contact the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no trial data are available, and there is currently no randomized controlled trial (RCT) in progress Therefore, the basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet. CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.en_GB
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816826/pdf/270_2010_Article_50.pdfen_GB
dc.rightsArchived with thanks to Cardiovascular and interventional radiologyen_GB
dc.subject.meshAzygos Vein-
dc.subject.meshBalloon Dilation-
dc.subject.meshCentral Nervous System Diseases-
dc.subject.meshCerebrovascular Circulation-
dc.subject.meshChronic Disease-
dc.subject.meshConstriction, Pathologic-
dc.subject.meshHumans-
dc.subject.meshIron-
dc.subject.meshJugular Veins-
dc.subject.meshMultiple Sclerosis-
dc.subject.meshRadiography, Interventional-
dc.subject.meshSocieties, Medical-
dc.subject.meshVascular Malformations-
dc.subject.meshVenous Insufficiency-
dc.titleCardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.en_GB
dc.typeArticleen
dc.contributor.departmentDepartment of Radiology, AMC, University of Amsterdam, Amsterdam, The Netherlands. j.a.reekers@amc.uva.nlen_GB
dc.identifier.journalCardiovascular and interventional radiologyen_GB
dc.description.provinceLeinsteren
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