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CCSVI  for multiple sclerosis patients in Egypt

MS Surgery - What is CCSVI?

CCSVI- Chronic Cerebrospinal Venous Insufficiency The medical discipline was mentioned by Dr P. Zamboni. A precondition where deoxygenated blood stream from the venous blood vessels smothering the spine and brain is decelerated or choked in its return to the heart. This sinister condition originates from an obstruction in the internal jugular and/or azygos veins. The Cerebrospinal arrangement is the brain and spine. (Chronic venous insufficiency or CVI is a medical term pertaining to obstruction in return of blood from the legs to the heart.) The extra-cranial venous escape roads in clinically defined multiple sclerosis (CDMS) had not previously been investigated.



CCSVI was first found using specialized extracranial and transcranial doppler sonography. Five ultrasound criteria of venous drainage have been proposed to be characteristic of the syndrome, although having two of them is enough for diagnosis of CCSVI:
reflux in the internal jugular and vertebral veins,
reflux in the deep cerebral veins,
high-resolution B-mode ultrasound evidence of stenosis of the internal jugular vein,
absence of flow in the internal jugular or vertebral veins on Doppler ultrasound, and
reverted postural control of the main cerebral venous outflow pathways.
It is still not clear whether magnetic resonance venography, venous angiography, or Doppler sonography should be considered as the gold standard for the diagnosis of CCSVI. Use of magnetic resonance venography for the diagnosis of CCSVI in MS patients has been proposed by some to have limited value, and to be used only in combination with other techniquesOthers have stated that magnetic resonance venography has advantages over doppler since results are more operator-independent.


Balloon angioplasty and stenting have been proposed as a treatment option for CCSVI in MS. As a form of treatment, outside the trial setting, these procedures are not currently recommended.The proposed treatment has been termed "liberation procedure". Such name election has been criticized for suggesting unrealistic results.

Angioplasty in a preliminary study by Zamboni improved symptoms in MS. High re-stenosing rates led authors of Zamboni's pilot study to propose that the use of stents might be a better treatment than balloons angioplasty, while later they stated that stents should not be used.

Further trials however are required to determine if the benefits, if any, of the procedure outweigh its risks. The neurological community and many MS organizations such as the National Multiple Sclerosis Society of the USA recommend not to use the proposed treatment until its effectiveness is confirmed by controlled studies, The Society of Interventional Radiology in USA and Canada considers that published literature on the effectiveness of CCSVI intervention is inconclusive and support decisions made by patients, families and physicians to perform angioplasty in such cases.The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) position is that procedures for CCSVI should not be offered outside well designed clinical trials as harm could be caused.

Kuwait has become the first country in the world where it is explicitly allowed by the medical authorities and paid by the state health system. The procedure is being performed privately in 40 countries.It is not available in Canada as of September 2010.


While the procedure has been reported to be in general safe for MS patients,.severe complications related to the angioplasty and stenting include intracranial hemorrhage, stent migration into the heart and jugular vein thrombosis. Two cases with severe adverse events have been reported in the scientific literature; a death due to a cerebral hemorrhage while on anticoagulant following a stent insertion, and a migration of a stent to the heart's ventricle.Some United States hospitals have banned the surgical procedure outside of clinical trials until more evidence to support its use is available.



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