New, Independent research from Serbia

September 12, 2011 at 9:10am

A new paper was recently published in Phlebology, Sept. 2011 issue.

Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis

D Radak, J Kolar, S Tanaskovic, D Sagic, Z Antonic, A Mitrasinovic, S Babic, D Nenezic and N Ilijevski Vascular Surgery Clinic, Dedinje Cardiovascular Institute, School of Medicine, Belgrade University, Heroja Milana Tepic ́a 1 Street, Belgrade, Serbia

(This study was not conducted by neurologists, nor was it funded with pharmaceutical monies.  These are vascular doctors --This study was partly funded by the Serbian Ministry of Science and Techonological Development – Project No. 41002.)

I have the full paper, and will break down what the researchers discovered.  

First, it is important to note that they only looked at the jugular veins with doppler.  No transcranial doppler, per the Zamboni criteria, and no venography or azygous.  These researchers wanted to see if they could find "morphological and haemodynamic abnormalities" in the jugular veins.  This means they were looking for physical irregularities and flow distubances in pwMS.  Not completely CCSVI, per Dr. Zamboni's definition.

The limitation of our study is that we did not examine the CCSVI prevalence in patients with MS because we did not investigate the intracranial and vertebral veins. The aim of our study was to evaluate morphological and haemodynamic IJV abnormalities in patients with MS and compare it with healthy controls. For morphological and haemodynamic abnormalities assessment of the IJVs, we used some of Zamboni’s criteria and two other parameters (parameters 1 and 2), which in our practice proved to be a good indicator of IJV flow disorder.

--What they were surprised to discover was that the IJV flow was very different in pwMS, and that they could pick this up with doppler ultrasound.

All these might result in IJV haemodynamics changes that could be assessed by non-invasive and cost-effective colour duplex sonography.6 The main finding of this study was to demonstrate a significantly higher prevalence of morphological and Doppler haemodynamics abnormalities in patients with MS in relation to healthy subjects.

Our study showed that 42% of the patients with MS had Doppler haemodynamic evidence of venous flow abnormalities as compared with 8.1% of the healthy controls. These data not only indicate that venous flow abnormalities were significantly associated with the presence of MS but also indicate that it can be seen in the population not suffering from MS, yet the difference remains statistically significant (P , 0.001).

--Also interesting was that they found faulty valves and stenosing lesions in some of the normal controls, but these irregularities didn't affect the blood flow as much as they did in pwMS.

Phlebology

June 26, 2011 at 3:08pm

Let's face it.  Phlebology, the diagnosis and treatment of venous disease, is just not as appealing as Neurology.  The word phlebology is hard to spell, hard to pronounce.  Reminiscent of phelgm, phlegmatic, other unsexy words that start with phl. 

The root of this word, phleb, is from the Latin fluere, meaning "to flow"

Truth is, phlebology is turning out to be a very, very important medical practice.  Veins, once thought to be uninvolved in disease, are turning out to be equally important as their brother arteries.  Maybe more so.

Veins take deoxygenated blood back to the heart.  If they are blocked, blood flow and hemodynamics are altered.  The influx of blood from the heart via the arteries is changed.   In the liver, in the kidneys, in the brain.  Any organ can be affected.  We think of varicose veins when we hear venous disease...again,  not sexy.  But veins run throughout the body, and if they are malformed, it can ruin our organs.

I got to meet and listen to a premiere phlebologist in Bologna in 2009.  Dr. Byung B. Lee was at the first symposium organized by Dr. Zamboni.  Dr. Lee talked about his introduction to venous disease as a liver transplant surgeon.    

Here are my notes from the conference.  Dr. Lee on venous malformations, in his own words.

Byung B. Lee- Georgetown University School of Medicine, Washington-Embryology of the venous system and origin of truncular venous malformations

Dr. Lee began as a transplant surgeon and admitted that his first liver transplant was a disaster. He learned the hard way that the vena cava is not just a single trunk, and a venous malformation was a most fearful thing, and a nightmare to a transplant surgeon. 

"We doctors have a tendency to specialize in our narrow fields, but I want to appeal to all of us to take a bird’s eye view. We need to look at the whole picture. We now understand the lower venous system, but it has taken us much too long to bring this knowledge all the way up to the neck and all the way to the junction of the superior vena cava.