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    You are here : Home » About MS » Causes of MS » Chronic Cerebrospinal Venous Insufficiency - CCSVI » CCSVI General Information

    CCSVI General Information

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    The Role Of MR Imaging In The Diagnosis Of CCSVI And In Pre-Treatment Planning And Monitoring Patient Outcomes

    E. Mark Haacke, PhD
    The MRI Institute for Biomedical Research
    Detroit, Michigan 48202

    Wayne State University
    Detroit, Michigan 48201

    Consensus document of the International Union of Phlebology
    CCSVI VenogramDiagnosis and treatment of venous malformations



    ...CVMs [congenital vascular malformations] are “self-perpetuating”embryologic tissue remnants. Precise understandingof this critical fact is required for successfulCVM management and treatment.

    CVM remains a difficult diagnostic and therapeuticchallenge among many vascular disordersdue to the wide range of the clinical presentations,unpredictable clinical course, erratic response tothe treatment with high recurrence/persistence rates,high morbidity following unspecific conventional treatment, and confusing terminology.

    CVM is, therefore, considered a unique vasculardisorder that carries a stigma of totally unpredictable behavior. “Recurrence and persistence”is the trademark of all the CVMs. High recurrence rates are generally due to the embryological characteristicsof the CVMs, which arise from embryonic tissue remnants derived from an earlier stageof embryogenesis. These lesions are now classified as “extratruncular” lesions by the Hamburg Classification.

    VM is the most common form among various CVMs. Most VMs exist alone as an independent lesion.

    ...Truncular VM lesions may also occur in veins with the same embryologic origin or draining the same territory (e.g., stenosing lesions of the extracranial jugular veins, superior vena cava, and azygos vein system along the main outflow pathways of the cerebro-spinal venous system as suspected cause of multiple sclerosis).

    Treatment of venous malformations

    Multidisciplinary team approach
     Surgical excision alone based on limited knowledge of the natural history and biology of the VM through earlier decades infrequently resulted in poor outcomes. These poor outcomes contributed to the confusion associated with the management of CVMs leading to mistaken prejudice.
    But lately new endovascular therapies utilizing various forms of embolo/sclerotherapy were developed
    in order to improve the clinical outcome of extratruncular VM lesions. For truncular VM
    lesions, endovascular balloon dilatation and stenting techniques were also found to be beneficial in
    correcting the stenosing condition.

    The new multidisciplinary team approach aims for full integration of surgical, non-surgical and endovascular treatment options. This team concept is extended not only useful for diagnosis but is also essential for “combined” treatment using two or more different techniques. Surgical resection is typically combined with embolization. Furthermore, surgical resection may often require a vascular surgeon, a hand and/or plastic surgeon, or other specialists.

    The multidisciplinary team often includes medical and allied health teams: Vascular Surgery, Pediatric Surgery, Plastic and Reconstructive Surgery, Orthopedic Surgery, Neurosurgery, Anesthesiology, Pathology, Physical Medicine and Rehabilitation, Oral-Maxillofacial Surgery, Head and Neck Surgery, Cardiovascular Medicine, Psychiatry, Dermatology, Interventional Radiology, Diagnostic Radiology, Nuclear Medicine, General Medicine, Neurology, Hematology, Genetics, General pediatrics, Occupational therapy, and many other health care practitioners.

    The multidisciplinary team approach is also mandatory for proper selection/combination of the treatment modalities. All the decision related to the management should be based on the consensus among this multidisciplinary team approach as well as life-time follow up on the natural course and treatment outcomes.

    General principle

    Not every VM lesion is amenable to treatment.

    Furthermore, not every VM lesion should be treated. Its mere presence often makes the practitioner feel obligated to treat. The only lesion assessed by the multidisciplinary team with justified indications should be considered for treatment. Although extratruncular VM lesions are more serious than truncular lesions with much poorer long-term outcome, an overzealous approach sometimes does more harm than good.

    “Not to intervene” is sometimes a wiser choice than to casually intervene without a full understanding of the biology and natural history of the VM lesion. Sometimes observation is the best approach. Another approach is to find an experienced center where the patient can be treated effectively in early childhood and not having to wait until after reaching adolescence.

    A “controlled” aggressive approach is favored where every effort is made to minimize collateral damage during treatment. In limb and life threatening situations, sacrificing limb over life may be necessary.
    The decision to initiate treatment should be based on the accepted indications.

    Full Document -

    Interview with Professor. Dr. Zamboni

    Interview with Professor. Dr. Zamboni.

    Interview with prof. Dr. Zamboni at the XXIV Annual Meeting of the European Society for Vascular Surgery, Amsterdam, September the 18th 2010. Prof. Dr. Zamboni spoke about CCSVI for an international audience of vascular surgeons (2 parts).

    Part 1

    Part 2


    Dr Salvatore Sclafani: Liberation

    Dr Sclafani discusses the Liberation Procedure, and some of his experience in treating patients.

    SUNY Downstate Symposium on CCSVI, July 26 2010.

    Dr Andrews' lecture on CCSVI and MS

    This is a 29 minute lecture that reviews MS, CCSVI, and the literature that supports the CCSVI concept.. This may be a good reference for doctors who have no background with CCSVI at all.

    Part 1 (here he details the effects of treating CCSVI):

    Part 2 (here he details on what causes MS and CCSVI):

    MS Society Canada - CCSVI and Multiple Sclerosis Information Videos

    On Wednesday April 7, 2010, the Multiple Sclerosis Society of Canada hosted an information session discussing the link between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS).

    The event was moderated by 680News morning anchor, Marlane Oliver.

    Speakers include:

    Yves Savoie
    President and Chief Executive Officer
    President, Ontario Division
    Multiple Sclerosis Society of Canada

    Dr. Jock Murray
    Founding Director, Dalhousie MS Clinic

    Karen Torrie-Racine
    Board member, Ontario Division
    Volunteer, Cornwall and District Chapter
    Living with multiple sclerosis

    Session 1

    Session 2

    Session 3

    Session 4

    Session 5

    Session 6

    Session 7

    Session 8

    Session 9

    Session 10

    Session 11

    Session 12

    Session 13

    Session 14

    A live Web forum on CCSVI and what it could mean to people living with MS

    AAN LogoOn 14th April the American Academy of Neurology, in partnership with the US National Multiple Sclerosis Society hosted a live web forum with regards to CCSVI and Multiple Sclerosis.

    Those taking part included: 

    Dr. Paolo Zamboni, Director, Vascular Diseases Center, University of Ferrara, Italy
    Dr. Robert Zivadinov, Associate Professor of Neurology, University of Buffalo, State University of NY
    Dr. Andrew Common, Radiologist in Chief, St. Michaels Hospital, University of Toronto, Ontario, CA
    Dr. Aaron Miller, Professor of Neurology & Director of the MS Center at Mount Sinai, NY, member of the AAN Board of Directors, Chief Medical Officer of the National MS Society

    You can watch the whole meeting here. (15/04/10)

    A Brief History of the Early Venous Vascular Observations in Multiple Sclerosis (MS)

    CCSVI VenogramAccording to Putnam (1) who discussed vascular abnormalities in MS in 1936, the first observations related to abnormal vasculature or effects related to the vasculature appeared in Cruveilhier (2) in 1839, more than 170 years ago who compared areas of sclerosis with the results of embolism. Rindfleisch (3) noted in 1863 an engorged vessel in the center of a plaque and in the same year Charcot (4) described vascular obstruction in MS. These observations would be noted again and again over the next 135 years.

    What was missing was the advent of imaging as a tool to investigate the vascular system in three dimensions, something that ultrasound takes a step toward as used by Zamboni and more recently the use of magnetic resonance imaging in the study of cerebro-spinal vascular insufficiency or CCSVI....................

    History Of Ms -

    CCSVI and Multiple Sclerosis Workshop St Joseph’s Healthcare Hamilton Sunday, February 7, 2010


    CCSVI and MRI Outcomes in MS Robert Zivandinov MD PhD

    CCSVI and MRI Outcomes in MS  Robert Zivandinov MD PhD

    Dutch TV CCSVI Story (English Subtitles)

    Dr. Zamboni interview - Canada AM - CTV News 08/02/10
    Dr. Zamboni interview - Canada AM - CTV News.

    New information from Dr. Mark Haacke
    While most of the MS world sleeps, Dr. Haacke has been busy establishing studies and scanning protocols.

    Here is his latest CCSVI scanning protocol. Please print this out for your doctors before you get scans, especially if they are using MRV (magnetic resonance venography) technology without doppler ultrasound. It is essential that the MRVs be done correctly:

    Here is a radio interview with Dr. Haacke regarding trials and research.

    Source: CCSVI in Multiple Sclerosis Facebook Page.

    Dr. Zamboni's CCSVI Doppler Demonstration

    Is the basic etiology of multiple sclerosis vascular in origin?

    Imaging Iron in MS using SusceptibilityWeighted Imaging (SWI):
    “Is the basic etiology of multiple sclerosis vascular in origin?”

    E. Mark Haacke, Wayne State University

    Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS) by Dr Jack Burks, MD
    You may be confused by all the recent talk and articles on the internet, and by statements by various National MS Charities, their "medical advisors" etc. around the world, and feel you do not know who, or what to believe.

    Dr Jack Burks, MD, the Multiple Sclerosis Association of America's Chief Medical Officer has written a concise, and very balanced article on "Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS)" which I think you will find will clarify a lot about the new theory and the treatment stemming from it.

     Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS)

    CCSVI, Ultrasound/MRI FAQs from Dr Haacke's website
    Some CCSVI,Ultrasound/MRI FAQs from Dr Haacke's website with regards to CCSVI and the MRI Protocols....

    CCSVI - Liberation Treatment - CTV News Presentations

    A CTV News programme explaining the theory behind 'The Liberation Treatment' and how Dr. Paolo Zamboni discovered CCSVI:

    Part 1  and Part 2

    © Multiple Sclerosis Resource Centre

    Related Items
    CCSVI - The Way Forward, Glasgow, UK October 2010
    CCSVI General News
    CCSVI Glossary
    CCSVI Organisations and Groups
    CCSVI Standard Letter To MPs
    CCSVI Treatment - Patient Comments
    Quotes on CCSVI
    The venous connection to MS- a timeline

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