Journal of Vascular Surgery
Volume 50, Issue 6 , Pages 1348-1358.e3 , December 2009

A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency

This work was presented at the Thirty-first Charing Cross Symposium, London, United Kingdom, Apr 3-7, 2009.

  • Paolo Zamboni, MD

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • Corresponding Author InformationCorrespondence: Prof Paolo Zamboni, Director, Vascular Diseases Center, University of Ferrara, 44100 Ferrara, Italy
    • ,
  • Roberto Galeotti, MD

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • ,
  • Erica Menegatti, RVT

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • ,
  • Anna Maria Malagoni, MD

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • ,
  • Sergio Gianesini, MD

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • ,
  • Ilaria Bartolomei, MD

      Affiliations

    • Department of Neurology, Bellaria Hospital, Bologna, Italy
    • ,
  • Francesco Mascoli, MD

      Affiliations

    • Vascular Diseases Center, University of Ferrara, Ferrara, Italy
    • ,
  • Fabrizio Salvi, MD

      Affiliations

    • Department of Neurology, Bellaria Hospital, Bologna, Italy

Received 11 June 2009 ,Accepted 23 July 2009.

  • Image Result

    Schematic representation shows the extracranial cerebrospinal venous system, a complex freely communicating network, with the only valve placed in the proximal left (IJVl) or right internal jugular ve

    Schematic representation shows the extracranial cerebrospinal venous system, a complex freely communicating network, with the only valve placed in the proximal left (IJVl) or right internal jugular vein (IJVr). The arrows refer to physiologic flow direction. The percentage rate indicates the location and the prevalence of venous stenoses observed in course of chronic cerebrospinal venous insufficiency. AZY, azygous vein; IVC, inferior vena cava; L REN, left renal vein; LV, lumbar veins; PterPlex, pterygoid plexus, one of the major intra-extracranial venous collateral pathways; SVC, superior vena cava; VPlex, vertebral plexus; VV, vertebral vein.

  • Image Result
    A, Selective venography shows a membranous obstruction of the outlet of the azygous (W AZY) vein into the superior vena cava (SVC). B, In the same patient, the outflow is further hampered by a hypopla

    A, Selective venography shows a membranous obstruction of the outlet of the azygous (W AZY) vein into the superior vena cava (SVC). B, In the same patient, the outflow is further hampered by a hypoplasia below the arch (arrow), with a long reflux extended downward the hemiazygous (E-AZY). C, Endovascular percutaneous transluminal angioplasty. D, Postoperative results show reflux disappearance and restored venous calibre.

  • Image Result
    Selective venography shows (A) a dramatic twisting of the azygous vein just below the arch with reflux toward the spine and (B) endovascular correction by stent insertion and reflux disappearance.

    Selective venography shows (A) a dramatic twisting of the azygous vein just below the arch with reflux toward the spine and (B) endovascular correction by stent insertion and reflux disappearance.

  • Image Result
    A, Selective venography shows a closed annular stenosis of the proximal left internal jugular vein (arrow). B, Percutaneous transluminal angioplasty was performed by road map facility. C, Selective ve

    A, Selective venography shows a closed annular stenosis of the proximal left internal jugular vein (arrow). B, Percutaneous transluminal angioplasty was performed by road map facility. C, Selective venography shows the postoperative result.

  • Image Result
    Selective venograph shows (A) the septum of the right internal jugular vein and (B) the septum of the right internal jugular vein with a significant collateral circle.

    Selective venograph shows (A) the septum of the right internal jugular vein and (B) the septum of the right internal jugular vein with a significant collateral circle.

  • Image Result
    Venous pressure decreased significantly postoperatively. Values are expressed as mean and standard deviation (error bars). ***P < .001.

    Venous pressure decreased significantly postoperatively. Values are expressed as mean and standard deviation (error bars). ***P < .001.

  • Image Result
    Kaplan-Meier estimates show the (Left) cumulative patency rate detected in the internal jugular veins (IJVs) and (Right) at the azygous (AZY) vein at 18 months of follow-up.

    Kaplan-Meier estimates show the (Left) cumulative patency rate detected in the internal jugular veins (IJVs) and (Right) at the azygous (AZY) vein at 18 months of follow-up.

 Competition of interest: none.

 Additional material for this article may be found online at www.jvascsurg.org.

 The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

PII: S0741-5214(09)01568-7

doi: 10.1016/j.jvs.2009.07.096

Journal of Vascular Surgery
Volume 50, Issue 6 , Pages 1348-1358.e3 , December 2009

Article Tools

* Image Usage & Resolution