A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency Paolo Zamboni, MD, Roberto Galeotti, MD, Erica.

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Presentation transcript:

A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency Paolo Zamboni, MD, Roberto Galeotti, MD, Erica Menegatti, RVT, Anna Maria Malagoni, MD, Sergio Gianesini, MD, Ilaria Bartolomei, MD, Francesco Mascoli, MD, Fabrizio Salvi, MD Journal of Vascular Surgery Volume 50, Issue 6, Pages 1348-1358.e3 (December 2009) DOI: 10.1016/j.jvs.2009.07.096 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 6 Venous pressure decreased significantly postoperatively. Values are expressed as mean and standard deviation (error bars). ***P < .001. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 7 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. Journal of Vascular Surgery 2009 50, 1348-1358.e3DOI: (10.1016/j.jvs.2009.07.096) Copyright © 2009 Society for Vascular Surgery Terms and Conditions