The physicians at Synergy Health Concepts prescribe a blood thinner called Pradaxa post CCSVI treatment. One of the…
 
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The physicians at Synergy Health Concepts prescribe a blood thinner called Pradaxa post CCSVI treatment. One of the most important post-procedure issues is preventing relapse of the blockages. There are three types of relapse: elastic recoil of the valve, fibrous re-stenosis, and thrombotic related relapse (clot). It is difficult to prevent the first two relapses, elastic recoil and fibrous re-stenosis; however, thrombotic related relapses (clots), can be significantly decreased through the use of a post-operative anti-coagulation regimen.

Pradaxa is an oral blood thinner that lowers the chance of your body forming blood clots. As with all blood thinners, Pradaxa can have side effects which need to be monitored. Patients can see easy bruising, bleeding from the gums, dark stool (a sign of GI bleeding), or frequent nose bleeds. Although very rare, any blood thinners can increase the change of internal bleeding and/or stroke. True blood thinners are the only effective anti-coagulants post-operatively. Aspirin and Plavix are not effective blood thinners and only help prevent early platelet aggregation, not blood clots.

Synergy chooses Pradaxa for post-operative CCSVI patients for a number of reasons. First, it is one of the few oral anti-coagulants available. Many other blood thinners are available only via injections which makes delivery much more difficult for many patients. Second, Pradaxa does not require monitoring of blood levels. Other oral medications require weekly or monthly blood levels to ensure safe dosages. Finally, the overall safety profile is one of the best on the market. These important medical indications for Pradaxa, coupled with its reasonable cost, make it the ideal choice for CCSVI patients.

Synergy Health Concepts prescribes Pradaxa at various dosages depending on the clinical situation, and the patient’s age. The following are the Synergy guidelines: Pradaxa 150mg, two times a day for 90 days, for patients who do not have a stent placed; 180 days for patients who have a stent placement. The Canadian dose for Pradax (the Canadian equivalent for Pradaxa) is 110mg, which is the recommended dose if you are filling your prescription in Canada prior to or following your CCSVI treatment. For patients who are over 65 years old, the Pradaxa dosage we recommend is 75mg two times a day for 90 days without a stent, and 180 days with a stent placement.

Synergy Health Concepts decided on a three-month dose of Pradaxa based on clinical observations made by our Physicians. A number of post-operative patients, who had completed a 2-week course of Pradaxa, developed a blood clot within the jugular or azygos vein. To minimize the chance of blood clots forming post-operatively, it was decided that a 3-month dose was potentially more beneficial. This 3 month duration for Pradaxa dosing, follows the standard duration of anti-coagulation for treatment of a blood clot. To ensure adequate time for stents to epithelialize within the body, the duration of anti-coagulation in patients with a stent is 6 months.

For US patients, a prescription for your full dose of Pradaxa can be given to you at the time of your visit. Synergy Health Concepts recommends that our CCSVI patients traveling from Canada speak with their primary physician about their willingness to prescribe the Pradaxa prescription for treatment. If you are unable to fill your prescription in Canada, Synergy Health Concepts will assist you in filling your Pradaxa while in Southern California.

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The National CCSVI Society is hosting the world’s first CCSVI Expo. This is a LIVE 36 hour broadcast…
 
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The National CCSVI Society is hosting the world’s first CCSVI Expo. This is a LIVE 36 hour broadcast for the worldwide CCSVI online community. Hundreds of people have already signed up and hundreds, or even thousands, more are expected by the time the broadcast begins! Sign up for audience members is free through http://ccsviexpo.eventbrite.com.

All the Physicians of Synergy Health Concepts will be speaking during the event. Dr. Joseph Hewett will be speaking Sunday November 20th about pre-procedure CCSVI imaging and the relationship of CSF flow to venous outflow. This includes the use of the CCSVI Dr. Mark Haacke MRI/MRV. Dr. Michael Arata will be speaking on Monday November 21st at 9:30am about research and an overview of central venous hypertension. Dr. Todd Harris will follow at 10am with a discussion about current techniques for CCSVI treatment, as well as some new advanced techniques available. Dr. Nina Grewal will be presenting pre-operative and post-operative CCSVI care on Monday November 21st at 11:30am (all times Pacific).

The National CCSVI Society is pleased to announce that Dr. Paulo Zamboni will be speaking live during this event and donating an item for our auction. The ending of the CCSVI Expo coincides with the second anniversary a news story about Dr. Zamboni’s work was aired in Canada.

There is no cost to participate in the Expo, although we do ask that you consider making a donation to the National CCSVI Society to offset costs ( http://ccsviexpo2011.eventbrite.com). A receipt will automatically be emailed to you.

The National CCSVI Society is dedicated to improving the lives of those affected by CCSVI through advocacy, research and education. This event will help show the human side of CCSVI, share new information, build community, and raise awareness.

For more information about how you can get involved in making the Expo a worldwide success, please contact Sandra Birrell – [email protected] – or, for technical questions, contact Landon Schmidt – [email protected]

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The CCSVI procedure consists of examining and treating the left and right jugular veins as well as the azygos vein. These three veins drain the blood from the brain and the spine. During the CCSVI procedure, Synergy Health Concepts images the jugular veins from the level of the intra-cranial sinus down to the central venous system allows complete evaluation of the venous drainage from the brain. This is important for a number of reasons including documenting the location and degree of blockages or stenosis within the veins.

The CCSVI procedure consists of examining and treating the left and right jugular veins as well as the azygos vein. These three veins drain the blood from the brain and the spine. During the CCSVI procedure, Synergy Health Concepts images the jugular veins from the level of the intra-cranial sinus down to the central venous system allows complete evaluation of the venous drainage from the brain. This is important for a number of reasons including documenting the location and degree of blockages or stenosis within the veins.
There are several locations where blockages can be seen within the jugular veins. The most common location is in the valves at the lower portion of the jugular veins (http://www.synergyhealthconcepts.com/wp-content/uploads/2011/03/ccsvi-infographic.jpg). However, there are other areas higher in the jugular veins where stenosis is also seen. In about 10% of patients we find a severe compression of the jugular vein at the level of the skull base. This compression or blockage causes almost complete occlusion of the jugular vein at the craniocervical junction preventing normal blood flow out of the brain. We have seen on MRI/MRV that this compression is caused by the styloid process of the skull and the lateral tubercle of the vertebral body C1. In these patients, during the CCSVI procedure, venogram images demonstrate minimal flow through the internal jugular vein, with the majority of flow through a small network of collateral veins in the upper neck.
Since the majority of patients have blockages at the level of the lower valve in the jugular veins, the CCSVI procedure is focused on opening this area. By tearing this valve, and relieving the blockage at this level, improvement in blood flow through the jugular veins is seen. However, treatment of craniocervical compression of the jugular veins is limited and until now, there has been no treatment available for these patients. Balloon angioplasty in this area is not helpful since the osseous compression causes immediate recoil or re-blockage of the jugular vein. Stents in this area are also not indicated since they would get crushed by the bone and cause worsening of the blood flow.
A recent abstract by Fiorella et al was published in Neurosurgery, Aug 19, 2020 (http://www.ncbi.nlm.nih.gov/pubmed/21866063) which described surgical removal of the styloid process and thus decompression the jugular veins. In their research, two patients had documented increased intracranial venous pressures and evidence of compression of the jugular veins on venogram. Surgical removal of the styloid process resulted in normalization of the intracranial venous pressures, and resolution of the jugular stenosis on followup venogram.
In the 10% of Synergy Health Concepts CCSVI patients seen with severe outflow disease of the jugular veins at the craniocervical junction, this procedure could offer hope. With surgical decompression of the jugular veins, these patients could potentially have some relief of their CCSVI symptoms similar to patients who have disease only within the valves of the lower jugular veins. Until now, there have been no successful treatments for patients with this type of jugular stenosis. Further research will be needed to identify whether CCSVI patients get symptomatic relief after this new procedure.

Todd S. Harris, MD
Synergy Health Concepts

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Most multiple sclerosis (MS) patients have had simple MRIs of their brain that take pictures to look for lesions. This is a very short and simple study that does not give much information, other than the number of lesions, location and whether the number has changed over time. The CCSVI Haacke MRI/MRV is very different than the normal MRI that an MS patient usually receives as a routine examination. It is also different than a standard MRV that simply looks at the veins of the neck. A standard MRVof a patient’s neck will show the anatomy of the veins. Often, this anatomic depiction of the veins is not very detailed. Also, it does not show any dynamic details depicting aspects of the flow within those veins.

Most multiple sclerosis (MS) patients have had simple MRIs of their brain that take pictures to look for lesions. This is a very short and simple study that does not give much information, other than the number of lesions, location and whether the number has changed over time. The CCSVI Haacke MRI/MRV is very different than the normal MRI that an MS patient usually receives as a routine examination. It is also different than a standard MRV that simply looks at the veins of the neck. A standard MRV of a patient’s neck will show the anatomy of the veins. Often, this anatomic depiction of the veins is not very detailed. Also, it does not show any dynamic details depicting aspects of the flow within those veins.
Synergy Health concepts is the first and only practice in the world to incorporate the CCSVI Haacke MRI/MRV as an integral component of the CCSVI evaluation and treatment. This is possible because Synergy Health Concepts is the only facility in the world with physicians that are board certified to read the CCSVI Haacke MRI/MRV and also perform the CCSVI procedure. Synergy Health Concepts has performed more CCSVI Haacke MRI/MRVs than any other institution in the world; this gives us the experience needed to provide the most accurate interpretations that have meaningful impact on treatment.
The CCSVI Haacke MRI/MRV is unlike any other MRI. It includes a standard, but very high resolution, MRI of the brain to look for the multiple sclerosis or white matter plaques in the periventricular region of the patient’s brain. This portion of the MRI is advanced using contrast to look for any enhancement of the lesions, which is thought to denote active inflammation in those lesions. From there, the Haacke MRI becomes very different. The CCSVI Haacke MRI/MRV gives an exquisitely detailed view of the venous and arterial structures in the head, neck and chest. First of all, this is important because it allows us to look for significant anatomic abnormalities that could be associated with CCSVI. It also gives a very detailed 3-Dimensional mapping tool for us to plan the treatment, making it much safer and more effective for the patient.
One of the most notable hallmarks of the CCSVI Haacke MRI/MRVs is the ability to quantify the flow in the jugular veins and the azygos vein. This is important because the quantification of this flow tells us a lot about how the blood is moving in the veins, and by knowing how the blood is moving in the veins, it tells us whether there is a problem with the flow and whether there is a significant issue regarding how that blood is flowing through the vein. We look at different parameters for the flow – how fast the blood is flowing, whether the blood is flowing in the wrong or reverse direction and the quantity of blood that is flowing through the brain. All of these details regarding the flow are combined in great detail and give us a very important picture to the dynamic aspects of the venous system in the head, neck and chest. The CCSVI Haacke MRI/MRV also gives us a definitive yardstick by which to measure the patients blood flow at anytime after the procedure. This gives the treating physician and the patient a very powerful and reassuring tool when assessing the state of the patient’s veins for years to come.

The Haacke MRI is also very useful from the cerebral spinal fluid (CSF) perspective. It is the clear liquid that bathes and cleans our brain and acts as a shock absorber. It filters down from the brain, through the neck and into the spinal cord. There is a growing body of data to suggest that the flow of CSF, in addition to the flow of the venous blood out of the brain, is very significant. The Haacke MRI allows us to measure that flow of CSF to determine if there is a problem. Combining the knowledge of the CSF flow with the knowledge of the venous flow gives us a complete picture of the fluid forces that affect the health of the brain.
The Haacke MRI is also very useful because it quantifies iron in the brain, using very complex algorithms, used in what is called susceptibility-weighted imaging. The Haacke MRI is able to measure the amount of iron in lesions in the brain as well as iron in the deep white matter structures in the brain. The iron is thought to be a surrogate marker for brain injury, the MS plaques and perhaps the progression the disease. By knowing the amount of iron and being able to quantify it in the brain, it may allow us to gauge the effectiveness of the CCSVI treatment in the future. It may also be a useful measure of the effectiveness of other treatments.
At Synergy Health Concepts, we feel that the Haacke MRI may be the most useful and meaningful diagnostic test that all patients with neurodegenerative disease should receive prior to the intervention. There really is no other diagnostic imaging exam that provides the wealth of useful data benefiting the patient at the time of procedure, and also benefits them in their future clinical course. It also benefits research endeavors in a fashion that really cannot be matched by any other diagnostic evaluation.

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Montel Williams took the time to share his private experience with the CCSVI procedure on “The Dr. Oz Show” this week. Montel was treated at a center in California, but is not a patient of Synergy Health Concepts. Many of the topics Montel discussed about his procedure and his results are important points that I feel can help other patients better understand CCSVI.

Montel Williams took the time to share his private experience with the CCSVI procedure on “The Dr. Oz Show” this week. Montel was treated at a center in California, but is not a patient of Synergy Health Concepts. Many of the topics Montel discussed about his procedure and his results are important points that I feel can help other patients better understand CCSVI.

Montel explains that the treatment for CCSVI involves “angioplastying and coming through both jugular veins and the azygos vein.” Other veins throughout the body which are not involved in drainage of blood from the brain or spine are not treated. These three veins are examined from the skull base down to the level of the heart to evaluate for compression or valvular abnormalities. Synergy Health Concepts, as well as several other centers, have found that blockages within the veins are caused by abnormal valves in the lower portion of the jugular veins. The CCSVI treatment is focused on opening these valves and restoring normal blood flow from the brain.

One of the most important topics that we discuss during all of our consultations at Synergy is to help patients differentiate between MS and CCSVI. Centers that have extensive experience with CCSVI procedures like Synergy Health Concepts, report that their patients often see immediate improvements in CCSVI symptoms after the procedure. These CCSVI symptoms include heat intolerance, fatigue, brain fog and cognitive impairment, cold hands and/or feet, morning headaches and poor sleep among others. At Synergy, we do our best to help patients understand that the dense, motor and sensory symptoms of MS are NOT likely to improve from the CCSVI procedure. When describing which symptoms improved, Montel said he had seen “no benefit as far as my gait, no benefits as far as my neuropathic pain.” These symptoms are likely caused by lesions within the brain which the CCSVI procedure does not improve.

Our staff was excited to hear Montel Williams reinforce this important point: “What’s been touted on the Internet is that some sort of Liberation Therapy from MS. I am going to say now, unequivocally, it is not.” He continues to say “What this surgery does is, it is extremely important maybe symptomatically.” This is the same differentiation that we have been making to our patients at Synergy for the past year, as we have learned which symptoms improved and which ones did not as a result of the CCSVI treatment. In our research over the past six months, we have found an almost uniform improvement in CCSVI symptoms, while we have seen only small changes in the motor-sensory symptoms of MS. Synergy is working diligently to publish these results as soon as all the data is analyzed. We are conducting studies to learn more about the CCSVI treatment, and how it can improve the quality of life for those who are affected by CCSVI.

By opening the blockages within the jugular and azygos veins, it is hypothesized that the blood flow through the brain is improved, and that increased venous pressures within the brain are reduced. Montel explains that “because of the blockages I have slowed down reflux in my brain, the blood flow pattern is obstructed.” These changes in blood flow are not going to cure the lesions within the brain causing MS. However, with the decreased intra-cranial venous pressure after the CCSVI procedure, patients with CCSVI symptoms can see immediate improvement. “Immediately, the next day and it’s been there since, it gave me back the ability to be outside in the heat,” Montel said. “This was not a cure of the MS symptom, this is a reduction of the symptom because as the blood flow increases in my brain it increased to my thalamus.”

When Dr. Oz asked Montel, “Put the disappointment about the relief of [pain] symptoms aside, are you glad that you had the procedure done?,” Montel responded “If the doctors told me that I needed to have this procedure done again next month, I’m in.” This sounds like one of the many testimonials that Synergy has received from our patient’s everyday for the past year and a half.

Montel finishes by saying exactly what Synergy feels is the most important point about CCSVI: “I want them to stop saying this is a cure for MS because it’s not. But I want them to start offering the patient, the people, the relief that they need. It’s not going to work for everybody. But this does work and it’s worked for me.”

Todd S. Harris, MD
Synergy Health Concepts
(877) RX-CCSVI
(949) 221-0129
[email protected]
www.synergyhealthconcepts.com

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In addition to being experts in the evaluation and treatment of CCSVI, the physicians at Synergy Health Concepts are experts in all fields of venous disorders, including the common venous abnormality of varicose veins. Many patients ask about the significance of varicose veins during their CCSVI evaluation. Some patients wish to have a basic work up and sometimes treatment for their varicose veins with Synergy Health Concepts while in Southern California. We hope the following information helps patients understand the cause of varicose veins and how they are treated.

In addition to being experts in the evaluation and treatment of CCSVI, the physicians at Synergy Health Concepts are experts in all fields of venous disorders, including the common venous abnormality of varicose veins. Many patients ask about the significance of varicose veins during their CCSVI evaluation. Some patients wish to have a basic work up and sometimes treatment for their varicose veins with Synergy Health Concepts while in Southern California. We hope the following information helps patients understand the cause of varicose veins and how they are treated.

Varicose veins are abnormal veins that cause the skin to bulge. They range from 1/8th inch to 1 inch in diameter and are typically purple or blue in color. When normal valves open and close in our veins, they allow blood to be pumped towards the heart and prevent blood from pooling back down into our legs. When valves are “leaky” they don’t close completely, thus allowing blood to pool back down into the veins of our legs as varicose veins. This is also called valve reflux and leads to chronic venous insufficiency. In addition to causing varicose veins, when valves are “leaky” they can also cause symptoms of heaviness, swelling, burning, itching, and fatigue within our legs. If left untreated, skin color changes and venous ulcerations can occur.

“Leaky” valves can be diagnosed on a venous ultrasound of the leg veins. Ultrasound is a non-invasive test that looks at valve performance within our leg veins. It can see them open and close and can assess whether the valves are leaky.

The treatment can be an out-patient procedure. Radiofrequency and laser ablation are revolutionary techniques being performed to treat varicose veins. Both techniques use heat to cause scarring within the diseased vein, resulting in complete closure of the vein, a relief of symptoms, and cosmetic improvements.

Synergy Health Concepts offers complete work up, diagnosis, and treatment of all venous disorders ranging from CCSVI to varicose veins. Patients wishing to have their varicose veins evaluated during their stay in Southern California with Synergy Health Concepts are encouraged to ask our office for more details.

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Patients traveling to Synergy Health Concepts for CCSVI treatment are required, for their safety, to stay near Costa Mesa, Calif. for 48 hours post treatment. Drs. Arata, Grewal, Harris and Hewett advise patients to rest and relax directly after CCSVI treatment, but may resume normal activities 24 hours post procedure. Patients usually stay for a minimum of five days, though many choose to extend their stay in Orange County, Calif. by one or even two weeks, especially those traveling with their families.

Patients traveling to Synergy Health Concepts for CCSVI treatment are required, for their safety, to stay near Costa Mesa, Calif. for 48 hours post treatment. Drs. Arata, Grewal, Harris and Hewett advise patients to rest and relax directly after CCSVI treatment, but may resume normal activities 24 hours post procedure. Patients usually stay for a minimum of five days, though many choose to extend their stay in Orange County, Calif. by one or even two weeks, especially those traveling with their families. Southern California is a beautiful place to explore with your loved ones. Here are some options that are fun, relaxing and wheelchair accessible (please call each location for details):

Fun Zone Boat Company
Located in Newport Beach, Balboa California. Offering charter boat services, celebrity home and sea lion tours, whale watch cruises, and more!
600 E Edgewater, Newport Beach (949) 673-0240

Lido Theatre
Opened in 1938, the Lido Theatre has become a landmark for independent and foreign films.
3459 Via Lido, Newport Beach (949) 673-8350

Rogers Gardens
Set on seven acres overlooking the Pacific Ocean, this home center is famous for its spectacular gardens, fully stocked nursery and unique gifts.
2301 San Joaquin Hills Road, Corona Del Mar (949) 640-5800

Huntington Beach Wheelchairs
Beach Wheelchairs are equipped with large, wide wheels, which can roll across the sand without sinking.
Huntington City Beach at Dwight’s Beach Concession
201 Pacific Coast Highway, (714) 536-8083

Whale Watching
Whale watching is year round at Dana Wharf as we see the Gray Whale migration November - April!
34675 Golden Lantern, Dana Point (949) 496-5794

At the consultation appointment each patient receives a binder full of information pertaining to their CCSVI treatment, including recommendations by Drs. Bill Code and Teri Jaklin, who agree on the importance of proper nutrition (for complete recommendations, please visit: http://www.synergyhealthconcepts.com/patientdocuments/). It is often difficult to find restaurants and grocery stores that cater to a strict nutrition plan; below are locations near Synergy Health Concepts that offer healthier food choices:

Mother’s Market
Organic, Non-GMO, Vegan, Vegetarian, Gluten-free, low carbohydrate, low-glycemic, low-fat, low-sodium and more.
1890 Newport Blvd, Costa Mesa (949) 631-4741

Yard House
Offers a gluten sensitive menu.
1875 Newport Blvd, Costa Mesa (949) 642-0090

Bear Flag Fish Company
A fish market with a modern ambiance and offers a healthy seafood cuisine.
407 31st Street, Newport Beach (949) 673-3474

118 Degrees
Offers raw, vegan, clean and healthy organic food.
2981 Bristol Street #B5, Costa Mesa (714) 754-0718

As always, please contact Synergy Health Concepts with any questions you have regarding CCSVI treatment.

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The innovative Baylis Medical RF Puncture wire has been used over the past several years to treat heart defects in children and adults as well as chronically blocked arteries in older patients with peripheral vascular disease (PVD).  It has been used sparingly in other applications within the venous system and elsewhere in the body.  However, Synergy Health Concepts has recently started using the Baylis Wire to treat occluded jugular veins and jugular vein stents in CCSVI patients. [...]

The innovative Baylis Medical RF Puncture wire has been used over the past several years to treat heart defects in children and adults as well as chronically blocked arteries in older patients with peripheral vascular disease (PVD).  It has been used sparingly in other applications within the venous system and elsewhere in the body.  However, Synergy Health Concepts has recently started using the Baylis Wire to treat occluded jugular veins and jugular vein stents in CCSVI patients.

We knew that more and more patients would present with occluded jugular veins from prior CCSVI interventions.  With traditional techniques only a small fraction of these patients would have successful re-cannulation of the jugular veins.  However, by using the Baylis RF wire, many patients who did not have hope for re-opening their blocked veins, can be offered this new therapy.

The Baylis RF wire produces a small amount of radio-frequency energy at its tip.  This small amount of RF energy is just enough to break through chronic, scarred, occluded veins, or through clot and thrombus within previously placed jugular stents.  Once this special wire is passed through the complete blockage, regular wires and balloons can be used to help re-open the vein.

Stents placed within the jugular vein for CCSVI have been found to occlude more frequently than in other locations.  However, due to the chronic nature of the blockages and occlusions within these veins, a stent often needs to be placed to keep the vein open in cases of re-cannulation with the Baylis RF wire.

On behalf of Synergy Health Concepts, we invite patients who have previously been told they have blocked jugular veins or stents from prior treatments to contact our office to discuss your options.

Todd S. Harris, MD

Synergy Health Concepts

www.SynergyHealthConcepts.com

(949) 221-0129

(877) RX-CCSVI

[email protected]

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Dr. Michael Arata MD, Dr. Bill Code MD and Dr. Teri Jaklin ND came together in two public information sessions in August to expand on the evolution of CCSVI, discuss benefits and potential outcomes, and encourage supportive measures for people living with CCSVI. [...]

Dr. Michael Arata MD, Dr. Bill Code MD and Dr. Teri Jaklin ND came together in two public information sessions in August to expand on the evolution of CCSVI, discuss benefits and potential outcomes, and encourage supportive measures for people living with CCSVI. Watch the videos from these sessions below to learn the latest developments in the CCSVI community.

Dr. Michael Arata - CCSVI - Aug 26, 2020 in Barrie, Ontario

Dr. Bill Code - CCSVI - Aug 26, 2020 Barrie, Ontario

Dr Teri Jaklin ND - CCSVI - Aug 26, 2020 in Barrie, Ontario

Q&A Session - CCSVI - Aug 26, 2020 in Barrie, Ontario

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I have been asked to share my thoughts on renal veins.

The jugular and azygous veins are the veins responsible for CCSVI. In the vast majority of cases this is from a malformed valve. When the flow in these veins is blocked the body has natural alternatives for draining the blood. [...]

I have been asked to share my thoughts on renal veins.

The jugular and azygous veins are the veins responsible for CCSVI. In the vast majority of cases this is from a malformed valve. When the flow in these veins is blocked the body has natural alternatives for draining the blood. In the jugular system the thyroidal and external jugular are the major alternative draining veins. The supreme intercostal vein and lumbar veins are the alternative veins for the azygous system. Less commonly the left renal vein provides alternative drainage. When the left renal is an alternative it is almost always in the setting of hemiazygos vein compression.

The important points are:

A) The renal veins do not directly cause CCSVI.
B) The left renal vein is rarely involved with CCSVI, as an alternative.
C) The left renal vein drainage is most often seen with hemiazygos vein compression.

Pathology of the left renal vein is quite unusual. Based on my evaluation with IVUS and review of literature it is not associated with a valve problem. Left renal vein abnormalities are caused by compression of the vein. When present it may cause flank pain or blood in urine.

Renal vein abnormalities are rare. I feel safe stating that I have treated as many hemiazygos compressions as anyone. In my experience hemiazygos compression is rare. Finding a patient with hemiazygos compression AND left renal vein compression is like finding the proverbial needle in a haystack!

So how would one identify when the renal vein is play a role, any role in CCSVI. Well first of all it would be evaluated last. What I mean by that is, you evaluate the azygous and hemiazygos veins. You correct any problems found in these veins. After treating the azygos and hemiazygos if you still have left renal drainage it means one thing. Blood is finding it easier to flow in the renal rather than the azygous. Logically one would try and search for the lesion blocking azygos/hemiazygos flow. If not found are able to be corrected I suppose one could make sure the left renal was wide open. Intuitively, this would be known since venous blood always flows in the direction of lowest pressure. The azygos blood draining into the left renal IMPLIES a normal renal.

For the sake of argument that all these rare events all came together in a single patient. Azygos/hemiazygos abnormality that could not be correct and alternative drainage into a left renal…that is abnormal. Well the treatment would be to stent the compressed renal vein. Balloon angioplasty of a compressed vein is not the standard of care for 2011.

So in summary. Renal vein involvement in CCSVI intuitively impossible and if it actually occurs exceedingly rare. If it ever were found it would be discovered after thorough treatment of the azygos/hemiazygos system. (renal vein treatment prior to azygos/hemiazygos should not EVER occur). In the off chance all this occurs, treatment of the left renal vein would be using a stent, NOT a balloon.

This is my opinion on renal veins and CCSVI. If another physician has a different opinion. I welcome a rebuttal on my Facebook page.

MICHAEL ARATA MD
Synergy Health Concepts

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