The Procedure Details

We have found that the symptoms that patients experience are associated with the function of the vagus nerve, which travels alongside the jugular vein. It may in fact be the physical manipulation of the jugular vein that produces the symptomatic changes.

The procedure involves a diagnostic process with venographic and intravascular ultrasound (IVUS) evaluation of the jugular, azygos, renal, and spinal veins. It also involves dilation of all abnormalities identified during the diagnostic process.

A large IV is placed into the femoral vein in the patient’s groin area. From this location, small catheters are navigated that drain the brain and spine using X-ray guidance. Video pictures of the veins are produced by injecting a dye into the veins in order to identify any flow abnormalities. These pictures are called venograms.

Unlike arteries, venous abnormalities are subtle and a challenge to identify. In this respect, venograms alone are inadequate in many cases. Therefore, Dr. Arata uses IVUS, which is attached to the end of the small catheter to create pictures from inside of the veins. This technique increases the accuracy of the overall evaluation of the venous system and allows for more precise measurements of the veins themselves. If an abnormality is seen, it is corrected by dilation in hopes of providing symptom relief.

The approach described above maximizes the opportunity for symptom relief with the greatest emphasis placed on patient safety.

Stents are not a typical part of the treatment. In unusual cases, veins that drain the spine such as the azygos may be compressed by external structures. To relieve venous compression, stents have been shown to be highly effective in published studies.

View a video of an actual procedure performed and narrated by Dr. Arata