JOURNAL OF VASCULAR SURGERY
Liberation Procedure in the Treatment of Chronic Cerebro-Spinal Venous Insufficiency - Is Chronic Cerebro-Spinal Venous Insufficiency Related To Brain Congestive Syndrome Rather Than Multiple Sclerosis
D.J. Milic, P. Bosnjakovic, S. Vojinovic, Z. Sasa, A. Ilic, D. Stojanov, V. Milojkovic
www.jvascsurg.org/article/S0741-5214(11)02629-2/fulltext
Background
Chronic cerebro-spinal venous insufficiency (CCSVI) is a term developed to describe compromised flow of blood in the veins draining the central nervous system. It has been suggested by some authors that this condition is related to Multiple Sclerosis (MS). Balloon angioplasty and stenting have been proposed as a treatment option for CCSVI in MS. The proposed treatment has been termed ”liberation procedure” though the name has been criticized for suggesting unrealistic results.
Methods
An open,prospective,single-center study, was performed in order to determine the efficacy of “Liberation procedure” in the treatment of different forms of MS (relapsing remitting,secondary progressive, primary progressive, and progressive relapsing). The evaluation of patient's status before the procedure, 6 and 12 months after the procedure was performed using: Expanded Disability Status Scale (EDSS); MSFC-Multiple sclerosis functional composite(TIMED 25-FOOT WALK;9-HOLE PEG TEST;PASAT-Paced auditory serial test) and SDMT-Symbol digit modalities test. The outcome of the procedure was also analyzed using: PRO-patient related outcomes, SF-36 questionnaire,EQ-5D (EuroQol) and Functional Assessment of Multiple Sclerosis (FAMS) quality of life. In order to determine the effects of the procedure blood sample from jugular vein was analyzed 24h before the procedure and 24h, 72h and 7 days after the procedure (pH and bicarbonate, BE, pCO2 and pO2, K+, Na+, CRP).
Results
Overall 205 patients completed the study (86 men and 119 women). Ninety-two patients had relapsing-remitting MS, 103 patients had secondary progressive form and 10 patients had primary progressive MS. Avarage patient's age was 41.21years. The EDSS before the “Liberation procedure” was 5.502±1.95(visual-0.24±0.71;brainstem-1.06±1.29; pyramidal-3.1±1.16;cerebellar-2.0±0.99; sensory-2.64±0.72; bowel/bladder- 1.14±0.87; cerebral −0.87±1.17). On the check-up 6 and 12 months after the procedure the EDSS did not show any statistical significant difference between the pre and post procedural values. However, initial benefit of the procedure was seen in almost 70% of treated patients. This benefit was impossible to quantify due to the fact that neurological tools measures quality of changes in different systems but not the quantity. During the one year follow-up period over 40% of treated patients developed almost all symptoms that were present before the procedure. It is interesting that initial benefit was associated with the improvement in the biochemical parameters from the blood sample analysis. This brain decongestions after “Liberation” procedure is probably the reason for relatively fast improvement in clinical signs that we see in some group of treated patients.
Conclusions
The results obtained in this study suggest that CCSVI is related to Brain Congestive Syndrome rather than MS indicating that “Liberation” procedure may improve clinical signs in patients with MS because of brain decongestion.