CCSVI: Cerebrospinal venous insufficiency

Chronic cerebrospinal venous insufficiency (CCSVI)

We are pleased to be able to offer patients with multiple sclerosis who may have CCSVI, duplex scans of their jugular and vertebral veins to exclude reflux and/or narrowing in these vessels.

We have Vascular Sonographers who are experts in this field.

• CCSVI is a hypothesised syndrome where abnormal flow of blood in veins draining the brain and spinal cord has been associated with multiple sclerosis (MS).

• This was first described and postulated by Paolo Zamboni in 2007.
  Although many papers have already been published, these have not been robust large studies and little remains known as to the relationship between CCSVI and MS.
  Many neurologists are sceptical as to this link.

• Proposed mechanism relates to cerebrospinal venous blood flow disturbances with chronic suboptimal and insufficient / slow venous drainage from the spine and brain. The veins involved include the intracranial veins, jugular veins, veins draining the spinal cord and the azygous vein in the chest.

• The hypothesis is that various abnormalities of these vessels do not allow normal blood flow.
  These include: circumferential stenosis of the whole vessel wall, congenital webs, valve malformation, vessel hypoplasia, vessel twisting and vessel agenesis. The thought is that the resulting increased pressure of blood in the brain and spinal cord allows for the deposition of iron deposits that may trigger local inflammation, brain cell injury and death.

• Clearly MS is a complex disease with likely many different causes and triggers. CCSVI may be just one of many of these. This certainly is exciting research as if the link between CCSVI and MS is proven there may be treatment options including venous stenting and angioplasty.

• Much work remains to be done, as even if a link is established, it is still unclear whether treating the venous obstruction would be helpful in the management of MS.

• As with any new condition most doctors are only now learning how to correctly image patients.
  This will no doubt evolve over time.