Rhode Island Vascular Institute (RIVI)
Chronic Cerebrospinal Venous Insufficiency (CCSVI)
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We currently offer diagnostic venography and endovascular treatment for CCSVI (also referred to as the Liberation Treatment) in patients with an established diagnosis of multiple sclerosis. We are committed to providing diagnosis and treatment in clinical situations where endovascular therapy for venous compression may be useful. We are providing this service to patients who reside both within and outside of the New England area. Duplex ultrasound testing is currently available here. If necessary, referral for MR venography is also available to diagnose disease in the dominant veins providing outflow from the central nervous system. Based on the findings from these examinations, or based on the patient's clinical presentation, we can consider patients on an individual basis for endovascular treatment.
Endovascular treatment for CCSVI can entail angioplasty and/or angioplasty and stent placement. Generally we perform these procedures through a single access in the groin, using ultrasound and or fluoroscopic guidance to enter the common femoral vein. Venography, which is performed first, is the process of creating pictures of the venous system by inserting a skinny tube or catheter (about 2 mm in diameter) into the veins in question. This insertion is guided with fluoroscopy or real-time x-ray imaging. Images are created by injecting contrast or dye into the vein to assess the size, anatomy and flow. This process is the “gold-standard” for evaluating vein abnormalities and it allows us to look for vein abnormalities and function. Our physicians have performed thousands of venograms over the last 30 years.
If we identify an abnormality the vein can be treated through the same access site we used for the venogram, again utilizing techniques with which we have vast experience for treatment of many vascular diseases, we then move ahead to therapy. Treatment of vein narrowing is usually performed with balloon angioplasty. This technique is the same as that used to open blocked heart arteries using a balloon. Stents or tiny metallic scaffolds, can be used to open resistant or complicated vein narrowing. Stent placement is slightly more complex than simple angioplasty and entails more complicated post treatment medication regimens. As with all medical diagnostic and therapeutic procedures there are risks associated with these techniques. Our interventional radiologists discuss the risks and benefits of these procedures in great detail. Together with the patient we arrive at a treatment plan and obtain informed consent to proceed.
Presently we place each patient on our waiting list. They are contacted as soon as an opening develops and offered that procedure date. The performing physician will then contact the patient several weeks before their procedure to do a complete history and phone consultation.. Due to the great demand for this service, and depending on geographic restrictions we perform diagnostic and therapeutic procedures within 14 days for those who are local and within 24-48 hrs for those traveling great distances. Our goal is to provide this service to as many patients who may benefit from it as possible and to limit the time away from home or regular routines as much as we can.
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