Chronic cerebrospinal venous insufficiency (CCSVI)

We are pleased to offer patients with multiple sclerosis or conditions with similar neurological symptoms, non-invasive ultrasound assessment of their jugular and vertebral veins to diagnose the presence of chronic cerebrospinal venous insufficiency (CCSVI). Patients require a referral from their GP or neurologist specifically requesting this ultrasound service.

CCSVI is a syndrome postulated by Dr Paolo Zamboni, a well-known vascular surgeon from Italy, where abnormal flow of blood in veins draining the brain and spinal cord is associated with multiple sclerosis (MS). CCSVI refers to cerebrospinal venous blood flow disturbances with chronic suboptimal and insufficient 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.

Internal Jugular Vein with distal reflux  
Internal Jugular Vein with Obstruction and Reflux (blue flow)

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, vessel agenesis and external vessel compression. 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, in a similar way to the damage that is seen with the development of venous ulcers in the lower legs associated with long-standing varicose veins.

If a patient is diagnosed as having CCSVI on ultrasound examination, they can then be referred for selective venography, an imaging procedure that visualises the affected veins. An interventional radiologist usually performs this procedure. If the stenoses (narrowings) or obstructions to flow are confirmed then treatment options including venous stenting and balloon angioplasty can be performed. Results to date have been promising.

 Dr Paul Thibault's published article on CCSVI is available for download- CCSVI

Dr Paul Thibault appearing on Catalyst - transcript

Catalyst Video MP4

Catalyst Video WMV