Venous Hemodynamic Insufficiency Severity Score variation after endovascular treatment of chronic cerebrospinal venous insufficiency

Phlebology. 2015 May;30(4):250-6. doi: 10.1177/0268355514524193. Epub 2014 Feb 14.


Introduction: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the internal jugular veins (IJVs) and/or azygos veins with disturbed flow and formation of collateral venous channels. The presence of CCSVI has been associated with multiple sclerosis (MS). Percutaneous venous angioplasty (PVA) has been proposed to improve extracranial outflow; however, a non-invasive, post-procedural follow-up outcome measure has not been established.

Aim of the study: To evaluate the short-term hemodynamic follow-up of CCSVI after PVA using color Doppler ultrasound (CDU) and to investigate whether hemodynamic variation correlated with clinical variation.

Materials and methods: Forty-five patients affected by MS with confirmed CCSVI underwent IJVs PVA. Venous hemodynamic (VH) parameters indicative of CCSVI and the Venous Hemodynamic Insufficiency Severity Score (VHISS) were evaluated by CDU at baseline and 3 months post-PVA. Concurrently, the MS-related disability status (EDSS) was evaluated.

Results: The VH parameters and VHISS 3 months after IJVs PVA significantly decreased: the VH parameters -32.1% and the VHISS -33.8% (p < 0.001). The EDSS score 3 months after IJVs PVA was significantly lower than the baseline (-5.5%, p < 0.001). Using the median value of the VHISS variation as the cut-off, we were able to identify two groups of patients: responders, group A; and non-responders, group B. The EDSS score variation at 3 months was 0.310 in group A and 0.275 in group B (p = 0.746).

Conclusions: CCSVI endovascular treatment can induce an improvement in VH parameters and the VHISS. The neurological disability score (EDSS) also improved after PVA; however, there was no correlation to the VHISS variation after PVA, MS type and duration.

Keywords: CCSVI; color Doppler ultrasound; jugular veins; percutaneous venous angioplasty.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Angioplasty* / methods
  • Azygos Vein / diagnostic imaging
  • Azygos Vein / physiopathology
  • Azygos Vein / surgery*
  • Cerebrovascular Circulation
  • Chronic Disease
  • Disability Evaluation
  • Female
  • Hemodynamics
  • Humans
  • Jugular Veins / diagnostic imaging
  • Jugular Veins / physiopathology
  • Jugular Veins / surgery*
  • Male
  • Middle Aged
  • Phlebography
  • Prospective Studies
  • Severity of Illness Index*
  • Spinal Cord / blood supply
  • Treatment Outcome
  • Ultrasonography, Doppler, Color
  • Venous Insufficiency / physiopathology
  • Venous Insufficiency / surgery*