The catheter venography is a well-recognized diagnostic technique, which is widely used in the definition of large veins occlusive disease. Catheter venography is performed under local anesthesia and not under general sedation because it is compulsory for the patient to be collaborative and conscious during the procedure. The access to the venous system is achieved through a percutaneous anterograde approach of right common femoral vein under ECD sonography guidance to avoid pain and accidental arterial puncture.

After the placement of a 8 Fr sheath introducer, an intravenous bolus of 5000 units of heparin is administered. The right IJV is first cannulated using a 0.035” short angle regular hydrophilic guidewire of 260 cm in length supported by a BER II diagnostic catheter.

BER II, a straight catheter with a short distal angulation of the tip, is used at the aim of minimizing possible interferences with endoluminal defects of IJVs. Before starting the frames acquisitions, the BER II is positioned in all cases at the level of the jaw angle.

The selective venography of the IJVs is performed using an automatic injection of a low viscosity contrast medium in anterior-posterior projection. A low PSI (100) is used to avoid induced reflux.

A long acquisition time is used to detect delay of contrast medium clearance through IJVs.

The patient is invited to maintain a straight head and neck position and a regular breathing during the frame acquisitions. The same procedure is used for the left IJV and the Azygos Vein.

“Venous angioplasty”

Angioplasty of the IJVs abnormalities is performed only in case of moderate or severe delayed flow using compliant or non-compliant balloons of variable diameters (10 to 20 mm) depending on the size of IJV at the site of the lesion.

The balloon is inflated at 8-12 ATM for 30 seconds. Repeated angioplasties are performed in case of unsatisfactory results. The angioplasty is considered effective when is able to reduce the abnormal delayed flow.

Post-angioplasty CV is performed following the same procedure as that one used during the diagnostic modality.

The CCSVI treatment is carried out in Malta, at Saint James Hospital which provides excellent structures and facilities:

• Four operating theatres with high standard equipment for anaesthesia and monitoring;

• Diagnostic imaging service of technical and professional excellence; laboratories of analysis equipped with high precision instruments and devices;

• Cutting-edge specific equipment dedicated to CCSVI (the EcoColorDoppler Mylab Vinco di Esaote – which is specifically designed according to CCSVI – is in use for diagnosis)

The procedure, which normally takes approximately 3 days, develops as follows:

Day 1 – The patient, who arrives in Malta the day before, undergoes the EcoColorDoppler and the other routine pre-surgery exams. The team reviews the results of the ECD exam and decides of the patient eligibility for the intervention.

Day 2 – the patient undergoes the dilatating angioplasty intervention which is performed under local anesthesia and consists of a balloon catheter inserted and used to dilate the narrow veins. The patient shall remain collaborative and conscious during the procedure and shall also maintain a straight head and neck position and a regular breathing during the frame acquisitions. The intervention lasts about 1 hour and it is followed by an observation period of 6-8 hours.

Day 3 – the patient undergoes the post surgery Echo Colour Doppler  and a neurological exam, following a change of medication and a general evaluation by the team for the discharge formalities.

The patient will stay at the hospital for all three days. He may also have the opportunity to be accompanied by one person who will be provided by board and lodging inside the hospital structure.

The overall cost of the procedure is 7.500,00 € including the three nights with complete meals for the patient and the helper, as mentioned above.

Interventions are usually performed on Fridays and Saturdays. Patients have to be hospitalized the day before the surgery for the pre-op exams, so they have to arrive in Malta 2 days before the intervention. Patients will be discharged on Saturday, or Sunday, depending on when they have been operated. After discharge formalities, patients can leave directly unless they choose to spend a few days in Malta relaxing.

The following are the upcoming ccsvi treatment session dates:

24-28 April 2013 | 22-26 May 2013 | 12-16 June 2013 | 10-14 July 2013

11-15 September | 16-20 October | 13-17 November | 11-15 December