A to Z of MS CCSVI (Chronic cerebro-spinal venous insufficiency)

Chronic cerebrospinal venous insufficiency (CCSVI) is a theory proposed by Professor Paolo Zamboni, a vascular surgeon, that suggests an abnormalities (including narrowing) in veins taking blood from the brain may contribute to damage of the central nervous system in multiple sclerosis.

Professor Zamboni's original study of 65 people with MS found narrowing of the jugular vein in 91% and of the azygous vein (in the spine) in 86%. Numerous studies have now been carried out by different research groups but findings have been contradictory.

It has been proposed that CCSVI can be treated with a surgical procedure known as percutaneous venoplasty. This procedure aims to open blocked veins by inflating a small balloon in the vein.

NICE Guidance published in March 2012 has stated that current evidence on the efficacy of percutaneous venoplasty for CCSVI in MS is inadequate in quantity and quality and the surgical procedure should only be used in the context of clinical trials.

NICE has recommended further research on percutaneous venoplasty for CCSVI for MS in the form of robust clinical trials and recommends that studies should have clearly defined selection criteria, good definitions of technical success and outcomes that include clinical and quality of life measures.

References

1. Zamboni P, et al.
   Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis.
   Journal of Neurology, Neurosurgery and Psychiatry 2009;80:392-399.
   read online
2. Zamboni P, et al.
   The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis.
   Journal of Neurological Sciences 2009;282:21-27.
   abstract
3. Wattjes MP, et al.
   No association of abnormal venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study.
   Journal of Neurology, Neurosurgery and Psychiatry 2011;82(4):429-435.
   abstract
4. Baracchini C, et al.
   No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset.
   Annals of Neurology 2011;69(1):90-99.
   abstract
5. Doepp F, et al.
   No cerebro-cervical venous congestion in patients with multiple sclerosis.
   Annals of Neurology 2010;68(2):173-183.
   abstract
6. National Institute for Health and Clinical Excellence.
   Percutaneous venoplasty for chronic cerebrospinal venous insufficiency for multiple sclerosis. NICE interventional procedure guidance 420.
   London; NICE: 2012.
   read on the NICE website

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