Review of catheter venography protocols in the evaluation of chronic cerebrospinal venous insufficiency

Abstract

Catheter venography has been considered to be the gold standard in the evaluation of venous pathology. Chronic cerebrospinal venous insufficiency (CCSVI) has recent- ly been described as a condition characterised by the presence of multiple stenotic lesions of the main pathways of extracranial venous drainage, especially the internal jugular veins and the azygos vein. The primary screening diagnostic method to identi- fy the venous lesions has been Doppler sonography. Once the abnormalities are iden- tified by the non-invasive method, patients undergo catheter venography to confirm the presence of venous lesions with the aim of performing treatment, which has main- ly been balloon angioplasty. Since the inception of CCSVI, several venographic pro- tocols to evaluate the internal jugular and azygos veins have been described, but none of them have been scientifically validated. The purpose of this review is to analyse the most recent catheter venography protocols reported for the diagnosis and manage- ment of CCSVI. The materials and methods sections of the most recently published series describing catheter venography for the evaluation and management for CCSVI were reviewed. The technical details, including venous access selection site, catheter selection, ideal catheter position, contrast injection techniques, and interpretation of venographic findings, were reviewed. Comments on each of the technical factors are presented. Final comments with proposed techniques are presented.