Show simple item record

dc.contributor.authorZamboni, P.*
dc.contributor.authorMenegatti, E.*
dc.contributor.authorConforti, P.*
dc.contributor.authorShepherd, Simon J.*
dc.contributor.authorTessari, M.*
dc.contributor.authorBeggs, Clive B.*
dc.date.accessioned2014-04-28T11:28:16Z
dc.date.available2014-04-28T11:28:16Z
dc.date.issued2012
dc.identifier.citationZamboni P, Menegatti E, Conforti P, Shepherd SJ, Tessari M and Beggs C (2012) Assessment of cerebral venous return by a novel plethysmography method. Journal of Vascular Surgery. 56(3): 677-85 e1.
dc.identifier.urihttp://hdl.handle.net/10454/6249
dc.description.abstractBACKGROUND: Magnetic resonance imaging and echo color Doppler (ECD) scan techniques do not accurately assess the cerebral venous return. This generated considerable scientific controversy linked with the diagnosis of a vascular syndrome known as chronic cerebrospinal venous insufficiency (CCSVI) characterized by restricted venous outflow from the brain. The purpose of this study was to assess the cerebral venous return in relation to the change in position by means of a novel cervical plethysmography method. METHODS: This was a single-center, cross-sectional, blinded case-control study conducted at the Vascular Diseases Center, University of Ferrara, Italy. The study involved 40 healthy controls (HCs; 18 women and 22 men) with a mean age of 41.5 +/- 14.4 years, and 44 patients with multiple sclerosis (MS; 25 women and 19 men) with a mean age of 41.0 +/- 12.1 years. All participants were previously scanned using ECD sonography, and further subset in HC (CCSVI negative at ECD) and CCSVI groups. Subjects blindly underwent cervical plethysmography, tipping them from the upright (90 degrees ) to supine position (0 degrees ) in a chair. Once the blood volume stabilized, they were returned to the upright position, allowing blood to drain from the neck. We measured venous volume (VV), filling time (FT), filling gradient (FG) required to achieve 90% of VV, residual volume (RV), emptying time (ET), and emptying gradient (EG) required to achieve 90% of emptying volume (EV) where EV = VV - RV, also analyzing the considered parameters by receiver operating characteristic (ROC) curves and principal component mathematical analysis. RESULTS: The rate at which venous blood discharged in the vertical position (EG) was significantly faster in the controls (2.73 mL/second +/- 1.63) compared with the patients with CCSVI (1.73 mL/second +/- 0.94; P = .001). In addition, respectively, in controls and in patients with CCSVI, the following parameters were highly significantly different: FT 5.81 +/- 1.99 seconds vs 4.45 +/- 2.16 seconds (P = .003); FG 0.92 +/- 0.45 mL/second vs 1.50 +/- 0.85 mL/second (P < .001); RV 0.54 +/- 1.31 mL vs 1.37 +/- 1.34 mL (P = .005); ET 1.84 +/- 0.54 seconds vs 2.66 +/- 0.95 seconds (P < .001). Mathematical analysis demonstrated a higher variability of the dynamic process of cerebral venous return in CCSVI. Finally, ROC analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839). CONCLUSIONS: Cerebral venous return characteristics of the patients with CCSVI were markedly different from those of the controls. In addition, our results suggest that cervical plethysmography has great potential as an inexpensive screening device and as a postoperative monitoring tool.
dc.relation.isreferencedbyhttp://dx.doi.org/10.1016/j.jvs.2012.01.074
dc.subjectAdult
dc.subject; Blood flow velocity
dc.subject; Case-control studies
dc.subject; Cerebral veins; Physiopathology; Ultrasonography
dc.subject; Cerebrovascular circulation
dc.subject; Cerebrovascular disorders/diagnosis
dc.subject; Chi-Square distribution
dc.subject; Chronic disease
dc.subject; Cross-sectional studies
dc.subject; Female
dc.subject; Hemodynamics
dc.subject; Humans
dc.subject; Italy
dc.subject; Logistic models
dc.subject; Male
dc.subject; Middle aged
dc.subject; Multiple Sclerosis
dc.subject; Multivariate analysis
dc.subject; Patient positioning
dc.subject; Plethysmography
dc.subject; Predictive value of tests
dc.subject; Principal component analysis
dc.subject; ROC curve
dc.subject; Regional blood flow
dc.subject; Sensitivity and specificity
dc.subject; Spinal cord; Blood supply
dc.subject; Supine position
dc.subject; Ultrasonography; Doppler; Color
dc.subject; Transcranial
dc.subject; Venous insufficiency
dc.subjectREF 2014
dc.titleAssessment of cerebral venous return by a novel plethysmography method
dc.typeArticle


This item appears in the following Collection(s)

Show simple item record