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An Observational Study of Venoplasty in Patients with Multiple Sclerosis

  • W. Pryse-Phillips (a1), M. Stefanelli (a1), K. Murphy-Peddle (a1) and B. Barrett (a1)

Abstract

Rationale:

It is estimated that some hundreds of Canadian patients with multiple sclerosis (MS) have journeyed abroad to avail themselves of ‘liberation therapy’ (venoplasty) following the initial report by Zamboni et al in 2009. That study also led to public pressure upon Departments of Health in Canadian Provinces to fund the procedure. The present study was done in order to advise the Government of Newfoundland and Labrador as to whether or not it should do so.

Methods:

We conducted an observational study of 30 MS subjects who had submitted to venoplasty, using objective, semi-objective and subjective measures.

Results:

Significant subjective improvement was reported by half of the subjects at three months, although the degree of perceived improvement was less at 12 months. The objective and semi-objective tests employed did not indicate improvement in any area over the one-year follow-up period. Seven of the 29 subjects in whom CT venography was performed at the end of the study year were found to have uni- or bilateral occlusion or >50% stenosis of at least one cervical draining vein, but they showed no deterioration in their clinical status compared to those in whom no venous occlusion nor stenosis was found.

Conclusion:

No objective improvement was found at one year in thirty MS subjects who had undergone venoplasty, although many reported a degree of subjective benefit.

Résumé: Justification:

On estime que des centaines de Canadiens atteints de sclérose en plaques (SP) se sont prévalu de la « thérapie de libération » (phlebographie) à l'étranger suite au compte rendu initial publié par Zamboni et al en 2009 et des pressions ont été exercées par le public pour que les Départements de santé des provinces canadiennes défrayent les coûts de cette intervention. Nous avons procédé à cette étude afin de conseiller le gouvernement de Terre-Neuve et du Labrador sur ce sujet.

Méthode:

Nous avons effectué une étude d'observation auprès de 30 patients atteints de SP qui ont subi une veinoplastie. Nous avons utilisé des mesures d'évaluation objectives, semi-objectives et subjectives.

Résultats:

Une amélioration subjective significative a été rapportée par la moitié des patients 3 mois après l'intervention, mais le degré d'amélioration perçue était moindre 12 mois après l'intervention. Les tests objectifs et semi-objectifs utilisés au cours de l'étude n'indiquaient pas qu'il y ait eu amélioration dans quelque domaine que ce soit au cours de la période de suivi d'un an. La phlebographie par tomodensitométrie effectuée chez 29 patients à la fin de l'année d'observation a montré une occlusion uni ou bilatérale ou une sténose de plus de 50% d'au moins une veine cervicale de drainage chez 7 de ces patients, sans détérioration de l'état clinique comparé à l'état clinique de ceux chez qui aucune occlusion ou sténose veineuse n'a été mise en évidence.

Conclusion:

Aucune amélioration objective n'a été notée après un an d'observation chez 30 patients atteints de SP qui avaient subi une veinoplastie, malgré que plusieurs d'entre eux rapportaient un certain degré de bénéfice subjectif.

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Copyright

Corresponding author

7. Monkstown Road, St. John's, Newfoundland, A1C 3T1, Canada. Email: wpryse@mun.ca.

References

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