It was only when someone asked me 'yes, but what exactly is the procedure', that I realised I had taken for granted that everyone reading this blog knew what was involved. So here is my summary of what is involved.
Pre-treatment:
You will have tests done to establish whether or not you have CCSVI. This is usually a combination of a specialised MRI to look at the veins in your neck and upper chest (MRV), often under the protocol established by Dr Mark Haake. Also a Doppler ultrasound to view the veins in your neck, as confirmation, and to give the surgeons starting information for the surgery. This is often done the day before surgery.
Immediately pre-treatment:
No food or drink for at least 6 hours before surgery. If you need to take medication this should be done with the minimum of water. Blood tests may be done to check kidney function, plus the standard consent forms and anaesthetist check. A catheter is often fitted, as you must remain immobile for several hours after the angioplasty. IV drips may be given to ensure that you are well-hydrated, to flush out the contrast medium after the treatment. If you haven't done it already, the nurses may shave your groin area.
The procedure itself:
A local anaesthetic is applied to your groin and you are given a sedative, so that you remain awake but calm throughout. This is likely to make you unaware of the true passage of time, and you may forget altogether what happened. You lie on an X-ray table, so that the surgeons can do venograms as they proceed. A small cut is made, usually in the right groin, and a small diameter catheter and wire is inserted, travelling up to the veins in the neck area. Occasionally you feel a little discomfort or pressure around the neck or ears.
A special dye, which is opaque to X-rays, called the contrast medium is injected, so that the exact location of any blockage can be found. A balloon is then inserted via the catheter and inflated at the point of the blockage. It is then deflated and the vein checked again. If the balloon cannot solve the blockage,they may insert a metal mesh tube or 'stent' to keep the vein open. This procedure is routinely carried out at various points around the body,including the coronary arteries and veins.
Once the doctors are satisfied that they have finished with one vein ,they move on to the next, usually working on the left and right jugular veins, the brachocephalic veins and the azygous vein. When everything is done, the catheter is withdrawn and a compression bandage placed over the groin to hold the tiny cut where the catheter went in closed.
After the operation:
You will be kept immobile in bed for several hours to allow the cut to close and the sedative to wear off. After then you will be allowed to eat and drink again. What medication you need to take and how long you stay in hospital will depend on what you have had done and the local protocol the doctors work to.
Some people start getting some response straight away, but for others it is small gradual improvements over a number of weeks. Like everything with MS, we are all different and it will also depend on how far your MS had progressed before you arrive. If you are wheelchair bound, do not expect to be running around immediately post surgery.
