title: What went wrong? The flawed concept of cerebrospinal venous insufficiency.
abstract: In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research.
authors: Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany. jose.valdueza@segebergerkliniken.de
authors: José M
authors: JM
authors: Valdueza
authors: Florian
authors: F
authors: Doepp
authors: Stephan J
authors: SJ
authors: Schreiber
authors: Bob W
authors: BW
authors: van Oosten
authors: Klaus
authors: K
authors: Schmierer
authors: Friedemann
authors: F
authors: Paul
authors: Mike P
authors: MP
authors: Wattjes
mesh_terms: D017130:Angioplasty / Q000379:methods; D000818:Animals; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D004453:Echoencephalography; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy