Interventional Radiology in the Treatment of Chronic Cerebrospinal Venous Insufficiency

Chronic cerebrospinal venous insufficiency (CCSVI) is a theory that implicated venous reflux in the cerebral veins as a cause of multiple sclerosis (MS). Originally diagnosed by indirect duplex findings of abnormal flow in the cervical veins, all patients were found to have large vein (internal jugular or azygous) stenoses on venography. Although 100% prevalence of positive duplex findings in the MS population has not been confirmed, multiple investigators have reported the frequent relief of symptoms after percutaneous recanalization. There is a strong patient demand for the intervention, despite the absence of prospective randomized studies. This report reviews the evidence for CCSVI, the anatomy and percutaneous interventions, and the reported safety and outcomes data.