MS: Review ordered into surgery for clogged neck veins
NHS guidance regulator announces consultation on the role of surgery for opening blocked neck veins as a treatment for multiple sclerosis
5th May 2011 - A consultation will take place this summer on a surgical technique that unblocks veins in the neck as a treatment for patients with multiple sclerosis (MS). The National Institute for Health and Clinical Excellence (NICE) has asked a specialist committee to examine whether the procedure, which improves blood flow, is of value to people with MS.
Chronic cerebrospinal venous insufficiency (CCSVI) has become a popular topic for discussion among MS patients since an Italian scientist first linked the disease with the condition of veins in the neck. Dr Paolo Zamboni put forward the theory that MS can be caused by blockages in veins draining blood from the brain and that, if the blockages are cleared, symptoms of MS may be eased.
Blocked, damaged veins
Zamboni's theory rests on a link between MS and iron deposits in blood vessels. He carried out ultrasound tests on blood vessels leading in and out of the brain and found that, in a majority of people with MS, the veins taking blood away from the brain were blocked or damaged. This was not the case in people without MS.
He further suggested that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the blood-brain barrier: a process he called Chronic Cerebrospinal Venous Insufficiency.
A number of clinics, notably in Poland and Bulgaria, are offering surgery to clear these blockages in veins - an angioplasty technique, also known as 'liberation procedure'. MS patients in the UK have had to arrange treatment abroad for this surgery, although last year it was offered at a private clinic in Scotland for the first time in the UK.
Few clinical trials have been carried out and the procedure remains scientifically unproven.
NICE has announced a four week consultation on the technique before the Interventional Procedures Advisory Committee (IPAC) is asked to review the evidence. Its findings are expected to be published in Autumn 2011. The committee's conclusions will be reviewed by NICE, which will issue UK-wide guidance.
The review will cover 'balloon angioplasty with or without stenting'.
Balloon angioplasty involves inserting a catheter with a small balloon tip towards a narrowed stretch of a vein. Once in place, the balloon is inflated to stretch the vein or compress any fatty matter. In a variation of the procedure, a stent (a small metal mesh tube) is inserted to permanently keep the vein expanded after the balloon has been withdrawn.
IPAC will base its review on evidence from three professional bodies: the Association of British Neurologists, the British Society of Interventional Radiology and the British Society of Neuroradiology.
'Good news for people with MS'
"The single most important thing in this announcement is that NICE are seeking specialist advice from neurologists and interventional radiologists together, Helen Yates Chief Executive of the Multiple Sclerosis Resource Centre(MSRC) tells us. Yates continues: "MSRC has long held the belief that these two specialities should be looking at the area of CCSVI together. It is generally good news for people with MS that this procedure is now receiving this kind of attention."