Chronic cerebrospinal venous insufficiency (CCSVI) refers to narrowing of veins in the neck. This narrowing is believed to cause reduced blood flow from the brain and spinal cord. As a result, blood backs up in the brain and spinal cord, which can trigger pressure and inflammation.
One theory is that reduced blood flow contributes to multiple sclerosis (MS), a progressive disease of the central nervous system. The disease attacks and destroys nerve linings in the brain and spinal cord, causing lesions to form in these areas of the body.
People diagnosed with CCSVI typically have symptoms of MS. These include:
- muscle cramping
- vision problems
- muscle paralysis
- “pins and needles” sensations
CCSVI can cause additional symptoms, as well, including:
- mental confusion
- severe headaches
- facial edema
The exact cause of CCSVI is unknown. But according to one study, its origin may be related to:
- hypercoagulable states
- trauma from prolonged catheterization
- neck compression
CCSVI is similar to a condition known as venous insufficiency, which primarily affects the leg veins. This condition may occur as a result of faulty valves in the vein. Risk factors for venous insufficiency include:
- a family history of the condition
- a personal history of deep vein thrombosis
- excess body weight
- sitting for long periods
Diagnosing CCSVI requires an imaging test. An ultrasound uses high-frequency sound waves to create an image of the inside of your body. Your doctor can use an ultrasound or a magnetic resonance venography to view the veins in your neck and to check for impaired blood drainage from your central nervous system.
Many researchers doubt the legitimacy of CCSVI and its connection to MS, so there’s conflicting information about treatment for this condition.
The only known treatment for CCSVI is a surgical procedure called venous angioplasty, also known as liberation therapy. It opens up narrow veins. A surgeon inserts a small balloon into the vein to keep it open. This procedure is designed to clear the blockage and restore blood flow from the brain and spinal cord. Increasing blood circulation may reduce inflammation in the brain and reduce symptoms of MS.
The success rate with liberation therapy varies. Although some people who had the procedure reported an improvement in their condition, nearly half experienced re-stenosis, meaning their blood vessels narrowed again.
Research investigating the effectiveness of surgery for CCSVI isn’t promising. According to the MS Society, a 2017 clinical trial study of 100 people with MS found that venous angioplasty did not reduce participants’ symptoms.
Risks of liberation therapy
Because it's unclear whether CCSVI treatment is effective, some doctors shy away from surgery due to the risk of complications. These complications include:
- blood clots
- abnormal heartbeat
- separation of the vein
- vein rupture
The FDA released a statement in May 2012 warning people with MS about the risk of surgery to treat CCSVI.
The link between CCSVI and MS was introduced in 2009 by Dr. Paolo Zamboni from the University of Ferrara in Italy. Dr. Zamboni conducted a study of people with and without MS. Using ultrasound imaging, he compared blood vessels in both groups of participants. He found that participants with MS had abnormal blood flow from the brain and spinal cord, whereas participants without MS had normal blood flow. Based on his findings, Dr. Zamboni concluded that CCSVI was a potential cause of MS.
This connection, however, has been a matter of debate in the medical community. Some researchers and doctors question whether CCSVI is a real condition, and some who acknowledge the validity of the condition question its connection to multiple sclerosis.
Dr. Zamboni’s study wasn't the only study conducted in an effort to find a link between CCSVI and MS. In 2010, the National Society in the United States and the MS Society of Canada joined forces and completed seven similar studies. But large variations in their results couldn’t provide a definitive answer, leading some researchers to believe there isn't a link.
MS is unpredictable and debilitating at times. Understandably, people living with this condition want relief and an effective treatment. But there isn't enough evidence to confirm whether treating CCSVI will improve MS or stop the progression of the disease.