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Chronic Cerebrospinal Venous Insufficiency (CCSVI) Diagnostics and Treatment Center
Angiology and Phlebology Sector of Tokuda Hospital Sofia established CCSVI center to focus on diagnosing and treating chronic cerebrospinal venous insufficiency (CCSVI), based upon the recently discovered connection with Multiple Sclerosis (MS). The center implements both leading methodologies in contemporary phlebology (veins science) and endovascular innovations to effectively diagnose and treat CCSVI, which has great potential to improve the quality of life of MS patients.
Background Information
MS is a progressive inflammation disease affecting the central nervous system in which the myelin sheaths covering the axons of the brain are damaged and the transmission of nerve signals is blocked, which leads to eventual paralysis and vision loss. Until recently MS was widely considered an autoimmune system disease with possible viral causes, which has hereditary predisposition factors. However, the core cause of the disease has remained undetermined, which had lead to serious difficulties in preventing, treating, and managing the disease.
During 2008 – 2009, the renowned Italian Doctor Paolo Zamboni published a theory purporting that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). He established that approximately 90% of MS patients have a severe blockages in the venous drainage of the brain, which leads to damage to the venous endothelium followed by infiltration and accumulation of toxic substances (iron) in the brain tissues. Dr. Zamboni proposed that this process is the key cause of the chronic inflammation of the sheathing around the brain nerves. Dr. Zamboni extended his research amongst a group of 65 MS patients; he inflated a small balloon in the veins to clear out blockages in the brain draining veins, which resulted in a considerable improvement in the status of most of the patients. In response to the positive clinical outcomes, several centers in Europe have started to provide venous diagnostics and treatment for MS patients.
The driving presumption of this treatment is by eliminating the cause of MS, namely the cerebrospinal venous insufficiency, a disease improvement will occur and the progressive disease development will cease. This treatment should be undertaken complementary to anti-inflammation therapy administered by neurologists, because currently the role of the venous abnormality disturbances in the ethopathogenesis of MS is not clear: CCSVI may be the basic cause, a triggering mechanism or a concomitant process.
Tokuda Hospital Sofia's Experience in Liberation Procedure
Tokuda Hospital Sofia's first CCSVI examinations were performed using Color Echo Doppler and Computer Tomography (CT) phlebography, in which the prevalence of the venous pathology was confirmed amongst MS patients.
Tokuda Hospital Sofia developed specialized protocols to diagnose and assess CCSVI , which includes 3 basic procedures: Color Echo Doppler testing (a non-invasive examination), MRI CT phlebography (a non-invasive examination), and direct invasive venography. The invasive venography is the gold standard to conclusively diagnose and precisely locate venous stenosis or blockages, which lead to CCSVI.
Upon confirmation of venous stenosis or blockages, the hospital offers endovascular balloon dilatation treatments to resolve the restricted vein to restore normal blood-flow. In cases of resistant stenosis, which doesn’t adequately respond to balloon dilatation treatment, with the consent of a patient the hospital offers venous stent implantation.
The entire examination and treatment process requires a 2 to 3 day hospital stay, and the hospital's protocols are designed to be minimally invasive, with a quick recovery period, and complications are not to be expected.
Our preliminary results are very positive, and we have examined and assessed over 750 patients from Bulgaria, North America and Europe, the majority of which had significant CCSVI. We treated the CCSVI cases with balloon dilation angioplasty and/or endovascular venous stent implantation, the positive clinical outcomes and the patient case data and results are being collected for analysis and scientific research.
Collectively, the medical teams of Tokuda Hospital Sofia annually diagnose and apply contemporary medical practices to treat thousands of patients with a wide range of cardiovascular and endovascular diseases, therefore we have the proper expertise and practical experience to offer quality and comprehensive CCSVI diagnosis and treatment services.
CCSVI Diagnostics and Treatment Process
Day I- Pre-Procedure Exams
1. Pre-procedural Echo-Doppler of the venous system.
2. Comprehensive blood tests, electrocardiography, echocardiography, and specialist consultations with angiology & phlebology specialist, endovascular treatment specialist and a neurologist.
3. MRI phlebography of the veins upon necessity.
Day II - Medical Procedures
1. Invasive phlebography (venography) examination of the vena cava, vena jugularis and vena azygos
2. Upon confirmed stenosis, treatment with endovascular balloon dilatation and/or stent implantation according to medical indications and patient consent
Day III - Recovery and Discharge
1. Post-procedure Echo-Doppler of the venous system
2. Routine post-procedural follow up exams
3. Issuance of medical report, CD of the venography and endovascular treatment(s), prescriptions, and final payment
4. Hospital discharge
CCSVI medical service packages prices include the following:
I. In-patient diagnostic exams/procedures -4,200 Euro
This service package includes all exams, a two - three day hospital stay, a private hospital room, and an invasive venography
II. In-patient diagnostic procedures and balloon dilatation treatment- 6,200 Euro
This service package includes the diagnostics , the two - three day hospital stay, and endovascular treatment. Upon confirmation of stenosis during the invasive venography, the hospital will perform endovascular balloon dilatation for an additional 2, 000 Euro
III. In-patient diagnostic procedures and balloon dilatation and stent implantation treatment- 6200 Euro + 650 per implanted stent
This service package includes the diagnostics, the two - three day hospital stay, and stent implantation treatment. If the results of the balloon dilation results are not satisfactory and upon your consent the hospital will implant a stent. The base charges are the same 6,200 Euro, however the stent implants are not included and the cost per stent is approximately 650 Euro.
IV. Out-Patient Check-Up Exam- 600 Euro
Additional Details
1. Upon hospitalization you will be required to sign an informed consent agreement to undergo the all the procedures for invasive diagnostics and treatment.
2. Upon hospital discharge you will be provided a medical report including the final diagnosis, specialist examination summaries, venography and treatment(s) summaries, prescriptions and post-procedural instructions.
Six Month Post Procedural Check-up Exam
Tokuda Hospital Sofia recommends that our CCSVI patients return six months post-procedurally for a comprehensive Out-Patient CCSVI Check-up Exam which includes full diagnostic testing and examinations to assess the results of your procedure and your current health status as follows:
1. Echo Doppler diagnostics to examine the status of the bloodflow of the jugular viens and the azygos vien.
2. Full Clinical diagnostics to examine the current health status and collect clinical data of our treated CCSVI patients.
3. Consultation with angiologist phlebologist specialist to interpret the results of the testing, complie clinical data, and recommend any additional therapy if necessary.
4. In very rare cases and upon medical indications it may be necessary to perform the in-patient procedures and treatments again. In these cases, the hospital offers reduced prices for the invasive venography and endovascular treatment.
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