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I was heartened to hear that the liberation procedure was successful for Mr. Kaye. I fully acknowledge that I am not an expert in this area.
From the limited reports of this procedure in the literature, it appears that imaging of the jugular venous and azygous systems as well as the verte-brobasilar system may be undertaken, although this is not clear from Zamboni’s report.1 To perform the imaging, one would, on occasion, advance a large catheter as far as the lower part of the brain. From the original description, balloon dilations and stent procedures are most commonly performed within the internal jugular system, as Kaye has suggested. As researchers initiate studies of cerebral venous drainage, venous imaging may eventually involve the brain’s venous system. This may eventually be followed by attempted dilations of intracranial venous systems.
In news reports, I mentioned that catheters were inserted through various entry points, including the jugular vein, as discussed, or advanced as far as the brain for imaging beyond possible stenosis. At present, this appears technically correct based on the limited descriptions of the procedure.
My major point, however, was that the liberation procedure is still experimental and requires much more evaluation before it is made widely available. All procedures have risks, not only widely reported benefits. All vascular procedures include death as a known complication. As an aside, I should point out that we cause stenoses of the venous system in a large number of patients receiving dialysis because of long-term catheter use. As far as I am aware, we see no increase in the occurrence of multiple sclerosis in these patients.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/11/1151#595164