Echocolor Doppler morpho-functional study of the jugulo-subclavian confluence in chronic cerebro-spinal venous insufficiency and multiple sclerosis patients
Sandro Mandolesi 1, Aldo d’Alessandro 4, Antonello Ignazio Desogus 9, Marco Matteo Ciccone 8, Annapaola Zito 8, Immacolata Stammegna 2, Tarcisio Niglio 3, Augusto Orsini 5, Dimitri Mandolesi 2, Alessandro d’Alessandro 7, Luca Revelli 3
Affiliations
Article Info
1 Department of Cardio-vascular and Respiratory Sciences, “Sapienza” University, Rome, Italy
2 Department of U.R. Occupational Medicine, “Sapienza” University, Rome, Italy
3 Istituto Superiore di Sanità, Roma, Italy
4 School of Medicine and Health Sciences “G. d’Annunzio” University, Chieti, Italy
5 Department of Vascular Surgery “Gioia” Hospital, Sora (FR), Italy
6 Dipartimento di Chirurgia Università Cattolica del S. Cuore, Roma, Italy
7 Faculty of Medicine University of Foggia, Italy
8 Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy
9 Department of Surgery “Policlinico Villa Elena”, Cagliari, Italy
Abstract
OBJECTIVES: The aim of this work is to measure the mean diameter of the confluence jugulo- subclavian, the impact of different types of jugular confluences and the correlation between the types of confluences and the Valsalva maneuver (jugular reflux) in subjects with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis. METHOD: We investigated by Echo-Color-Doppler (ECD) 103 subjects (67 F 36M) of mean age 45 ± 12 years (a minimum of 22 to a maximum of 79 years, with a median of 44 and a modal value 42 years), mean EDSS of 4.7 and average disease duration of 12 years. RESULTS: The 103 right jugular veins investigated had an average diameter of 8.4 ± 2.4 mm (minimum 4.0, maximum 14.9 mm; median 7.9; modal value 7.6 mm). Three form types were found: 56 cylindrical, 29 conical and 18 funnel. Valsalva maneuver was positive in 30 patients. The 103 left jugular investigated had an average diameter of 8.9 ± 2.4 mm (minimum 2.8, maximum 14.4 mm; median of 8.8; modal value 8.7 mm). The form types were found: 42 cylindrical, 45 conical and 16 funnel. Valsalva maneuver was positive in 30 patients. CONCLUSIONS: The mean diameter of the jugular veins was 8.7 mm. Internal jugular veins with cylindrical morphology have a diameter smaller than other forms; this difference is statistically significant. The different morphology of the jugular vein confluence does not increase the possibility of a reflux because the positive Valsalva maneuvers are not statistically significant when compared to the various types.
Keywords
- CCSVI
- EchoColorDoppler Map
- Jugulo-Subclavian Confluence Diameter

