Paolo Zamboni

This article is about the doctor. For the athlete, see Paolo Zamboni (athlete).
Paolo Zamboni
Paolo Zamboni
Born(1957-03-25)25 March 1957
Ferrara, Italy
CitizenshipItaly
AwardsISNVD Gold Medal
Scientific career
FieldsVascular Diseases
InstitutionsFerrara, Italy

Paolo Zamboni (born 25 March 1957, Ferrara, Italy) is an Italian doctor and scientist. He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.

He is known for his description and proposed cure of the vascular disease chronic cerebrospinal venous insufficiency (CCSVI) strongly related with multiple sclerosis and other neurodegenerative diseases such as Ménière and Parkinson's, but the existence of this disease is very controversial, with significantly more detractors than supporters, and there is no good evidence that the surgery helps MS patients.

Biography

Graduated with honors in Medicine and Surgery in 1982, Zamboni specialized in General Surgery in 1987 and in Vascular Surgery 1992. In 1992 he obtained the fellowship at the Department of Vascular Surgery of the University of California in San Francisco. From 1993 to 2000 he was visiting professor at the Department of Surgery of the Uniformed Services University of the Health Sciences of Bethesda, Maryland and from 2008 to 2012 at the Jacobs Institute of Neurology in Buffalo, New York, and at the Neuroscience Department of Harvard University (2010) and Chicago University (2012).

Since 2004 he is director of the Vascular Disease Center of Ferrara University.[1] In 2008 he announced the discovery of a new venous pathology, called chronic cerebrospinal venous insufficiency (CCSVI) and postulates a controversial correlation between this pathology and multiple sclerosis[2][3][4]

During 2010-2011 he was the president of the International Society for Neurovascular Diseases (ISNVD).

Chronic Cerebrospinal Venous Insufficiency – CCSVI

Main article: Chronic cerebrospinal venous insufficiency controversy

In 2008 Zamboni described Chronic cerebrospinal venous insufficiency (CCSVI or CCVI), the compromised flow of blood in the veins draining the central nervous system.[2][5] He hypothesized that it might play a role in the cause or development of multiple sclerosis (MS)[6][7] and devised a surgical procedure which the media nicknamed a liberation procedure or liberation therapy, involving venoplasty or stenting of certain veins.[8] Zamboni's ideas about CCSVI are very controversial, with significantly more detractors than supporters, and any treatments based on his ideas are considered experimental.[9][10]

There is no scientific evidence that CCSVI is related to MS, and there is no good evidence that the surgery helps MS patients. Zamboni's first published research was neither blinded nor did it have a comparison group.[8] Zamboni also did not disclose his financial ties to Esaote, the manufacturer of the ultrasound specifically used in CCSVI diagnosis.[11] The "liberation procedure" has been criticized for possibly resulting in serious complications and deaths, while its purported benefits have not been proven.[8][10] In 2012, the United States Food and Drug Administration states that it is not clear if CCSVI exists as a clinical entity and that these treatments may cause more harm.[12] In 2017 they emphasized that this use of balloon angioplasty is not an approved use.[13] In a 2017 study Zamboni et al. stated "Venous PTA cannot be recommended for patients with relapsing-remitting multiple sclerosis."[14] In 2018 a study in Neurology concluded "Our data do not support the continued use of venoplasty of extracranial jugular and/or azygous venous narrowing to improve patient-reported outcomes, chronic MS symptoms, or the disease course of MS."[15]

Research on CCSVI was fast-tracked, but researchers have been unable to find a connection between CCSVI and MS.[16] This has raised serious objections to the hypothesis of CCSVI originating multiple sclerosis.[17] Additional research investigating the CCSVI hypothesis is underway.[18] A 2013 study found that CCSVI is equally rare in people with and without MS, while narrowing of the cervical veins is equally common.[19][20][21]

Research on Chronic Venous Insufficiency - CVI

Zamboni has conducted research on lower extremity Chronic venous insufficiency, testing a minimally invasive and conservative treatment of the saphenous vein: the CHIVA method. On this topic he conducted several randomized clinical trials [22][23] and published books.[24][25]

The CHIVA and the stripping methods are equivalent regarding recurrence of varicose veins, but the CHIVA method may slightly reduce nerve injury and hematoma. The CHIVA method is also equivalent to either radio frequency ablation or endovenous laser therapy regarding recurrence and side effects.[26]

Cell therapies for the treatment of severe vascular ulcerations of the lower limbs are another Zamboni field of study. Randomized studies with autologous stem-cell derived from adipose tissue were conducted by his team.[27]

Research on physiology of cerebral venous drainage

The cerebral venous return was investigated by Professor Zamboni also in the Space, as PI of the study Drain Brain of the International Space Station, promoted by NASA, ESA and ASI. A novel post processing analysis of jugular vein ultrasound and strain gauge plethysmography allowed to monitor the astronaut cerebral venous drainage in microgravity condition.[28][29][30] Space trials involved the Italian astronaut Samantha Cristoforetti.

Zamboni also described other anomalies of cerebral venous return which generates neurological symptoms,[31][32] as well as models in physiology of brain drainage [33][34]

Diagnosis on painting

Initially started as a hobby, identify disease processes in paintings and canvas is lately one of the Professor Zamboni' research fields. Diagnosis ranges from the Raphael's Michelangelo, Rembrandt's Bathsheba at Her Bath and Caravaggio's Bacchus. In "The medical enigma of Rembrandt's Bathsheba", Zamboni solves the mystery of the controversial detail of the woman's left breast, furrowed by an irregular, slightly swollen mark of a color between bluish and brownish. The model for the Bathsheba, admired by millions of visitors to the Louvre, was suffering from thrombophlebitis of a superficial vein of the breast, a condition described by Mondor in 1939," states the professor. So not mastitis or carcinoma, as believed for centuries. According to Zamboni, the varicose veins on the legs and knees are evident in Michelangelo, in the role of Heraclitus, frescoed by Raphael in The School of Athens. The evident anemia, brown skin, and acanthosis nigricans of Young Sick Bacchus of Caravaggio exhibited at the Galleria Borghese in Rome, according to Zamboni suggest the diagnosis of Addison's disease, a condition described in the 1800s affecting the adrenal glands.[35][36][37][38]

Works

  • Alessia Giaquinta; Byung-Boong Lee; Carlo Setacci; Pierfrancesco Veroux; Paolo Zamboni (2018). Latest Frontiers of Hemodynamics, Imaging and Treatment of Obstructive Venous Disease. Minerva Medica. ISBN 978-88-7711-929-2.
  • Paolo Zamboni; Erika Mendoza; Sergio Gianesini (2018). Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Cham, Switzerland: Springer. ISBN 978-3-319-70638-2.
  • Paolo Zamboni; Claude Franceschi (2009). Principles of Venous Hemodynamics. Nova Science Publishers. ISBN 978-1-60692-485-3.

Awards and recognition

Zamboni was appointed "Commander" of the Order of Merit of the Italian Republic in 2017.[39]

He is listed on topitalianscientists.org.[40]

References

  1. ^ "Curriculum - Paolo Zamboni".
  2. ^ a b Zamboni, P; Galeotti, R; Menegatti, E; Malagoni, A M; Tacconi, G; Dall'Ara, S; Bartolomei, I; Salvi, F (2008-12-09). "Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis". Journal of Neurology, Neurosurgery & Psychiatry. 80 (4): 392–399. doi:10.1136/jnnp.2008.157164. ISSN 0022-3050. PMC 2647682. PMID 19060024.
  3. ^ Rosalind C. Kalb (2008). Rosalind C. Kalb (ed.). Multiple sclerosis: the questions you have-- the answers you need. Demos Health Series (4th ed.). New York: Demos Medical Pub. p. 72. ISBN 978-1-932603-45-3. OCLC 162501964.
  4. ^ Eric Mowatt-Larssen; Sapan S. Desai; Anahita Dua; Cynthia E. K. Shortell, eds. (2014). Phlebology, vein surgery and ultrasonography: diagnosis and management of venous disease. Cham: Springer. pp. 208–210. ISBN 978-3-319-01812-6. OCLC 870563977.
  5. ^ Al-Omari MH, Rousan LA (April 2010). "Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis". International Angiology. 29 (2): 115–20. PMID 20351667.
  6. ^ Khan O, Filippi M, Freedman MS, Barkhof F, Dore-Duffy P, Lassmann H, et al. (March 2010). "Chronic cerebrospinal venous insufficiency and multiple sclerosis". Annals of Neurology. 67 (3): 286–90. CiteSeerX 10.1.1.606.8269. doi:10.1002/ana.22001. PMID 20373339. S2CID 16580847. A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS).
  7. ^ Lee AB, Laredo J, Neville R (April 2010). "Embryological background of truncular venous malformation in the extracranial venous pathways as the cause of chronic cerebro spinal venous insufficiency". International Angiology. 29 (2): 95–108. PMID 20351665. A similar condition involving the head and neck venous system may cause chronic cerebro-spinal venous insufficiency (CCSVI) and may be involved in the development or exacerbation of multiple sclerosis.
  8. ^ a b c Qiu J (May 2010). "Venous abnormalities and multiple sclerosis: another breakthrough claim?". The Lancet. Neurology. 9 (5): 464–5. doi:10.1016/S1474-4422(10)70098-3. PMID 20398855. S2CID 206159378.
  9. ^ Ferral, Hector; Lorenz, Jonathan M. (2018-04-13). Radcases Interventional Radiology. Thieme Medical Publishers. ISBN 978-1-62623-283-9.
  10. ^ a b "Experimental multiple sclerosis vascular shunting procedure halted at Stanford". Annals of Neurology. 67 (1): A13-5. January 2010. doi:10.1002/ana.21969. PMID 20186848. S2CID 37071227.
  11. ^ Stone K (March 2012). "Medical device conflict of interest in the CCSVI debate". Annals of Neurology. 71 (3): A6-8. doi:10.1002/ana.23560. PMID 22451214. S2CID 205343879.
  12. ^ FDA (May 2012). "FDA Safety Communication: Chronic Cerebrospinal Venous Insufficiency Treatment in Multiple Sclerosis Patients". Food and Drug Administration. Retrieved 6 November 2013.
  13. ^ "Safety Alerts for Human Medical Products - Balloon angioplasty devices to treat autonomic dysfunction: FDA Safety Communication - FDA concern over experimental procedures". www.fda.gov. Retrieved 9 March 2017.
  14. ^ Zamboni P, Tesio L, Galimberti S, Massacesi L, Salvi F, D'Alessandro R, et al. (January 2018). "Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial". JAMA Neurology. 75 (1): 35–43. doi:10.1001/jamaneurol.2017.3825. PMC 5833494. PMID 29150995.
  15. ^ Traboulsee AL, Machan L, Girard JM, Raymond J, Vosoughi R, Hardy BW, et al. (October 2018). "Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial". Neurology. 91 (18): e1660 – e1668. doi:10.1212/WNL.0000000000006423. PMC 6207414. PMID 30266886.
  16. ^ Ghezzi A, Comi G, Federico A (February 2011). "Chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis". Neurological Sciences. 32 (1): 17–21. doi:10.1007/s10072-010-0458-3. PMID 21161309. S2CID 27687609.
  17. ^ Dorne H, Zaidat OO, Fiorella D, Hirsch J, Prestigiacomo C, Albuquerque F, Tarr RW (December 2010). "Chronic cerebrospinal venous insufficiency and the doubtful promise of an endovascular treatment for multiple sclerosis". Journal of NeuroInterventional Surgery. 2 (4): 309–11. doi:10.1136/jnis.2010.003947. PMID 21990639.
  18. ^ Jagannath VA, Pucci E, Asokan GV, Robak EW (May 2019). "Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis". The Cochrane Database of Systematic Reviews. 5 (7): CD009903. doi:10.1002/14651858.CD009903.pub3. PMC 6543952. PMID 31150100.
  19. ^ Traboulsee AL, Knox KB, Machan L, Zhao Y, Yee I, Rauscher A, et al. (January 2014). "Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study". Lancet. 383 (9912): 138–45. doi:10.1016/S0140-6736(13)61747-X. PMID 24119384. S2CID 25925875.
  20. ^ Paul F, Wattjes MP (January 2014). "Chronic cerebrospinal venous insufficiency in multiple sclerosis: the final curtain". Lancet. 383 (9912): 106–8. doi:10.1016/S0140-6736(13)61912-1. PMID 24119383. S2CID 205970625. Archived from the original on 29 October 2019. Retrieved 29 October 2019.
  21. ^ Cocozza S, Canna A, Lanzillo R, Russo C, Postiglione E, Liuzzi R, et al. (August 2016). "Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study". Br J Radiol. 89 (1064). doi:10.1259/bjr.20160321. PMC 5124897. PMID 27282838.
  22. ^ Zamboni, P.; Cisno, C.; Marchetti, F.; Mazza, P.; Fogato, L.; Carandina, S.; De Palma, M.; Liboni, A. (2003). "Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial". European Journal of Vascular and Endovascular Surgery. 25 (4): 313–318. doi:10.1053/ejvs.2002.1871. PMID 12651168.
  23. ^ Carandina, S.; Mari, C.; De Palma, M.; Marcellino, M.G.; Cisno, C.; Legnaro, A.; Liboni, A.; Zamboni, P. (2008). "Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a Long Term Randomised Trial". European Journal of Vascular and Endovascular Surgery. 35 (2): 230–237. doi:10.1016/j.ejvs.2007.09.011. PMID 17964822.
  24. ^ Zamboni, Paolo; Franceschi, Claude (2009). Principles of venous hemodynamics. Hauppauge, NY: Nova Science Publishers. ISBN 978-1-60692-485-3. OCLC 265657952.
  25. ^ Zamboni, Paolo; Mendoza, Erika; Gianesini, Sergio (2018-05-29). Saphenous vein-sparing strategies in chronic venous disease. Cham, Switzerland: Springer. ISBN 978-3-319-70638-2. OCLC 1038068108.
  26. ^ Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ (September 30, 2021). "CHIVA method for the treatment of chronic venous insufficiency". Cochrane Database of Systematic Reviews. 2021 (9): CD009648. doi:10.1002/14651858.CD009648.pub4. PMC 8481765. PMID 34590305. S2CID 238229135.
  27. ^ Zollino, Ilaria; Campioni, Diana; Sibilla, Maria Grazia; Tessari, Mirko; Malagoni, Anna Maria; Zamboni, Paolo (2019). "A phase II randomized clinical trial for the treatment of recalcitrant chronic leg ulcers using centrifuged adipose tissue containing progenitor cells". Cytotherapy. 21 (2): 200–211. doi:10.1016/j.jcyt.2018.10.012. PMID 30583949. S2CID 58610844.
  28. ^ "Space station investigation goes with the flow". phys.org. Retrieved 2020-01-09.
  29. ^ Zamboni, Paolo; Sisini, Francesco; Menegatti, Erica; Taibi, Angelo; Gadda, Giacomo; Tavoni, Valentina; Malagoni, Anna Maria; Tessari, Mirko; Gianesini, Sergio; Gambaccini, Mauro (March 2018). "Ultrasound Monitoring of Jugular Venous Pulse during Space Missions: Proof of Concept". Ultrasound in Medicine & Biology. 44 (3): 726–733. doi:10.1016/j.ultrasmedbio.2017.11.001. PMID 29276139.
  30. ^ Taibi, A; Gadda, G; Gambaccini, M; Menegatti, E; Sisini, F; Zamboni, P (2017-10-31). "Investigation of cerebral venous outflow in microgravity". Physiological Measurement. 38 (11): 1939–1952. Bibcode:2017PhyM...38.1939T. doi:10.1088/1361-6579/aa8980. ISSN 1361-6579. PMID 28857747. S2CID 42665674.
  31. ^ Zamboni, Paolo; Scerrati, Alba; Menegatti, Erica; Galeotti, Roberto; Lapparelli, Marcello; Traina, Luca; Tessari, Mirko; Ciorba, Andrea; De Bonis, Pasquale; Pelucchi, Stefano (December 2019). "The eagle jugular syndrome". BMC Neurology. 19 (1): 333. doi:10.1186/s12883-019-1572-3. ISSN 1471-2377. PMC 6925502. PMID 31864313.
  32. ^ De Bonis, Pasquale; Menegatti, Erica; Cavallo, Michele Alessandro; Sisini, Francesco; Trapella, Giorgio; Scerrati, Alba; Zamboni, Paolo (July 2019). "JEDI (jugular entrapment, dilated ventricles, intracranial hypertension) syndrome: a new clinical entity? A case report". Acta Neurochirurgica. 161 (7): 1367–1370. doi:10.1007/s00701-019-03908-2. ISSN 0001-6268. PMID 31025176. S2CID 131776842.
  33. ^ Zamboni, Paolo; Menegatti, Erica; Pomidori, Luca; Morovic, Sandra; Taibi, Angelo; Malagoni, Anna Maria; Cogo, Anna Luisa; Gambaccini, Mauro (2012-03-01). "Does thoracic pump influence the cerebral venous return?". Journal of Applied Physiology. 112 (5): 904–910. doi:10.1152/japplphysiol.00712.2011. ISSN 8750-7587. PMID 22174396. S2CID 25820701.
  34. ^ Gadda, G.; Taibi, A.; Sisini, F.; Gambaccini, M.; Zamboni, P.; Ursino, M. (2015-02-01). "A new hemodynamic model for the study of cerebral venous outflow" (PDF). American Journal of Physiology. Heart and Circulatory Physiology. 308 (3): H217 – H231. doi:10.1152/ajpheart.00469.2014. hdl:11392/2370597. ISSN 0363-6135. PMID 25398980. S2CID 9201170.
  35. ^ Zamboni, Paolo (2020). "The medical enigma of Rembrandt's Bathsheba". Journal of Thrombosis and Haemostasis. 18 (6): 1268–1270. doi:10.1111/jth.14801. PMID 32346960.
  36. ^ "Diagnosi su tela: le grandi malattie dipinte dei pittori del passato". 27 June 2020.
  37. ^ Corriere della Sera Corriere Salute, pp. 10 e 11 Giovedì 18 Giugno 2020
  38. ^ "Risolto l'enigma sul seno della Betsabea". 18 June 2020.
  39. ^ "Commendatore Ordine al Merito della Repubblica Italiana".
  40. ^ "Top Italian Scientists". topitalianscientists.org. Retrieved 2020-01-09.