• Adnan I Qureshi, Muhammad A Saleem, Omer Naveed, Mohtasim A Qureshi, and Shawn S Wallery.
• Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
• J Vasc Interv Neurol. 2017 Dec 1; 9 (6): 14-19.

BackgroundSeveral studies using Doppler ultrasound have suggested cerebral venous drainage is through paravertebral venous plexus due to the collapse of internal jugular veins in an upright position.MethodsWe present a technique of acquiring venographic images during an upright position as part of catheter-based angiography to provide additional information regarding cerebral venous diseases. Angiographic images in anteroposterior projection were acquired in lying position and after patients were placed at 60° using radiolucent supporting wedges on angiographic table.ResultsIn the first patient, there was activation of the paravertebral venous plexus as supplemental venous drainage to right internal jugular vein and stenosis of left internal jugular vein in high cervical segment in the upright position. There was relative collapse of both internal jugular veins in the mid-cervical region. In the second patient, there was attenuation of contrast opacification of right posterior cervical veins and complete occlusion of right internal jugular vein proximal extracranial segment (high-grade stenosis in lying position). There was activation of additional supplemental drainage to left internal jugular vein including paravertebral venous plexus. In the third patient, there was exacerbation of stenoses of the left and right internal jugular veins proximal extracranial segment in the upright position (moderate stenoses in lying position). There was activation of additional supplemental drainage via paravertebral venous plexus to both internal jugular veins.ConclusionOur results demonstrate prominent changes in venous drainage patterns during upright angiographic images. Further studies would have to identify the patients in whom additional information in the upright angiography may provide clinically relevant information.

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