Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that 
has been suggested by some to have a direct causative relation with the 
symptomatology associated with multiple sclerosis (MS) [1]. The core foundation 
of this theory is that there is abnormal venous drainage from the brain due to 
outflow obstruction in the draining jugular vein and/or azygos veins. This 
abnormal venous drainage, which is characterised by special ultrasound criteria, 
called the "venous hemodynamic insufficiency severity score" (VHISS), is said to 
cause intracerebral flow disturbance or outflow problems that lead to 
periventricular deposits [2]. In the CCSVI theory, these deposits have a great 
similarity to the iron deposits seen around the veins in the legs in patients 
with chronic deep vein thrombosis. Zamboni, who first described this new theory, 
has promoted balloon dilatation to treat the outflow problems, thereby curing 
CCSVI and by the same token alleviating MS complaints. However, this theory does 
not fit into the existing bulk of scientific data concerning the pathophysiology 
of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the 
associated balloon dilatation treatment, even though there is no supporting 
scientific evidence. Furthermore, most of the information we have comes from one 
source only. The treatment is called "liberation treatment," and the results of 
the treatment can be watched on YouTube. There are well-documented testimonies 
by MS patients who have gained improvement in their personal quality of life 
(QOL) after treatment. However, there are no data available from patients who 
underwent unsuccessful treatments with which to obtain a more balanced view. The 
current forum for the reporting of success in treating CCSVI and thus MS seems 
to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we 
receive approximately 10 to 20 inquiries a month about this treatment. In 
addition, many interventional radiologists, who are directly approached by MS 
patients, contact the Cardiovascular and Interventional Radiological Society of 
Europe (CIRSE) for advice. Worldwide, several centres are actively promoting and 
performing balloon dilatation, with or without stenting, for CCSVI. Thus far, no 
trial data are available, and there is currently no randomized controlled trial 
(RCT) in progress Therefore, the basis for this new treatment rests on anecdotal 
evidence and successful testimonies by patients on the Internet. CIRSE believes 
that this is not a sound basis on which to offer a new treatment, which could 
have possible procedure-related complications, to an often desperate patient 
population.