Paolo Zamboni

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Paolo Zamboni
Paolo Zamboni image.jpg
Paolo Zamboni
Born(1957-03-25)25 March 1957
AwardsISNVD Gold Medal
Scientific career
FieldsVascular Diseases
InstitutionsFerrara, Italy

Paolo Zamboni (born 25 March 1957, Ferrara, Italy) is an Italian doctor included among the Top Italian Scientists.[1] He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.[2][3]

He is known to have discovered, identified and described a vascular disease called chronic cerebrospinal venous insufficiency (CCSVI)[4] strongly related with multiple sclerosis and other neurodegenerative diseases such as Ménière and Parkinson.[5][6][7]


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.[8] 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[9][10][11]

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

Chronic Cerebrospinal Venous Insufficiency – CCSVI[edit]

Balloon dilatation of stenosed jugular vein in a MS patient.

Chronic Cerebrospinal Venous Insufficiency[4] is characterized by defective venous drainage from the brain and spinal cord as a result of outflow obstruction in the extracranial venous system, mainly caused by stenosis, defective valves, hypoplasia, and or compression of the Internal jugular vein, azygos vein. CCSVI was initially brought forth as possible contributing factor to the pathogenesis and clinical manifestations of multiple sclerosis and of other neurodegenerative diseases.[12][13][14] Indeed, in 2009 he claimed to have found this vascular condition in an unblinded preliminary study that in over 90% of the participants with multiple sclerosis there were problems in veins draining their brain.[15] He also noted a high level of accumulation of iron deposits in the brain, presumably due to limited blood outflow.

Studies have demonstrated a relationship between tissue iron accumulation and the inflammatory changes associated with chronic venous insufficiency,[16][17] so the presence of iron may contributes to the neurodegeneration of brain.[18]

Nowadays evidence already exists for reduced perfusion in patients with MS that in turn contributes to neurodegeneration.[19][20] Current data suggests that defective extracranial venous drainage reduces the perfusion of brain parenchyma.[21][22][23] Attention has been drawn to the role of abnormal venous drainage in multiple sclerosis in the form of CCSVI. Recent quantitative studies on cerebral venous drainage demonstrate that flow in the jugular veins is linearly related to global brain perfusion.[23]

According to Zamboni some symptoms of multiple sclerosis in his own wife as well as in 73% of his patients were abated after an endovascular procedure to open these veins.[24][25][26]

The theory was controversial. The National Multiple Sclerosis Society had said that, while "there is not yet enough evidence to conclude that obstruction of veins causes MS," that "[Zamboni's] hypothesis on CCSVI and its corrective treatment is a path that must be more fully explored and one that we are supporting with research funding."[27] Since 2010, there has been more research that disputes the Zamboni theory.[28][29][30]

On November 28, 2017, Zamboni admitted that balloon venous angioplasty cannot be indiscriminately applied to all patients affected by relapsing remitting MS with associated CCSVI on the basis of "a double-blind randomized controlled trial versus sham therapy.[31] A further expanded analysis of the same double blinded randomized sham controlled trial (Brave Dreams) [32] showed that venoplasty decreases new cerebral lesions at 1 year in a wider patients population which includes also secondary progressive MS. Further post hoc analysis demonstrated the need to select patients. Patients appropriate for venoplasty, according to the morphology of venous malformation, were more likely to be free from accumulation of new cerebral lesions at MRI.[32][33]

Research on Chronic Venous Insufficiency - CVI[edit]

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 [34][35] and published books.[36][37]

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.[38]

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.[39]

Research on physiology of cerebral venous drainage[edit]

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.[40][41][42] Space trials involved the Italian astronaut Samantha Cristoforetti.

Zamboni also described other anomalies of cerebral venous return which generates neurological symptoms,[43][44] as well as models in physiology of brain drainage [45][46]

Diagnosis on painting[edit]

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.[47][48][49][50]


  • 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.{{cite book}}: CS1 maint: multiple names: authors list (link)
  • Paolo Zamboni, Erika Mendoza, Sergio Gianesini (2018). Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer. ISBN 978-3-319-70638-2.{{cite book}}: CS1 maint: multiple names: authors list (link)
  • Paolo Zamboni, Claude Franceschi (2009). Principles of Venous Hemodynamics. Nova Science Publishers. ISBN 978-1-60692-485-3.


Zamboni was appointed "Commander" of the Order of Merit of the Italian Republic in 2017.[51]


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  4. ^ a b "The Liberation Treatment: A whole new approach to MS" (FLV, Web page). CTV Television Network, W5. 2009. Retrieved 2009-12-10.
  5. ^ P. Zamboni, R. Galeotti, E. Menegatti, A.M. Malagoni, G. Tacconi, S. Dall'Ara, I. Bartolomei and F. Salvi. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 2009;80;392-399
  6. ^ Rosalind C. Kalb (2011). Multiple Sclerosis: The Questions You Have-The Answers You Need (5th ed.). p. 72.
  7. ^ Mowatt-Larssen, Eric; Desai, Sapan S.; Dua, Anahita; Shortell, Cynthia E. K. (2013). Phlebology, Vein Surgery and Ultrasonography: Diagnosis and Management of Venous Disease. Springer Science & Business Media. pp. 208–210.
  8. ^ "Curriculum - Paolo Zamboni".
  9. ^ 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.
  10. ^ 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.
  11. ^ 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.
  12. ^ "The Contribution of Extra Cranial Venous Drainage to Neuro-Inflammation in Multiple Sclerosis"". Neuroinflammation (Second ed.). London: Minagar, Alireza. 2018-07-30. p. 579. ISBN 978-0-12-811724-8. OCLC 1047959805.
  13. ^ Zivadinov, Robert; Bastianello, Stefano; Dake, Michael D.; Ferral, Hector; Haacke, E. Mark; Haskal, Ziv J; Hubbard, David; Liasis, Nikolaos; Mandato, Kenneth; Sclafani, Salvatore; Siddiqui, Adnan H. (2014). "Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease". Journal of Vascular and Interventional Radiology. 25 (11): 1785–1794.e17. doi:10.1016/j.jvir.2014.07.024. PMID 25255703.
  14. ^ Lee, B. B.; Baumgartner, I.; Berlien, P.; Bianchini, G.; Burrows, P.; Gloviczki, P.; Huang, Y.; Laredo, J.; Loose, D. A.; Markovic, J.; Mattassi, R. (2015). "Diagnosis and Treatment of Venous Malformations. Consensus Document of the International Union of Phlebology (IUP): updated 2013". International Angiology: A Journal of the International Union of Angiology. 34 (2): 97–149. ISSN 1827-1839. PMID 24566499.
  15. ^ "Sclerosi multipla: la speranza viene da Ferrara? | NN - Notizie dall'Italia e dal Mondo dal 2009". 14 January 2010. Retrieved 7 September 2013.
  16. ^ Ducksoo Kim; Dan E Orron; Nilesh H Patel; Alik Farber (2019-10-31). "Chapter 32: Chronic Cerebrospinal Venous Insufficiency". Vascular imaging and intervention. New Delhi, India. ISBN 978-93-85999-02-4. OCLC 950933946.
  17. ^ Zamboni, Paolo; Tognazzo, Silvia; Izzo, Marcello; Pancaldi, Francesca; Scapoli, Gian L.; Liboni, Alberto; Gemmati, Donato (2005). "Hemochromatosis C282Y gene mutation increases the risk of venous leg ulceration". Journal of Vascular Surgery. 42 (2): 309–314. doi:10.1016/j.jvs.2005.04.003. PMID 16102632.
  18. ^ Singh AV, Zamboni P (December 2009). "Anomalous venous blood flow and iron deposition in multiple sclerosis". J. Cereb. Blood Flow Metab. 29 (12): 1867–78. doi:10.1038/jcbfm.2009.180. PMID 19724286.
  19. ^ D'haeseleer, Miguel; Cambron, Melissa; Vanopdenbosch, Ludo; De Keyser, Jacques (2011). "Vascular aspects of multiple sclerosis". The Lancet Neurology. 10 (7): 657–666. doi:10.1016/S1474-4422(11)70105-3. PMID 21683931. S2CID 18944605.
  20. ^ Minagar, Alireza, ed. (2018). "The Contribution of Extra Cranial Venous Drainage to Neuro-Inflammation in Multiple Sclerosis". Neuroinflammation. Department of Neurology, Louisiana State University HealthSciences Center, Shreveport, LA, United States (2nd ed.). London: Academic Press. p. 579. ISBN 978-0-12-811724-8. OCLC 1047959805.
  21. ^ Zamboni, Paolo; Menegatti, Erica; Weinstock-Guttman, Bianca; Dwyer, Michael G; Schirda, Claudiu V; Malagoni, Anna M; Hojnacki, David; Kennedy, Cheryl; Carl, Ellen; Bergsland, Niels; Magnano, Christopher (2011). "Hypoperfusion of brain parenchyma is associated with the severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: a cross-sectional preliminary report". BMC Medicine. 9 (1): 22. doi:10.1186/1741-7015-9-22. ISSN 1741-7015. PMC 3059278. PMID 21385345.
  22. ^ Garaci, Francesco G.; Marziali, Simone; Meschini, Alessandro; Fornari, Maria; Rossi, Silvia; Melis, Milena; Fabiano, Sebastiano; Stefanini, Matteo; Simonetti, Giovanni; Centonze, Diego; Floris, Roberto (2012). "Brain Hemodynamic Changes Associated with Chronic Cerebrospinal Venous Insufficiency Are Not Specific to Multiple Sclerosis and Do Not Increase Its Severity". Radiology. 265 (1): 233–239. doi:10.1148/radiol.12112245. ISSN 0033-8419. PMID 22915599.
  23. ^ a b Utriainen, David; Trifan, Gabriela; Sethi, Sean; Elias, Saba; Hewett, Joseph; Feng, Wei; Haacke, E Mark (2012). "Magnetic resonance imaging signatures of vascular pathology in multiple sclerosis". Neurological Research. 34 (8): 780–792. doi:10.1179/1743132812Y.0000000078. ISSN 0161-6412. PMID 22971468. S2CID 206851847.
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  26. ^ [1] Archived January 23, 2010, at the Wayback Machine
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  29. ^ Traboulsee AL. (2013). "Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study" (PDF). The Lancet. 383 (9912): 138–145. doi:10.1016/S0140-6736(13)61747-X. PMID 24119384. S2CID 25925875. Archived from the original (PDF) on 2013-10-17. Retrieved 2013-10-17.
  30. ^ Crowe, Kelly. "'From bold idea to scientific quackery': UBC study claims to debunk controversial MS treatment | CBC News". CBC. Retrieved 17 January 2019.
  31. ^ Branswell H. Scientist concedes his controversial MS therapy, once a source of great hope, is ‘largely ineffective’ StatNews:Health. November 28, 2017
  32. ^ a b Zamboni, Paolo; Galeotti, Roberto; Salvi, Fabrizio; Giaquinta, Alessia; Setacci, Carlo; Alborino, Salvatore; Guzzardi, Giuseppe; Sclafani, Salvatore J.; Maietti, Elisa; Veroux, Pierfrancesco (2019-11-17). "Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial". Journal of Endovascular Therapy. 27: 9–17. doi:10.1177/1526602819890110. ISSN 1526-6028. PMC 6970429. PMID 31735108.
  33. ^ "Liberation therapy: What we know about the controversial MS treatment 10 years later". CTVNews. 2019-11-22. Retrieved 2020-01-09.
  34. ^ 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.
  35. ^ 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.
  36. ^ Zamboni, Paolo; Franceschi, Claude (2009). Principles of venous hemodynamics. Hauppauge, NY: Nova Science Publishers. ISBN 978-1-60692-485-3. OCLC 265657952.
  37. ^ Zamboni, Paolo; Mendoza, Erika; Gianesini, Sergio (2018-05-29). Saphenous vein-sparing strategies in chronic venous disease. Cham, Switzerland. ISBN 978-3-319-70638-2. OCLC 1038068108.
  38. ^ 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. doi:10.1002/14651858.CD009648.pub4. PMID 34590305.
  39. ^ 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.
  40. ^ "Space station investigation goes with the flow". Retrieved 2020-01-09.
  41. ^ 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.
  42. ^ 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.
  43. ^ 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.
  44. ^ 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.
  45. ^ 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.
  46. ^ 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. ISSN 0363-6135. PMID 25398980.
  47. ^ 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.
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  49. ^ Corriere della Sera Corriere Salute, pp. 10 e 11 Giovedì 18 Giugno 2020
  50. ^ "Risolto l'enigma sul seno della Betsabea".
  51. ^ "Commendatore Ordine al Merito della Repubblica Italiana".

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