TVAM (Transvascular Autonomic Modulation)

TVAM (Transvascular Autonomic Modulation) is an endovascular procedure in which a catheter is inserted via a small incision and threaded up into the jugular vein. Treatment involves stretching the vein with small catheters, activating autonomic nerve fibers located within the outer tissues of the vein. By stimulating the nerve fibers, we activate the venous distension reflex leading to increased sympathetic tone. The reinvigorated ANS (autonomic nervous system) optimizes function of the body. Patients respond with relief from cognitive impairment (brain fog), chronic fatigue, waking headaches, thermal intolerance, bladder/bowel dysfunction, and other debilitating symptoms of autonomic dysfunction.

The basis of TVAM is the venous distention reflex (VDR) Venous Distension Reflex. Our clinical experience supports this theory, we believe that the benefits of the treatment may come through stimulation of the afferent autonomic nerve fibers encasing the jugular vein. These nerve fibers are stimulated during the procedure. By activating the VDR sympathetic function improves leading to symptom relief for treated patients.

Our Medical Facility

The TVAM procedure is performed on an outpatient basis at our state-of-the-art medical center, located in Newport Beach, California.

Our medical center houses the very latest in diagnostic equipment along with on-site surgical suites and recovery facilities. As a result, the entire treatment process can be handled in-house, from initial testing through the procedure itself.

The Procedure

During the procedure, the patient will receive conscious sedation to maintain comfort throughout, and the treatment will typically take under an hour to perform.

The procedure involves both venographic and intravascular ultrasound (IVUS) evaluation of the jugular, azygos, renal, and spinal veins. Since venous abnormalities are subtle and challenging to identify, during the procedure Dr. Arata uses an IVUS probe attached to the end of the small catheter to create pictures from inside of the veins.

This technique increases the accuracy of the overall evaluation of the venous system and allows for more precise measurements of the veins themselves. If a venous abnormality is seen during the procedure, it is corrected by dilation in hopes of providing symptom relief.

Safety Precautions

Our treatment protocols maximize the opportunity for symptom relief while placing the greatest possible emphasis on patient safety.

After the Procedure

The majority of patients experience little to no discomfort following their procedure, and they are typically able to resume normal activity within two days.

Patients are released from the center after they meet our discharge criteria and are asked to remain in the immediate area for 48 hours after their procedure. After this 48 period, patients are typically allowed to return to their homes.

In an effort to provide optimal safety and comfort we have all patients stay at the Newport Beach Fairmont, which is in close proximity to our medical center.


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*The actual benefits that individual patients experience from treatment can vary from patient to patient. This disparity is based on a number of factors that are often times uncontrollable. While some patients have experienced substantial relief, most patients describe symptom relief of a moderate degree. Others who have undergone treatment have experienced minimal or no relief at all. While we make every effort to provide treatment that will improve symptoms to the greatest degree possible, there is no guarantee that treatment will provide symptom relief.

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