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segments.

b) Open deviating shunt – in these shunts blood never returns to the escape point. Valsalva manoeuvre is negative and venous blood is deviated by a branch of the saphenous stem.

c) Open bypass shunt – bypasses occlusions and obstacles. Occluded or stenosed or congenitally missing parts of the deep venous system mean a high resistance of flow is bypassed by a

superficial compensatory pathway. This type of shunt can have a vital significance in the circulation of the limb, therefore they must be preserved in any intervention.

d) Mixed shunt – is a combination of open bypass and active closed shunts.

The world of shunts is a great challenge for a practising phlebologist. There are many variations, so duplex ultrasound mapping is time-consuming at the beginning, but with some experience this becomes routine

40) FELIPE PUCINELLI FACCINI et Al.: CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report

J. vasc. bras. vol.18  Porto Alegre  2019  Epub Jan 14, 2019

ABSTRACT

CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site.

ARTICLES CONCERNING SUBJECTES OF CHIVA PROCEDURE NOT IN TERMS OF RECURRENCES / CLINIC DATA BUT OF BIOCHEMICAL, HEMODYNAMIC PARAMETERS, THROMBOSES AND COMPLICATIONS

1) CAPPELLI M. et Al.: Considerazioni sul ruolo fisiopatologico delle perforanti nella varicosi essenziale, quale presupposto alla concezione terapeutica dell’intervento CHIVA

Ospedali d’Italia – Chirurgia nov–dic 1991, vol. XLIV n°6, pp.

425–438.

2) ZAMBONI P. et Al.: Alternative saphenous vein sparing surgery for future grafting

Panminerva Med 1995; 37:19

There are two possibilities: External valvuloplasty and CHIVA. Clinical, ecographic parameters, pressure values and R.L.R have been evaluated

3) PINTOS T., SENIN E., RAMOS R., RODRIGUEZ E., MARTINEZ PEREZ M., Trombosis de safena interna post–CHIVA. Incidencia, factores condicionantes y repercusiones clınicas, Presented at the XLVII National Congress of the Spanish Society of Angiology and Vascular Surgery, Valladolid 2001.

Pintos et al. Studied 165 patients after CHIVA treatment and compared the presence of postoperative superficial venous thrombosis of the GSV in different groups. 101 patients (61%) were treated with CHIVA 1 or 2, 64 patients (39%) with a non-draining method consisting of CHIVA 1+2 (simultaneous closure of the saphenous-femoral junction and CHIVA 2 points with type 3 shunt) . The preoperative mean diameter of the GSV was 0.78 cm (0.28 to 1.70 cm). All patients carried out prophylaxis with low molecular weight heparin for 15 days after the operation, and wore class II compression stockings for 6 weeks. Controls were performed by ultrasonography at 1, 3 and 6 months after surgery.

The incidence of superficial venous thrombosis of GSV in the CHIVA 1 or 2 group was 9 patients (9%) while in the CHIVA group non-drained 25 patients (38%).

The difference between the incidence of superficial venous thrombosis in the two groups was statistically significant (p <0.001).

This shows that the relatively high incidence of superficial venous thrombosis from the first publications on the CHIVA technique it has been negatively affected by the use of the CHIVA 1 + 2 procedure. If the CHIVA 1 + 2 (non-draining) procedure is not used, the incidence of superficial venous thrombosis decreases significantly. (Comment by Paolo Zamboni)

4) ZAMBONI P., CISNO C., MARCHETTI F., QUAGLIO D., MAZZA P., LIBONI A., Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery, Eur. J. Vasc. Endovasc. Surg., 2001 Apr, 21(4): pp. 361–9.

The aim of this prospective study was to verify the possibility of reflux suppression in GSV without any crossectomy and / or stripping procedure. The authors studied about forty patients with primary chronic venous insufficiency of all clinical classes, with demonstrated Doppler incompetence of both the saphenous-femoral junction and the large trunk of the GSV, with the presence of a re-entry perforator placed along a saphenous tributary. The air plethysmography and duplex data were both collected before the intervention and at 1 and 6 months after. The duplex investigation showed the presence of an antegrade flow and the disappearance of reflux in the GSV in 100% of cases after 1 and in 85% at 6 months (Comment by Paolo Zamboni)

5) FRANCESCHI C.: CHIVA effectiveness score: the correct one is below.

Eur J Vasc Endovasc Surg. 2012 Sep;44(3):351; author reply 352. 

Comment on: Validation of a new duplex derived haemodynamic effectiveness score, the saphenous treatment score, in quantifying varicose vein treatments. [Eur J Vasc Endovasc Surg. 2012]

6) MALDONADO-FERNANDEZ et Al.:  Postoperative complications of CHIVA technique for the treatment of chronic venous failure 

(2010) Angiologia, 62 (3), pp. 91-96. 

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