aree scientifiche

Abstract

Introduction. The most commonly used technique for varicose vein surgery is saphenectomy, although haemodynamic surgery (CHIVA) has been becoming increasing popular in the last decade in our country, probably, due to its good postoperative recovery and fewer complications. Objective. To describe and quantify postoperative complications of CHIVA technique in our experience as well as that reported in the literature. Methods. Retrospective descriptive study of 269 limbs operated on by our group and analysis of 2,793 audited limbs described in the literature. Results. The main complications in our patients were: 17 cases in 269 limbs (6.33 %), distributed as follows: 11 symptomatic saphenous vein thrombosis, two temporary paresthesias, two groin haematomas, one wound infection, and one headache after spinal anaesthesia. Complications reported in the literature: 208 cases in 2,793 limbs (7.44 %), distributed as follows: 82 symptomatic saphenous vein thrombosis, 70 neuritis and paresthesias, 25 minor skin infections, 9 haematomas, 7 groin infections, 6 lymphatic groin leakages, 4 deep vein thrombosis, and one groin haemorrhage. There is no mortality or major complications associated with this procedure. Conclusions. CHIVA surgical approach to chronic venous insufficiency is accompanied by a rapid recovery and active life with a 7 % complication rate, which are mostly benign and do not hinder recovery. Symptomatic saphenous vein thrombosis is the most common complication after surgery for varicose veins using this technique. © 2010 SEACV. Published by Elsevier España, S.L. All rights reserved.

7) MENDOZA E., BERGER V., ZOLLMANN C., BOMHOFF M., AMSLER F., Calibre reduction of great saphenous vein and common femoral vein after CHIVA

Phlebologie, 2011, 40(2): pp. 73–78

8) MENDOZA E., Diameter reduction of the great saphenous vein and the common femoralvein after CHIVA Long–term results, Phlebologie, 2013, 42: pp. 65–69.

The diameters of the GSV and the common femoral vein (CFV) reflect the hemodynamic overload of venous disease. This study was designed to answer Prof. Hach’s question in 2002, who asked if the femoral vein was overloaded after CHIVA.

Hach hypothesized that tributary blood (R3) that flowed through the saphenous vein (R2) into the deep veins (R1) usually through the saphenous-femoral junction could overload the femoral vein. Usually this blood would never circulate through the femoral vein, while after crossotomy in the CHIVA treatment, it will flow retrograde and drain through a perforating vein of the thigh or calf. Therefore, after surgical treatment, the femoral vein and the common femoral vein (CFV) distal to the saphenous-femoral junction would be overloaded by the blood returning from the perforating vein. The aim of this study was therefore to investigate the long-term effects of CHIVA treatment on CFV diameters. Patients underwent interventions aimed at maintaining drainage (CHIVA 2 in one or two phases, depending on the hemodynamic pattern).

In an initial phase, the evolution of the GSV diameters at the level of the proximal thigh and the CFV diameter in an upright position was measured (Mendoza 2011).

383 patients with 470 treated legs (84.4%) repeated a duplex examination between 8 and 25 weeks after surgery. The GSV and CFV diameters were compared before and after the surgery. The GSV diameter went from 6.1 mm before surgery to 4.5 mm after surgery in the female group and from 6.8 mm to 5.1 mm in the male group. The diameter of the common femoral vein went from 14.0 mm before surgery to 13.7 mm after surgery in the female group and from 16.5 mm to 16.1 mm after surgery in the male group, all of these

results showed a statistically significant difference.

In a second study (Mendoza 2013), the long-term effect on diameter was checked after 5 years in 43 patients included in the first study.

In addition, the clinical class (CEAP) and filling time were

compared with preoperative values ​​and after 8 weeks.

The diameter of the CFV and the diameter of the GSV decreased significantly even after 5 years, the CEAP clinical class decreased from 2.77 _ 0.81 before surgery to 1.72 _ 1.10 after 5 years (p = 0.007). The venous filling time measured with photoplethysmography was significantly longer from 15.24 _ 6.18s to 21.61 _ 9.2s after 5 years from the intervention (p = 0.022).

The authors therefore concluded that not only in the short term, but

also as a long-term result, the CHIVA intervention reduced both the CFV and GSV diameter and the C of the CEAP clinical classification and improved the venous filling time. (Comment by Paolo Zamboni)

9) MENDOZA E.: Crossectomy of the great saphenous vein with the CHIVA method

(2004) Vasomed, 16 (2), pp. 46-48.

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