aree scientifiche

Abstract

During the last years a lot of new techniques to treat varicose Veins were introduced in Germany. They question established concepts, specially the treatment of refluxive great saphenous vein with safeno-femoral incompetence. CHIVA treats the groin-region in a different way than the classical accepted crossectomy and stripping of saphenous vein. The saphenous vein and healthy side branches of the crosse are left in situ, just double ligation of the safeno-femoral junction is performed. This technique is explained with fotos and pictures: Disection of safeno-femoral junction, double ligation of safeno-femoral junction, once just at the level of femoral vein and twice just below the side branches.

10) DELFRATE R., BRICCHI M., FRANCESCHI C., GOLDONI M., Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins,

Veins and Lymphatics, 2014, 3: pp. 19–22, https://www.pagepressjournals.org index.php/vl/article/view/vl.2014.1919.

The aim of this study was to determine if a crossotomy was needed or if a ligation could be performed for safety reasons on patients operated on an outpatient basis.

199 legs were followed-up after the saphenous-femoral interruption in the CHIVA context with three different techniques.

Common to all techniques was to place a titanium clip (10 mm long and 1 mm thick) flush with the femoral vein in order to prevent the presence of a residual saphenous stump.

– First group: (N = 61) Crossotomy (with interruption of the saphenous-femoral junction, 29 months follow-up);

– second group: (N = 82) triple ligature of the saphenous vein (TSFL performed with a suture covered with non-absorbable thread (14 months follow-up);

– third group: (N = 56) Triple polypropylene ligature (TPL; 12 months follow-up).

In the first two groups the percentage of new refluxes to the Valsalva maneuver at SFJ level was 6.1%, in the second (which however had a shorter follow-up) the presence of reflux on the SFJ at Valsalva was 4.9% , without statistically significant differences. In the third group, a percentage of channelization of 37.5% was detected after one year, the difference between group 3 and 1, as well as with group 2 was highly significant with p <0.001 (Comment by Paolo Zamboni)

11) MENDOZA E, AMSLER F., CHIVA with endoluminal procedures: LASER versus VNUS –treatment of the saphenofemoral junction, Phlebologie, 2017, 46: pp. 5–12.

From its description, the CHIVA strategy has always been performed with open surgical techniques.

After the introduction of endoluminal thermal techniques, this first approach aimed to compare LASER and / or Radio Frequency in the obliteration of the saphenous-femoral junction in the CHIVA context.

104 patients were studied before and at 3 and 6 months after GSV treatment with CHIVA strategy using endoluminal thermal techniques to close the inguinal segment (75 patients with VNUS [Closure – Fast], 29 LASER [1470nm, Radial Intros]).

A significant reduction of the GSV diameters at the level of the proximal thigh and of the CFV was detected, as well as an improvement in the clinical results (Table 10.17), the latter comparable to those achieved after surgical lacrossectomy.

The author concludes that it is suitable to apply endoluminal thermal techniques in the context of the CHIVA strategy. (Comment by Paolo Zamboni)

12) PASSARIELLO F. et Al.: The office based CHIVA

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