aree scientifiche

Abstract

OBJECTIVE:

Evaluation of long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery.

EXPERIMENTAL DESIGN:

Prospective evaluation of 125 operations for primary varicose veins, 52 external valve-plasties of the sapheno-femoral junction (EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic correction of varicose veins (French acronyms: CHIVA), mean follow-up 30 months.

SETTING:

Department of General Surgery, University of Ferrara. Institutional practice, one-day surgery.

PATIENTS:

Patients were selected using clinical, Doppler cw, and duplex scanning evaluations. Patients with early varices due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and light reflection rheography-refilling time (LRR-RT) measurements.

INTERVENTIONS:

EV-SFJ restores valve function correcting vein wall dilitation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators.

MEASURES:

The outcome was evaluated with clinical and ultrasonographic examinations, AVP and LRR-RT measurements.

RESULTS:

Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments preserve the drainage function in the saphenous system. Varicose veins recurrence percentage rate was 9.6% and 10.9%, respectively.

CONCLUSIONS:

Following the proposed selection criteria, these two alternative procedures seem to be more effective in varices treatment than high ligation and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.

21) E. Mendoza, M. Cappelli : Sclerotherapy technique in CHIVA strategy

Phlebologie 2017; 46(02): 66-74

Summary

CHIVA has been developed by Claude France-schi in the 1980-es and was first published in 1988 (1). CHIVA is a strategy to treat venous insufficiency keeping the drainage through the saphenous veins and reentry perforating veins. Venous recirculations are stratified into shunt types depending on the origin of the reflux and the distal reentry to the deep veins (2). Originally the method was described with surgical interventions: Flush ligation of the saphenous veins from the deep veins (crossotomy), flush ligation of the tributaries at the saphenous trunk, disconnection of the refluxive saphenous trunk distal to a reentryperforating vein, disconnection of a refluxive perforating vein, if it is the proximal insufficiency point. Techniques in phlebology have developed: in the field of the vein ablating strategies (originally stripping) new possibilities are currently used, as foaming under ultrasound-guidance of the complete saphenous vein, and endoluminal heat techniques, as well as glue. In the same way, the CHIVA strategy has incorporated new techniques. This article highlights the application of foam sclero-therapy in combination with the CHIVA strategy. Sometimes in CHIVA it is useful to start with one step and complete the treatments months later, if a vein did not reduce its caliper or revert its flow after the first step.

22) FERRACANI E.: A Change of a Paradigm Under the Scope of a Cardiovascular Surgeon. Remodeling of the Great Saphenous Vein Instead of Ablation for Preservation of the Patient Anatomical Capital

Cardiology December 30, 2019  ecronicon.com open access.

Abstract

The presented work is an ongoing study by using a combined approach of sparing surgical techniques plus LASER 1470 nm for sparing the Great saphenous vein (GSV) at early hemodynamics stages.

Peak reflux Volume lower than 30cc by second, Total Reflux Volume (TRV) between 10 and 100 cc/s using low LASER LEED and no tumescence anesthesia for preservation of patient anatomical capital and the actual recovery value of this conduit for a future arterial bypass.

23) MENDOZA E. : Does the suture material influence the outcome after high ligation of great saphenous vein?

Vasa (2020), 49 (2), 153–155 https://doi.org/10.1024/0301-1526/a000833

It is a review of the literature concluding that non-resorbable threads give less angiogenetic phenomena.

ARTICLES CONCERNING THE RESULTS OF CHIVA PROCEDURE IN TERM OF RECURRENCES / CLINIC DATA WITHOUT COMPARISON WITH OTHER METHODS

1) MANDOLESI S, Ballo M, Galeandro I, Filippo S, Migaldi D, Spinelli F, Nasso C, Carbone P, Scaramuzzino L, Passariello F.: The 1st national multicenter study of the CHIVA “Conservative Therapy and Hemodynamics in Venous Insufficiency in Outpatient Departments method of treatment of varices. One-year follow-up”

Ann Ital Chir. 1990 Jul-Aug;61(4):425-7.

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