aree scientifiche

RESULTS:

In 20 patients symptoms and varices relief were recorded (80%), in 5 patients varices reduction was observed only during walking (20%). In 2 of these latter patients there was no re-entry through the perforators, with a recurrent sapheno-femoral reflux in 1 of them. Early complications recorded were: 2 long saphenous vein thrombosis (8%); 7 ecchimosis (28%) when heparine/saline solution had been used for angioscopic clearance.

CONCLUSIONS:

Intraoperative angioscopy is feasible and useful when the hemodynamic situation is complex and the Duplex map is difficult to be interpreted by the surgeon. In this series the second look percentage rate has been minor compared to the percentage rates published so far by other authors.

8) BAHNINI A, Bailly M, Chiche L, Franceschi C.: Ambulatory conservative hemodynamic correction of venous insufficiency. Technique, results.

Ann Chir. 1997;51(7):749-60.

Abstract

Ambulatory conservative haemodynamic correction of venous insufficiency (CHIVA) is a surgical treatment of superficial venous insufficiency designed to correct the pathological haemodynamic effects of superficial venous insufficiency apparent on standing. Surgical treatment is based on precise preoperative anatomical and haemodynamic mapping performed by duplex ultrasound, providing preoperative ultrasound-guided marking. Surgical treatment consists of dividing the hydrostatic pressure column and disconnecting venovenous shunts by ligation-section of the superficial venous network at precise points determined by the preoperative ultrasound-guided marking. This strategy should achieve a superficial venous circuit draining perfectly into the competent deep venous network. The operation is performed under local anaesthesia as an outpatient procedure and allows immediate resumption of walking, which promotes a good result due to activation of the calf muscle pump. The results of the technique are very good provided a reliable preoperative ultrasound-guided marking and a precise surgical procedure are performed. Failures are due to poor haemodynamic assessment or inappropriate surgical procedure.

9) CAPPELLI M. et Al.: I risultati della cura CHIVA.

Osp Ital Chir 1998; 4: 615-8.

10) ZAMBONI P., MARCELLINO M.G., CAPPELLI M., FEO C.V., BRESADOLA V., VASQUEZ G., LIBONI A., Saphenous vein sparing surgery: principles, techniques and results, J.

J. Cardiovasc. Surg., Torino 1998 Apr, 39(2): pp. 151–62.

ABSTRACT

Follow–up a 4 anni dopo CHIVA (Zamboni 1998). Sono stati studiati 357 pazienti, operati utilizzando la metodica CHIVA e monitorati per 4 anni, non era incluso alcun gruppo di controllo. Nel 94% dei pazienti, alla fine dello studio la vena grande safena (GSV) presentava un flusso di drenaggio per tutta la sua lunghezza (ovvero non si è rilevata la presenza di trombosi venose

superficiali). L’11%dei pazienti ha presentato una recidiva. La reografia a luce riflessa ha mostrato miglioramenti significativi subito dopo l’operazione e dopo 6 mesi rispetto ai valori preoperatori. (PAOLO ZAMBONI)

11) CAPPELLI M. et Al. “Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years”

ANNALS OF VASCULAR SURGERY 2000 Vol 14 n°4 pag 376-384

Abstract

This report describes the results of our 3-year experience using ambulatory conservative hemodynamic management (ACHM) for lower extremity venous insufficiency involving the greater saphenous vein (GSV), with specific analysis of recurrence due to neoformation of vessels. We performed 289 ACHM procedures in 259 consecutive patients with GSV-related varicose veins. Follow-up clinical examination and Doppler ultrasound imaging was carried out at 3, 6, 12, 24, and 36 months in all cases to assess formation of neovessels supplied either by the superficial (A) or deep (B) venous system. Our data showed that ACHM achieved excellent improvement, with complete disappearance of varicose veins in 41.2% of cases, good improvement in 43%, fair improvement in 14.1%, and no improvement in 1.7%. The only predictor of outcome was the quality of drainage from the GSV vein. Poor drainage leads to neoformation of vessels supplied by the superficial (A) venous system. In about 50% of cases, drainage appeared spontaneously within 1 year, with a subsequent reduction in formation of neovessels. Neoformation of vessels supplied by the deep (B) venous system (10%) was independent of the quality drainage. This finding suggests that formation of these neovesseis is unrelated to the surgical method used to treat varicose veins. In patients with poor drainage of the saphenous network, neoformation of vessels supplied by the superficial (A) venous system is predictable with regard to both topography and delay. ACHM is a good tool for treatment of varicose veins, as reliable statistical prediction of mid-term results is possible using available models.

The article focouses on the problem of draining and non-draining systems, and therefore the difference in terms of recurrences and saphenous thrombosis in the two groups

12) ESCRIBANO J.M., JUAN J., BOFILL R., MAESO J., RODRÍGUEZ–MORI A., MATAS M., Durability of reflux–elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3–year prospective case study, Eur. J. Vasc. Endovasc. Surg., 2003, 25: pp. 159–63.

José María Escribano and the team of Barcelona Vall d’Hebrón University have published a study on the results of CHIVA in 2 steps in type 3 shunt cases. 58 patients were analyzed during 3 years after performing the first step of “CHIVA 2” in Type 3 shunts with a saphenous tributary below the knee.

The GSV diameter decreased significantly after surgery, although 51 of the patients had the reappearance of reflux after 6 months and 53 after 3 years. In all patients, the presence of a re-entry perforator was found, i.e. the transformation of the type 3 shunt into type 1 shunt.

46 patients underwent a disconnection of the saphenous-femoral junction over the 3 years of the study (crossotomy). The conclusion reported by this study is that the percentage of recurrences after the first half of CHIVA in Type 3 shunts is high. (Comment by Paolo Zamboni)

13) ZAMBONI P, ESCRIBANO JM.: Regarding ‘Reflux Elimination Without any Ablation or Disconnection of the Saphenous Vein. A Haemodynamic Model for Venous Surgery’ and ‘Durability of Reflux-elimination by a Minimal Invasive CHIVA Procedure on Patients with Varicose Veins. A 3-year Prospective Case Study’.

Eur J Vasc Endovasc Surg. 2004 Nov;28(5):567.

14) ESTEBAN-GRACIA C. et Al.: Application of the CHIVA strategy. A prospective study at one year 

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