aree scientifiche

J Mal Vasc. 1992;17(3):241-9.

Abstract

After a brief introduction describing the principle, strategy and tactics of hemodynamic treatment of venous insufficiency in ambulant patients, the following atypical case is described. Ms P., aged 38 years, presented a functional symptomatology including waking at night and was obliged to get out of bed. Varices were moderately visible but she asked for treatment for esthetic reasons. A future pregnancy was discounted. Clinical examination and the pulsed ultrasound-Doppler cartogram showed incontinence of the internal perineal, opening from the genitofemoral fold and rejoining the summit of Jacomini’s vein arch. The dorsal segment of Jacomini’s vein was incontinent with a retrograde flux and rejoined an incontinent short saphenous continuing as a type III shunt. The cartogram obtained, the strategy decided and the intervention carried out on 19 June 1990 are illustrated by photographs. At 4 month follow up and despite the heat wave of summer 1990, all functional signs had disappeared and a sufficiently esthetic result had been obtained. Unexpectedly, the patient announced that she was pregnant.

9) HUGENTOBLER JP, Blanchemaison P.: Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). Study of 96 patients operated on between June 1988 and June 1990

J Mal Vasc. 1992;17(3):218-23.

Abstract

96 patients were treated in two years by Ambulatory and Hemodynamic Treatment of Varicose Veins (CHIVA cure), representing 131 legs that underwent surgery. 71 patients (74%) representing 102 CHIVA cures in the long saphena territory were followed up, with a maximum of 28 months of follow-up. The CHIVA cure represents a new and interesting therapy: ambulatory, painless, it allows a very early resuming of normal life. The follow-up shows that the aesthetic and functional results are especially satisfying and seem to be steady. The CHIVA cure certainly neglects the histological and parietal aspects of venous incompetence but the treatment of the hemodynamic factor is effective. It can be applied on every type of varicose veins concerning the long saphena territory, provided that the deep venous system is normal. The interest of CHIVA cure concerning the short saphena territory remains to be demonstrated. Arteritic patients, patients with coronary arteries diseases, sportmen, young patients with a brief evolutive potential, especially women, are the best indications. The CHIVA cure is a reliable strategy in the short and medium term, offering excellent aesthetic and functional results that still have to be confirmed in the long term and or a large scale.

10) BAILLY M.: Cartographie CHIVA

Encyclopédie Médico–Chirurgicale, Paris 1993, pp. 43–161 – B, pp. 1–4.

11) FRANCESCHI C.: La cure Chiva et la critique: 14 réponses et 1 conclusion STV. 

Sang thrombose vaisseaux, 1993

12) ZAMBONI P. et Al.: Video-assisted venous surgery.

Ann Ital Chir. 1995 May-Jun;66(3):379-86.

Abstract

The use of intraoperative angioscopy, till now utilized exclusively in arterial surgery, is now used also in venous surgery. From January 1992 54 patients underwent to video-guided venous surgery: 23 cases of external valvuloplasty of the sapheno-femoral junction (EV-SFJ), 25 cases of hemodynamic correction of varicose veins (French acronyms CHIVA), 5 cases of high ligation plus long saphenous vein intraoperative sclerotherapy (HL-IS) 1 case of sub-fascial perforators interruption (SPI), the only extraluminal videoguided procedure. We have used 3 different video-angioscopes: a 1 mm monofibroscopy let in a 6 Fr Fogarty catheter, a disposable 2,8 mm colangioscope and a 2,2 mm operative angioscope. For the perforators interruption we have utilised the thoracoscope. EV-SFJ: the angioscopy has confirmed the presence of normal valvular cusps in a dilated vein wall in 21 cases, so excluding 2 patients from the planned treatment. At the end of the operation the angioscope has verified the reapproach of valvular cusps. CHIVA: the angioscopy has allowed to identify the exact points of the superficial venous system which should be interrupted, according to the Franceschi’s theory. This procedure can avoid the technical errors due to intraoperatory misleadings of the duplex mapping. HL-IS: consists of a classic high ligation followed by long saphenous vein intraoperative sclerotherapy. The angioscopy has allowed a complete deconnection of the long saphenous vein from tributaries and perforators. Furthermore has facilitate the proportional distribution of the sclerosing agent along the long saphenous vein. SPI: the videoassistance have permitted the identification of the insufficient perforating veins reducing their surgical exposures.

13) ZAMBONI P. et Al: Haemodynamic correction of varicose veins (CHIVA): An effective treatment?

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