aree scientifiche

Angiologia 2004, 56 (3), pp. 227-235.

Abstract

Introduction. There is a tendency for surgery to become less and less invasive. The CHIVA strategy could be included within the concept of minimally invasive surgery. Aims. Our aim was to perform a prospective evaluation of the clinical results at one year after applying the CHIVA strategy in the treatment of primary varicose veins. Patients and methods. A one-year follow-up of 225 patients (147 females, 78 males). Clinically, 195 of them were in stage 2 (CEAP). A Doppler ultrasound recording was conducted before surgery. Later, at one month and one year, patients were evaluated clinically and the results were classified in four categories. Patients were again submitted to a new Doppler ultrasound recording at one year. The type of strategy employed was in a single intervention in 97.8% of the cases. Results. At one year, the objective and subjective clinical assessment were good in 87.6 and 90.7% of cases, respectively. The mean diameter of the internal saphenous vein changed from 6.4 to 4.0 mm (t test; p = 0.001). Significant differences were observed between the objective assessment at one month and at one year (p = 0.001), as well as in the subjective assessment (p = 0.001), since a third of the patients with a poor evaluation at one month presented a good one at one year. Conclusions. The CHIVA strategy shows good results at one year in our series. The significant reduction of the diameter of the saphenous vein indicates that the haemodynamic component is important in the pathophysiology of varicose veins.

15) LINARES-RUIZ, P., Bonell-Pascual, A., Llort-Pont, C., Romera, A., Lapiedra-Mur, O. : Mid-term results of applying the CHIVA strategy to the external saphenous vein. 

Angiologia 2004 , 56 (5), pp. 481-490.

Abstract

Introduction. The anatomical complexity and widely varying distribution of the external saphenous vein (ESV) means that surgical treatment is associated to high rates of relapse and residual varicose veins. Aim. To evaluate the mid-term results of using the CHIVA cure strategy on ESV varicose veins. Patients and methods. Between February 1996 and December 2002 we performed 142 CHIVA interventions to treat ESV. A random sample of 80 interventions was taken and data collected about their factors related to chronic venous insufficiency, pre-operative clinical features (CEAP), primary shunt and the surgical strategy applied. Doppler ultrasound was used to assess competence, patency, flow direction, diameter and neoaortic arch of the ESV in the post-operative period, visible relapses and symptoms. In addition, the relationships between the following parameters were also analysed: Doppler ultrasound recordings, surgical strategy, relapses and symptoms. Results. Competence of the deep vein system (DVS) and ESV patency were found to be > 95% (four ESV thromboses). Haemodynamically favourable situations: 66%. Mean diameter of the ESV: 3.5 cm; neoaortic arch: six patients (7.5%). Clinical features of the post-operative period: 59 asymptomatic patients (73.8%), 16 with a clinical improvement (20%) and five patients with no improvement in their symptoms (6%). Visible relapses: 15 cases, 12 of which were not important enough to require reintervention. There were no cases of DVS thromboses or peripheral neuropathy. There was a statistically significant correlation between the presence of anterograde flow and the absence of relapses and symptoms in the post-operative period, as well as between symptoms and relapses with higher absolute ESV diameters and neoaortic arch. There was a correlation, although statistically non-significant, between relapses and symptoms in the postoperative period and surgical strategy. Conclusion. The best results (i.e. less thromboses and relapses): CHIVA 1 + 2 in the case of ESV.

16) ZAMBONI P., GIANESINI S.,MENEGATTI E., TACCONI G., PALAZZO A., LIBONI A., Great saphenous varicose vein surgery without saphenofemoral junction disconnection, Br. J. Surg., 2010 Jun, 97(6): pp. 820–5.

This case-control study was designed to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without disconnecting the saphenous-femoral junction (SFJ).

The duplex protocol included a reflux elimination test (RET-test) and the evaluation of the competence of the terminal valve of the femoral vein. Patients with negative reflux elimination tests were therefore excluded.

One hundred patients with chronic venous insufficiency who had a positive RET test and an incompetent terminal valve were compared with 100 patients, homogeneous by age, sex, CEAP clinical class, duration of disease, who had a positive RET test but a valve competent terminal. All patients underwent proximal ligation of incompetent tributaries from the saphenous trunk without disconnection of the saphenous-femoral junction. Clinical and duplex follow-up lasted for 3 years and included the Hobbs clinical score.

The evaluation with Duplex after 1 and 3 years respectively is reported in table 10.14.

The recurrence rate after 3 years was significantly different depending on the competence or otherwise of the terminal valve. With the competent terminal valve, the recurrence rate was 3% at the sapheno-femoral junction, compared to 71% in case of incompetent terminal valve after 3 years. (Comment by Paolo Zamboni)

17) EVA I. et Al.: CHIVA – ECOGRAPHIC ASPECTS AND SURGICAL RESULTS

Maxilo-facial surgery volume 18 • issue 1 January / March 2014 • pp. 64-70

Abstract

Varices (milk leg) represent pathological dilatations of the superficial veins at the level of the inferior members. Up to now, the strictly anatomical aspect of varix formati- ons inspired only traditional, strictly ablative treatments, generally applied without aiming at improving the hae- modynamic condition of veins. Haemodynamic surgery attempts at modifying the reflux pattern, while preserving the most efficient channels of venous drainage. Implemen- tation of such a treatment requires an exact understanding of the physiological principles and of the reflux patterns on which haemodynamic surgery relies. Ecographic eva- luation of the venous system in patients with varicose dila- tations permits drawing of a detailed map of the venous system, and also of its haemodynamic pattern [1]. Con- sequently, CHIVA appears as a viable therapy, applicable in outpatient services, as well. Post-surgery results are excellent and patients’ comfort is appreciated as highly satisfactory. The method is reliable, having produced no incidents, accidents or complications.

18) Claude FRANCESCHI, Massimo CAPPELLI, Stefano ERMINI, Sergio GIANESINI Erika MENDOZA, Fausto PASSARIELLO, Paolo ZAMBONI

CHIVA: hemodynamic concept, strategy and results

International Angiology 2016 February;35 (1):8-30

Pagine: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30