aree scientifiche

ABSTRACT

The  first part of this review article provides the physiologic background that sustained the CHIVA principles development. Then the venous networks anatomy and  ow patterns are described with pertinent sonographic interpretations, leading to the shunt concept description and to the consequent CHIVA strategy application. An in depth explanation into the hemodynamic conservative cure approach follows, together with pertinent review of the relevant literature.

19) MALDONADO-FERNANDEZ et Al.: Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

Cir Esp. 2016 Mar;94(3):144-50.

Abstract

INTRODUCTION:

Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins.

METHODS:

This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale.

RESULTS:

The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases.

COMPLICATIONS:

3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome.

CONCLUSIONS:

This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively.

20) ZMUDZINSKI M, MALO P, HALL C, HAYASHI A., CHIVA – A prospective study of a vein sparing technique for the management of varicose vein disease, Am. J. Surg., 2017, 213: pp. 967–969.

ABSTRACT

CHIVA. Una tecnica di risparmio del patrimonio venoso nell’insufficienza venosa cronica (Zmudzinski 2017)

Studio prospettico che ha valutato la percentuale di recidiva dovute a reflusso venoso con tecnica CHIVA. Gli autori hanno valutato 150 procedure sia con esami ecografici che clinici pre e post operatori. I pazienti sono stati seguiti a 3 mesi e a 1 anno dopo l’intervento.

La valutazione duplex post–operatoria del reflusso è stata eseguita in posizione supina, l’intervento al sito di giunzione safeno–femorale consisteva in una doppia legatura con 2–0 di seta a 2 cm della giunzione safeno–femorale (distalmente alla confluenza delle vene epigastriche ). La recidiva è stata definita come presenza di reflusso nella GSV alla coscia durante l’esame duplex.

Non sono state rilevate recidive al follow–up iniziale, in seguito, 58 gambe hanno completato il follow–up a lungo termine ed il reflusso è stato rilevato all’esame Doppler in 5 gambe con un tasso di recidiva dell’8,6%; CI del 95% (2,4%, 19%).

Nessuno di questi pazienti ha presentato complicazioni cliniche. Gli autori hanno concluso che la percentuale di recidiva utilizzando il metodo CHIVA compete favorevolmente con le tecniche di ablazione venosa. L’elevata soddisfazione del paziente, la bassa percentuale di complicanze ed il basso costo incoraggia a proseguire gli studi con questa tecnica (tabella10.16). (PAOLO ZAMBONI)

21) FRANCESCHI C, Bahnini A, Cappelli M, Cuaranta RL, Dadon M, Delfrate R, Ermini S, Gianesini S, Mendoza E, Passariello F, Puskas A. : Commentary on the article “A prospective study of a vein sparing technique for the management of varicose vein disease” by M Zmudzinski et al.

Am J Surg. 2018 Nov;216(5):1035.

22) Felipe Puricelli Faccini, Stefano Ermini, Claude Franceschi :  CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results 

 J Vasc Bras. 2019;18:e20180099. https://doi.org/10.1590/1677-5449.009918  

Abstract 

There is considerable debate in the literature with relation to the best method to treat patients with chronic venous disease (CVD). CHIVA is an office-based treatment for varicose veins performed under local anesthesia. The aim of the technique is to lower transmural pressure in the superficial venous system and avoid destruction of veins. Recurrence of varicosities, nerve damage, bruising and suboptimal aesthetic results are common to all treatments for the disease. This paper evaluates and discusses the characteristics and results of the CHIVA technique. We conclude that CHIVA is a viable alternative to common procedures that is associated with less bruising, nerve damage, and recurrence than stripping saphenectomy. The main advantages are preservation of the saphenous vein, local anesthesia, low recurrence rates, low cost, low pain, and no nerve damage. The major disadvantages are the learning curve and the need to train the team in venous hemodynamics. 

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATA  WITH OTHER PROCEDURES  EMPLOING NOT RANDOMIZED STUDIES

1) GORNY PH., BLANCHEMAISON PH., CHAHINED.,HUTINEL B., CHANVALLON C., PAYEN

B., REINHAREZ D., Chirurgie Conservatrice et Ambulatiore: étude comparative entre CHIVA et Crosseectomie chez 321 patients opérés de la saphène interne. Discussion,

Phlébologie, 1995, 48, 2: pp. 255–259.

2) CAPPELLI M.,MOLINO LOVA R., ERMINI S., TURCHI A., BONO G., BAHANINI A., FRANCESCHI

C.I., La Cure CHIVA dans le traitement de la Maladie Variqueuse: analyse critique des résultats après trois ans, Ann. Chir. Vasc., 1996.

Cappelli et al. they examined 148 patients treated with an average 3-year follow-up CHIVA. The authors compared their own results with the large series of stripping present in the literature (Hobbs 1974, Taulaniemi 1963). The “Hobbs criteria”  were chosen as the evaluation method, so that the groups were comparable. Hobbs’ criteria were established in 1974

in the first randomized controlled trial in the history of phlebology, which compared surgery to sclerotherapy (Hobbs 1974). (Comment by Paolo Zamboni)

3) MAESO J., JUAN J., ESCRIBANO J., ALLEGUEN.M.,DIMATTEO A.,GONZALEZ E.,MATAS M.: Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities

Ann. Vasc. Surg., 2001, 15: pp. 661–5.

Maeso et al., of the university clinic in Barcelona, instead monitored 90 patients operated on with the CHIVA strategy, in a prospective 3-year follow-up study and compared them: with 85 of their historical patients operated on stripping, with data from interventions stripping already present in the literature (see above) and with patients in the Cappelli group. In the Vall d’Hebron university clinic in Barcelona, stripping was completely abandoned in favor of the CHIVA method in

1995, therefore a prospective comparison of the two methods was not possible.

In both the Cappelli and Meso studies, the CHIVA method produced significantly better outcomes than the three stripping groups (p <0.001). The comparison between the two groups CHIVA – Cappelli and Maeso – did not produce significant differences. The results are shown in tables 10.2, 10.3, 10.4, 10.5. (Comment by Paolo Zamboni)

4) NOPPENEY, T., Noppeney, J., Kurth, I.:  Results of standard varicose vein surgery 

(2002) Zentralblatt fur Chirurgie, 127 (9), pp. 748-751.

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