aree scientifiche

Abstract

The principles of modern varicose vein surgery are based on the interruption of the cranial and distal points of venous insufficiency. Especially due to the rise of alternate surgery procedures, we have scrutinized our results of varicose vein surgery. In a retrospective analysis, the results of those patients (pat.) who underwent venous surgery in our institution in 1995 were analysed. In 1995 we performed 1575 varicose vein operations (n = 1019 pat., 16.8 % male, 83.2 % female). 63.5 % were on an out-patient basis. During a follow-up period of 4 to 66 months (av. 38 months) the patients were re-examined, 481 (47.2 %) by Duplex sonography, 94 (9.2%) by clinical examination alone, from 103 (10.1 %) information was obtained through a written inquiry. 341 pat. (33.5%) had just perioperative follow-ups. We didn’t find any signs of varicosis in 301 pat. (33.3 %). Minor side branches could be detected in 515 pat. (56.8 %). In 90 pat. (9.9 %) a clearly visible varicosis could be seen. Based on the results of the Duplex examinations, 86 % of the pat. showed no recurrence after ligation of the sapheno-femoral junction and stripping of the LSV, the results after stripping of the short saphenous vein were similar. Analysis of the inquiry forms concluded that 62.3 % of the pat. were satisfied with surgery and the results. The results of the standard varicose vein surgery are satisfactory regarding recurrence rate and patient satisfaction. Our results are comparable to those published in prospective randomised studies. Alternate procedures, for example the CHIVA method, have still to proof their efficiency, especially in view of long-term results.

5) MARIA S. et Al. : Varicose disease of lower limbs: What kind of treatment? Personal experience 

Chirurgia 2008, 21 (4), pp. 195-198. 

Abstract

Aim. We report the experience over 422 patients admitted and treated for varicose disease on lower limbs, in the U.O. Clinicizzata di Chirurgia D’urgenza of Vittorio Emanuele Hospital of Catania from 01/01/2001 to 12/31/2005. The surgical treatment was modulated by the intensity of the disease. Methods. The 422 patients were treated according to the following surgical techniques: 14 (3,3%) patients with CHIVA method; 4 (0,9%) patients with reconstruction of saphenofemoral valve (as described by Belcaro); 10 (2,3%) patients with multiple phlebectomies (as described by Muller); 8 (1,9%) patients with crossectomy and multiple phlebectomies; 252 (59,7%) patients with stripping of the great saphenous vein from the groin to the knee (short stripping); 134 (31,7%) patients with stripping of the great saphenous vein from the groin to the ankle (long stripping). Results. On the 14 (3,3%) patients treated with CHIVA method were noticed the following complications: 6 (42,9%) cases of saphenous vein thrombosis; 8 (57,1%) cases of varicose recurrences during the follow-up (15 months – 3 years) Pochi casi e la maggioranza non drenanti. On all 4 cases (0,9%) treated with reconstruction of saphenofemoral valve (as described by Belcaro) were noticed saphenous vein thrombosis before the 48-hours following the procedure. On 252 (59,7%) patients treated with the short stripping were noticed: 8 (3,17%) cases of postoperative complications; 3 (1,2%) cases of varicose recurrences. On 134 (31,7%) patients treated with the long stripping were noticed: 9 (6,7%) cases of postoperative complications; no case of varicose recurrences. Conclusion. Finally, according to obtained results, we agree that the gold standard of surgical treatment of the varicose disease of the lower limbs, is represented by the stripping of the saphenous vein, with a low percent of postoperative complicances and/or varicose recurrences.

6) Solís, J.V., Ribé, L., Portero, J.L., Rio, J.: Stripping saphenectomy, CHIVA and laser ablation for the treatment of the saphenous vein insufficiency

(2009) Ambulatory Surgery, 15 (1), . 

Abstract

Aim: To analyze the results of three different techniques for the treatment of the great saphenous vein insufficiency as the main cause of varicose veins.

Methods: We analyze three groups (Stripping, CHIVA 1 and Endovenous Laser ablation) with 40 patients each. Follow up was done at 1, 3, 9 and 12 months. Results: The CHIVA and laser ablation had the best aesthetic result and fewer discomfort, but laser ablation had higher economic cost. There was no recurrence after 1 year in any of the groups. Conclusions: The three techniques proved very good results for the saphenous insufficiency treatment. 

7) FRANCESCHI C.: “Stripping versus the CHIVA Method” 

Angéiologie, 2010

8) MILONE M., SALVATORE G.,MAIETTA P., SOSA FERNANDEZ L.M.,MILONE F., Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience, G. Chir., 2011, p. 32.

This is a retrospective analysis that compared the result after stripping with those of CHIVA method (5-year follow-up) in two different periods: the first group concerned the patients treated in the years immediately following the learning of the CHIVA 1995-2000 method, the second group included patients treated between 2001 and 2005 after the team had completed a sufficient learning curve relative to the surgical strategy used.

The results were evaluated according to the Hobbs criteria. In the first period 223 patients underwent stripping and 88 under CHIVA. Complete success of the treatment was found in 30.9% after stripping and in 12.6% after CHIVA (p <0.05), while treatment failure instead was found in 47.5% stripping and 67 % of CHIVA patients (p <0.05). In the second period 186 patients were treated with Stripping and 208 with CHIVA. The success rate in the Stripping group remained constant at 29.5% while it significantly increased in the CHIVA group at 44.2% (p <0.05). 46.7% of stripped patients were classified as inefficient treatment while in the CHIVA group there was a significant reduction of failed treatments to 30.2% (p <0.05). The authors conclude that training and adequate experience in vascular surgery and ultrasound ultrasound are required to successfully perform the CHIVA method. (Comment by Paolo Zamboni)

9) CHAN CY et Al.: Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins.

World J Surg. 2011 Jul;35(7):1679-86. doi: 10.1007/s00268-011-1093-8.

Abstract

BACKGROUND:

The purpose of the present study was to compare management of varicose veins by endovenous laser ablation (EVL) and a vein-sparing procedure (CHIVA: Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) for management of varicose veins.

METHODS:

Data from 82 consecutive patients with great saphenous vein (GSV) reflux and primary varicose veins presenting to the vascular clinic at the Far Eastern Memorial Hospital between June and December 2005 were reviewed. Of these, 74 who met the inclusion criteria were included in this study. CHIVA was performed by a double division of the refluxing saphenous vein (i.e., proximal and distal ligation), and EVL was performed using 10-14 W beginning approximately 4 cm below the saphenofemoral junction to the level of the knee. Phlebectomy for significant branch varicose veins on the leg was routinely performed in all patients. Outcome measures included postoperative thrombophlebitis, bruising, pain, assessment of ultrasonographic and clinical symptoms (measured by the Venous Clinical Severity Score [VCSS]) and comparison of quality of life survey scores obtained preoperatively and postoperatively (measured by the Aberdeen Varicose Veins Score [AVVQ] and RAND-36). Patients were examined one week post-procedurally and again at 1, 3, 6, and 12 months.

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