aree scientifiche

Abstract:

Objective: To develop a new method of classifying hemodynamics in varicose veins of lower extremities (VVLE) and make a comparative analysis to determine the efficacy of ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) treatment. Methods: 150 cases with VVLE in our hospital were selected. Firstly, color doppler ultrasound examination was performed for each patient. Secondly, the hemodynamics of the patients were systematically divided into 6 types: I, II, III, IV, V, and VI. Lastly, complications and recurrence rate were detected to investigate the clinical efficacy, the patients were evenly divided into 3 groups which receiving different treatments: traditional surgery group, endovenous laser treatment group and CHIVA group. Results: Compared with the other two groups, patients in CHIVA group showed significant better performances on clinical efficacy, cure rate, complications and recurrence rate (P<0.05 and P<0.01). Conclusion: CHIVA treatment has significant better curative effect than traditional surgery and endovenous therapy in the treatment of varicose veins. CHIVA treatment induced less damage, quicker health recovery, high safety factor and lower complications. Thus, CHIVA treatment can be widely used in clinical restoration than general minimally invasive operations. 

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATA  WITH OTHER PROCEDURES  EMPLOING RANDOMIZED STUDIES (RCT)

1) ZAMBONI P., CISNO C., MARCHETTI F., MAZZA P., FOGATO L., CARANDINA S., DE PALMA M., LIBONI A., Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial, Eur. J. Vasc. Endovasc.

Surg., 2003 Apr, 25(4): pp. 313–8.

This prospective randomized study compared CHIVA strategy associated with compression with the use of compression alone in the treatment of venous ulcers associated with chronic superficial venous insufficiency of the lower limbs (C6 in the CEAP classification). 24 patients were treated with compression, advanced wound dressings (and treatment antibiotic if necessary) the dressings were changed every 3 to 5 days during the first month and every 7 days thereafter.

The CHIVA group included 21 patients, 16 limbs had a hemodynamic presentation similar to type I shunts and were treated with crossectomy and further tributary ligatures, 7 limbs had a type III shunt and were treated with type CHIVA 2 procedure.

The study assessed:

– the healing process expressed in 2 mm per day;

– the functionality of the venous system based on air plethysmography data before treatment, 6 months and 3 years after treatment;

– quality of life through SF-36 questionnaire before treatment

and 6 months after treatment. In addition to the clinical evaluation, an eco-Doppler examination was performed

every 6 months for a total of 3 years. The results are presented in table 10.7. (Comment by Paolo Zamboni)

2) S CARANDINA, C Mari, M De Palma, MG Marcellino, A Legnaro, A Liboni : Stripping vs haemodynamic correction (CHIVA): a long term randomised trial

Phlebology / venous forum of the royal society of medicine, 2006, 21(3), 151 | added to CENTRAL: 31 October 2007 | 2007 Issue 4 (Cochrane Library)

3) CARANDINA S., MARI C., DE PALMA M., MARCELLINO M.G., CISNO C., LEGNARO A., LIBONI A., ZAMBONI P., Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial, Eur. J. Vasc. Endovasc. Surg., 2008 Feb, 35(2): pp. 230–7.

This randomized comparative study aimed to compare the long-term results of stripping with respect to CHIVA in the treatment of chronic superficial venous insufficiency.

180 consecutive patients underwent clinical evaluation, including CEAP classification, and duplex examination performed by expert operators. 30 patients were excluded second because they did not meet the study inclusion criteria, while 150 patients were randomized to

two groups, 75 were treated with stripping and 75 with CHIVA. All operated limbs were examined by three independent assessors who had not been involved in previous surgical procedures. The results were evaluated according to the Hobbs criteria and are presented in tables 10.8 and 10.9.

The relative risk of recurrence in the Stripping group doubled to 10 years compared to the CHIVA group (OR 2.2; 95% CI 1–5, p <0.04).

No significant difference was found between the two 3-year techniques. During the 3 to 10 year period the different recurrence rates in the two groups become evident and significant, so it is concluded that at 10 years the risk of recurrence is double in the ablative group (Figure 10.1). (Comment by Paolo Zamboni)

J Mal Vasc. 2009 Feb; 34 (1): 65. doi: 10.1016 / j.jmv.2008.10.002. Epub 2008 Dec 4.

[Correspondence: letter by P. Zamboni about the analysis of the article “Varicose vein stripping versus haemodynamic correction (CHIVA): a long term randomized trial”].

[Article in French]

Zamboni P.

4) E IBORRA : Comparative clinical study: CHIVA vs phlebectomy

Anales de cirugía cardíaca y vascular, 2006, 12(2), 109 | added to CENTRAL: 31 March 2020 | 2020 Issue 03 (Archivio Cocrhane Library)

5) IBORRA–ORTEGA E., BARJAU–URREA E., VILA–COLL R., BALLÓN–CARAZASH., CAIROLS–CASTELLOTE M.A., Estudio comparativo de dos técnicas quirúrgicas en el tratamientode las varices de las extremidades inferiores: resultados tras cinco años de seguimiento,

ANGIOLOGÍA, 2006, 58(6): pp. 459–468.

Iborra and his team published a prospective randomized study in Spanish in 2006 that included 100 legs treated with CHIVA or Stripping with a 9-year follow-up. 62 women and 38 men with an average age of 49 years were selected following the Spanish guidelines for the treatment of varicose veins. The patients included did not have a history of venous surgery, thrombosis, were not overweight or older than 70 years. 49 patients were randomized to the Stripping group and 51 to the CHIVA group. There were no differences in age, gender, weight and CEAP

between the 2 groups. All patients underwent Doppler examination and after the surgery, they received the same dose of prophylactic heparin. The follow-up with questionnaires and ultrasonography was performed 1 week after the intervention and then after 1, 3, 6 months and every year for 5 years. All patients in the stripping group were hospitalized (44 spinal and 5 under general anesthesia)

While of the CHIVA group 9 patients remained in hospital for one night, the rest were treated on an outpatient basis (6 spinal, 3 general, 42 local anesthesia), table 10.10.

The average working disability in the stripping group was 19 days while in the CHIVA group 8 days (p <0.001). Neither group experienced serious complications, 11 patients in the stripping group reported ankle paresthesia, while in the CHIVA group 4 patients reported symptomatic superficial venous thrombosis (table 10.11).

Despite the best recovery after CHIVA, the 5-year results for the

outcomes considered were not significantly different (table 10.12).

(Comment by Paolo Zamboni)

6) PARÉS J.O., JUAN J., TELLEZ R., MATA A., MORENO C., QUER F.X., SUAREZ D., CODONY I., ROCA J., Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial,

Ann. Surg., 2010 Apr, 251(4): pp. 624–31.

The aim of this study was to compare the effectiveness of the CHIVA method for the treatment of varicose veins compared to the standard stripping treatment. The study design was randomized and controlled monocentric, and 501 patients with primary varices were included. Patients were randomly assigned to the CHIVA procedure (experimental group n = 167) or stripping without duplex mapping (control group 1, n = 167) or stripping with duplex mapping (control group 2, n = 167). The outcome measure was 5-year clinical recurrence, examined by independent evaluators previously trained in the procedures. Duplex ultrasonography has also been used to evaluate the causes of relapses. The results are summarized in table 10.13. 

The odds ratio for the presence of 5-year relapses between the stripping group with clinical marking and the CHIVA group was 2.64, (95% confidence interval [CI]: 1.76–3.97, P <0.001). The odds ratio for relapses after 5 years of follow-up, between stripping with duplex mapping and CHIVA group, was 2.01 (95% CI: 1.34-3.00, P <0.001).

The conclusion was that the CHIVA surgical treatment had

fewer side effects and less recurrence after 5 years compared to both stripping groups. No statistical differences were found between the two stripping groups (with and without duplex mapping). (Comment by Paolo Zamboni)

7) JO PARES, J Juan, R Tellez, A Mata, C Moreno, FX Quer, D Suarez, I Codony, J Roca : Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial

Vasomed, 2011, 23(2), 98 | added to CENTRAL: 31 December 2014 | 2014 Issue 12 (Cochrane Library)

8) GONZALEZ CANAS E. et AL.: A randomized controlled noninferiority trial comparing radiofrequency with stripping and CHIVA technique for insufficiency of the great saphenous vein.

J Vasc Surg Venous Lymphat Disord. 2020 Apr 27. pii: S2213-333X(20)30233-X. doi: 10.1016/j.jvsv.2020.04.019. [Epub ahead of print]

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