aree scientifiche

Phlebology 1996, 11, pp. 98-101. 

14) LEONI V., MISURI D.: IL TRATTAMENTO DELLE VARICI DEGLI ARTI INFERIORI MEDIANTE CHIVA 2. NOSTRA ESPERIENZA

UO di Chirurgia Generale Ospedale S.M.N Firenze – academia.edu 1996

15) A BANHINI, C Franceschi, X Mouren, P Caillard et Al.: Superficial venous insufficiency

JOURNAL DES MALADIES VASCULAIRES, 1996

16) FRANCESCHI, C.: Physiopathologie hémodynamique de l’insuffisance veineuse des membres inférieurs

(1997) Actualités Vasculaires Internationales, 22, pp. 17-27

17) FRANCESCHI C.: La Cure Hemodynamique de l’Insuffisance Veineuse en Ambulatoire.

Journal des Maladies Vasculaires. 1997 ; 22 (2) :91-95

18) CAPPELLI M. et Al.: Criteri di scelta della Strategia CHIVA 

Arch. Soc. Ital. Chirurgia 4, 118, 1998

19) CAPPELLI M.: POSTERS-Conservative surgery of the saphenous trunks

Journal des Maladies Vasculaires, 1999

20) E MENDOZA: Einteilung der Rezirkulationen im Bein: anatomische und physiologische Grundlagen der CHIVA-Methode

Phlebologie, 2002 

21) CRIADO E. et Al.: Conservative hemodynamic surgery for varicose veins. 

Semin Vasc Surg. 2002 Mar;15(1):27-33.

Abstract

Conservative hemodynamic surgery for varicose veins is a minimally invasive, nonablative technique that preserves the saphenous vein and helps avoid excision of varicosities. It represents a physiologic approach to the surgical treatment of varicose veins based on knowledge of the underlying venous pathophysiology gained through detailed duplex scanning. A change in venous hemodynamics is attained through fragmentation of the blood column by interruption of the refluxing saphenous trunks, closure of the origin of the refluxing varicose branches, and preservation of the communicating veins that drain the incompetent varicose veins into the deep venous system. After surgery, varicose veins regress through a reduction in hydrostatic pressure and efficient emptying of the superficial system by the musculo-venous pump. Obvious advantages of this technique are that it is done in an ambulatory setting, minimizes the risk of surgical complications, and permits a rapid return to full activity. The long-term hemodynamic improvement and recurrence rate of this technique remain to be established.

22) MENDOZA, E.: CHIVA – Alternative oder Ergänzung zum Stripping?

(2002) Vasomed, 14, pp. 6-17. 

23) HACH W. : What is CHIVA? [Was ist CHIVA?]

(2002) Gefasschirurgie, 7 (4), pp. 244-250.

Abstract

The French phlebologist Claude Franceschi introduced the “Cure conservatrice et hémodynamique de l’insuffisance veineuse en ambulatoire” (CHIVA; ambulatory conservative and hemodynamic treatment of venous insufficiency) in 1988. It is based on Perthes’ observation (1895) that varicose veins fill on standing and empty on walking when a tourniquet is applied to the thigh. This hemodynamic situtation is intended to be mimicked in CHIVA by graded surgical corrections of the varices. Franceschi’s method is based on the theory of the four venous networks differing in the degree of harm they cause when affected. Different shunting patterns are referred to this theory, a shunt being a connection between one venous network and the next. Recirculation R1 designates the intrafascial leading veins. The R2 network comprises the stem veins. They, too, are thought to be situated intrafascially within a special saphenous fascia, which is visible on ultra-sound imaging. The R3 network comprises the epifascial collateral veins in the subcutaneous fat layer regardless of diameter; and reticular veins and capillaries and starburst varices make up R4. The surgical principle consists in flush ligation and division of the great or small saphenous vein junction without crossectomy. The effect of this is that a retrograde stream of blood is still fed into the preserved varicose stem vein, but it is reduced by that part of the retrograde flow that comes from the common femoral vein. Ultrasound diagnosis of the competent perforating veins and conservation of drainage into the deep venous system are considered very important.

24) MENDOZA E.: Classification of the recirculations in the leg: Anatomic and physiologic bases of the CHIVA-method 

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