aree scientifiche
ABSTRACT
Objective: This study was conducted to determine whether it was feasible to increase the diameter of smaller great
saphenous veins (GSVs) in preparation for possible bypass and whether such a conditioned conduit could be used with
reasonable patency.
Methods: Twenty-five patients (26 cases: 24 peripheral arterial occlusive disease, 2 popliteal aneurysms) with GSV diameters
between 2 and 3 mm underwent in situ GSV valvulotomy and were observed for 3 months. After GSV dilation to
>3 mm for below-knee revascularization and >3.5 mm for above-knee revascularization, arterial bypass surgery was
performed with the valvulotomized GSV.
Results: Adequate GSV diameter was reached in 20 cases (77%). Arterial bypass surgery using valvulotomized GSV was
performed an average 131 days (range, 64-373 days) after valvulotomy in 16 patients (61.5%). No deaths, amputations, or
aneurysms occurred 2 years after surgery. At 1 and 2 years, primary patency was 81% 6 9.8% and 69% 6 11.8%, respectively,
and secondary patency was 87% 6 8.3% and 75% 6 11%, respectively.
Conclusions: Valvulotomy can be used to expand small-diameter GSV for lower extremity arterial bypass.
114 ARTICLES ON CHIVA TREATMENT
BOOKS and CHAPTERS OF OTHER BOOKS
1) FRANCESCHI C.
(1988) Théorie et Pratique de la Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse Ambulatoire,
Précy-sous-Thil: L’Armançon
Edizione: Francese, Italiana, Inglese
2) ZAMBONI P.
(1996) La chirurgie conservativa del sistema venoso superficiale. (1° EDIZIONE)
Gruppo Editoriale Faenza Editrice
3) CAPPELLI M. ERMINI S. MOLINO LOVA R.
(2001) Chapter: La correzione emodinamica o cura CHIVA pag 431-456 book: Trattato di Flebologia e Linfologia Vol 1 Sergio Mancini (1° Edizione)
Masson Editor
4) MENDOZA, E.
(2002) Chiva Handbuch,
Arrien, Wunstorf
5) CAPPELLI M. MOLINO LOVA R. ERMINI S.
(2003) Chapter: Chirurgia conservativa emodinamica pag 177-187 book: Chirurgia delle vene e dei linfatici Giuseppe Genovese
Masson Editor
6) ESCRIBANO J.M.
(2006) Cirugia Hemodinamica en el tratamiento de la insuficiencia venosa superficial
Tesis Doctoral
Universitat Autonoma de Barcelona
7) FRANCESCHI C., ZAMBONI P.
(2009) Principles of venous hemodynamics
Hauppauge, NY: Nova Science Publishers
MENDOZA E. CHRISTOPHER R. LATTIMER NICK MORRISON N.
(2014) Duplex Ultrasound of Superficial Leg Veins
Springer Editor
8) ROBERTO DEL FRATE
(2014) A new diagnostic approach to varicose veins: haemodynamic evaluation and treatment
Lorena Dioni publisher
9) ZAMBONI P., MENDOZA E., GIANESINI S.
(2018)Saphenous vein-sparing strategies in chronic venous disease
Springer Editor
10) ZAMBONI P.
(2019) La chirurgie conservativa del sistema venoso superficiale. (2° EDIZIONE)
Aracne editrice
11) JORDI JUAN SAMSO’
(2019) La cura CHIVA en el tratamiento de las varices primarias de las extremidades inferiorores
Aran editor
12) RUTHERFORD’S
Vascular surgery and Endovascular therapy
Elsevier 2018
2030 section 33: “Saphenous sparing operation” CHIVA
Conclusion: Better results than stripping
9 BOOKS PUBLISHED ON CHIVA TREATMENT
3 CHAPTES IN OTHER BOOKS
CONCLUSION
The following elements rise up from the analysis of the articles:
- The results of different CHIVA studies about clinical data, recurrence rates and quality of life, comparing them with other methods of treatment without randomization, are superimposable on each other. So they are not sporadic cases, referring to individual studies.
- All randomized studies as well as the two cochrane reviews and the meta-analysis demonstrate the superiority of CHIVA compared to other treatments in terms of recurrence and quality of life at 5 and 10 years.
- The biochemical analysis of the pre- and post-chiva inflammatory markers, together with the demonstration of a regression of the saphenous wall alterations after treatment, confirm exetremely the possible use of a post-CHIVA saphens trunk for arterial by-pass. Anyway the incompetent great saphenous vein has been always used for by-pass, especially in case of infra-inguinal arteriopathies.
- The low spread of CHIVA treatement and the learning curve cannot be criteria influencing the levels of evidence. Indeed, they must be a stimulus to optimize the own work.
- Incompetent great saphenous vein can be used for arterial by-pass. It is exremely rare to find a varicous saphenous trunk.
In case of infrainguinal PAD the variables the vascular surgeon is interested in, are:
1) The minimum caliber measured along the axis
2) The length of the saphenous segment usable. (The fragmantation of the saphenous trunk during CHIVA procedure is performed less then 2% and always in the leg)
3) In case of aplasia / hypoplasia, the presence of a straight collaterality bypassing the aplastic/hypoplastic segment
The dilations of the saphenous trunk do not create problems as they are treated in various ways.
In coronary artery disease the variables for the eligibility of the saphenous trunk are:
1) The caliber. The leg tract is prefered as the small caliber and therefore more appropriate to the coronary arteries
2) the absence of ectasias
The way of harvesting the saphenous trunk, using not-touch technique, give better results.
The presence of reflux is not important, as often undetectable since the saphenous trunk is examened in lying position especially in case of urgency.
Futhermore some vascular surgeons, in case of a small saphenous caliber, prefer to performe a devalvulation first for obteining a reflux with caliber dilation and wall modifications such as an incompetent saphenous trunk and perform the by-pass in situ later.
Therefore CHIVA represents the treatment of superficial venous insufficiency which gives the best results over time compared to all the other methods applied: stripping and endovascular procedures; with the big advantage of being able to preserve a saphenous trunk for a possible use as an arterial by-pass. About this aspect, I would like to underline , two concepts:
- The age of population increases, therefore the probability of finding phlebopathic patients with arteriopathies increases
- Patients, awareness of venous problems, approch earlier their own phlebological problems so the probability of finding saphenous veins not involved or less alterated is high.
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