aree scientifiche

Phlebologie  2002, 31 (1), pp. 1-8.

Abstract

Recirculation in varicose veins was firstly thought of by Trendelenburg and further developed by Hach. This idea is also the basis on which Claude Franceschi founded his treatment for insufficient veins – CHIVA (in English ACHM). He divided the veins of the legs in the nets R1, R2 and R3. Deep veins correspond to R1, saphenous veins to R2 and epifascial tributaries to R3. Depending on the participation of these nets in the recirculation of a varicosity, Franceschi divided the recirculations in four types, which he called shunts (type I to IV). On these shunts he based the therapeutic decisions for the CHIVA-method. Most of the shunts are type I or III. In this cases the reflux fills the saphenous veins directly from the deep veins via a crosse or a perforator vein. The study of these models of recirculation throws a new light on the understanding of the distally dilated perforator veins, as well as on the direction of blood-flow in the different segments of the veins. Therefore it is interesting not only for persons that perform the CHIVA-method. Without having understood these concepts, it is impossible to judge upon CHIVA. 

25) JUAN-SAMSO’ J.: Venous haemodynamic surgery in the treatment of varicose syndrome

(2003) Angiologia, 55 (5), pp. 460-475.

Abstract

Aims. The objective of this study is to update our knowledge of the different aspects of this subject, i.e. the rationale behind the method used, the anatomical-functional terminology employed, strategic principles and ways they can be applied. The results reported from the different series available are also analysed. Development. The CHIVA cure technique (ambulatory and haemodynamic treatment of venous insufficiency) was described by Franceschi in 1988. After the initial expansion of the procedure, its use diminished because it had not been submitted to adequate testing. Later standardisation of the method has led to different groups’ adopting the strategy with satisfactory results. The terminology put forward by the European CHIVA Association in 2002 allows the different types of strategies in this therapy to be applied accurately. It must be noted that in the register of activities of the Spanish Society of Angiology and Vascular Surgery (SEACV) for the year 2002, a third of the varicose veins submitted to surgery in Angiology or Vascular Surgery units or services in Spain were performed using venous haemodynamic surgery. Conclusions. No definitive evidence exists (randomised prospective clinical trials are under development) in favour of the CHIVA cure, yet the data available do support this procedure as an alternative to stripping in the treatment of varicose veins.

26) CAPPELLI M.; Molino Lova R.; Ermini S. Franceschi C.: Nouvelle approche de la physiopathologie de l’insuffisance veineuse superficielle: conséquences thérapeutiques

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