CHIVA strategy in chronic venous disease treatment: instructions for users

Gianesini, Sergio; Occhionorelli, Savino; Menegatti, Erica; Zuolo, Michele; Tessari, Mirko; Spath, Paolo; Ascanelli, Simona; Zamboni, Paolo

doi:10.1177/0268355514531953

Cited by 25 publications

(22 citation statements)

References 18 publications

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“…15,25 Non-ablative saphenous sparing strategies have shown promising results in a long follow-up analysis, but deeper investigations are required, in particular in the objective characterization of the differences among a reflux and a retrograde draining flow. 19,26,27 More than 50% of recurrences are localized at the SFJ: a phenomenon that is linked to GSV trunk recanalization, a pelvic leaking point involvement and/or a neovascularization. 1,4,5 Neovascularization has been defined as the appearance of not previously present veins in an abnormal position or tissue.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure was in accordance with CHIVA strategy, a therapeutic surgical approach based on the venous reflux suppression by means of selective ligations without saphenous ablation. 18,19 Since the study was retrospective and the procedure was used in normal clinical practice, it has not been necessary for a specific ethical approval. All the patients signed an informed consent allowing the anonymous use of their data for research purpose.…”

Section: Methodsmentioning

confidence: 99%

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Femoral vein valve incompetence as a risk factor for junctional recurrence

et al. 2017

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Background Recurrent varicose veins occur up to 80% of procedures. The sapheno-femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno-femoral junction recurrence. Methods Three-hundred-eighty-one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2-6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre-operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac-femoral vein tract above the sapheno-femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac-femoral vein tract incompetence. Results In a 5.5 ± 1.9 years follow-up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8%) cases. The reflux source was found in a reconnected sapheno-femoral stump in 11/45 cases (24.5%), in the pelvic network in 8/45 cases (17.8%), in a neovascularization process in 7/45 (15.5%) and in a newly incompetent great saphenous vein tributary in 19/45 (42.2%). At the pre-operative assessment, iliac-femoral vein tract reflux was present in 7 (26.9%) of the 26 cases who developed a sapheno-femoral junction recurrence and in 25 (7%) of the 355 patients who did not demonstrate sapheno-femoral junction recurrence (odds ratio: 4.8; confidence interval 95%: 1.8-12.6; p < .003). Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac-femoral vein tract incompetence and sapheno-femoral junction recurrences after high ligation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Femoral vein valve incompetence as a risk factor for junctional recurrence

et al. 2017

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“…Incompetent tributaries along the leg were flush ligated, sparing the remaining SSV, according to the hemodynamic principle of the saphenous sparing strategy. 19 In all patients, the skin incisions were sutured by a subcuticular running suture using a 4-0 monofilament absorbable thread.…”

Section: Methodsmentioning

confidence: 99%

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

et al. 2019

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Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.

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“…The actual anatomical and physiological interpretation of the lower limb venous network indicates a draining direction from the most superficial to the deepest lower limbs compartments: from the tributaries network (N3), towards the saphenous system (N2) and the deep venous system (N1). 11 Nevertheless, evidences concerning these networks kinetics are lacking.…”

Section: Introductionmentioning

confidence: 99%

Lower limbs venous kinetics and consequent impact on drainage direction

et al. 2017

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Background Literature concerning the lower limbs physiological venous haemodynamics is still lacking of reference velocity values and consequent impact on drainage direction. Aim of the present study is to assess the flow velocities in the different venous compartments, evaluating the possible Venturi effect role, thus finding clues for the identification of the physical model governing the flow direction. Methods Thirty-six lower limbs underwent a velocity and diameters echo-color-Doppler assessment in several anatomical point of analysis along both the deep and superficial venous systems. The investigation protocol included and compared two different manoeuvres to elicit the flow: manual calf compression/relaxation (CR) and active foot dorsiflexion (AFD). Both peak systolic (PSV) and time average velocities (TAV) were measured. Results The different venous segments demonstrated an overlap among the velocity values and the anatomical subdivision of the deep and superficial compartments. At the CR, TAV was 34 ± 12 cm/s in the deep venous system (N1), 15 ± 7 cm/s in the saphenous system (N2), 5 ± 2 cm/s in the saphenous tributaries (N3); PSV was 89 ± 35 cm/s in N1, 34 ± 16 cm/s in N2, 11 ± 4 cm/s in N3, p < 0.05. At the AFD, TAV was 33 ± 13 cm/s in N1, 15 ± 7 in N2, 9 ± 5 in N3; PSV was 83 ± 35 in N1, 32 ± 17 in N2, 15 ± 4 in N3, p < 0.05. A diameter decrease was reported from N1 to N3 ( p < 0.05). Conclusion This investigation provides evidences of the velocity decrease from the deepest to the most superficial compartments. These data introduce the Venturi effect as potential factor in the flow aspiration from the tributary to the deeper veins. The reported data represent a first step towards an objective evaluation of the physic laws governing the drainage. These values can constitute the basis for further investigations in pathological and post-procedural scenarios.

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CHIVA strategy in chronic venous disease treatment: instructions for users

Cited by 25 publications

References 18 publications

Femoral vein valve incompetence as a risk factor for junctional recurrence

Femoral vein valve incompetence as a risk factor for junctional recurrence

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

Lower limbs venous kinetics and consequent impact on drainage direction

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