Short endovenous laser ablation of the great saphenous vein in a modified CHIVA strategy

Abstract

Mini-invasiveness, ease of use and execution speed represent the reasons for endovenous laser ablation success. Nevertheless, the strategic choice remains the ablation of the saphenous trunk. Hemodynamic correction (CHIVA) represents an option, based on a saphenous-sparing therapeutic strategy. We tested the feasibility of a modified CHIVA strategy by means of endovenous lasers (EL) shrinkage of segmental great saphenous vein (GSV) tracts, in networks characterized by sapheno-femoral incompetence and re-entry perforators focused on the GSV. We report the follow up of the first 2 chronic venous disease [C 1,2,3 sEpAsPr 1,2,3 , venous clinical severity score (VCSS) 8 and 9 respectively] treated cases. At 1-year follow up both patients were C 1,2,3 sEpAsPr 1,2,3 and the VCSS were 1 and 2 respectively. The non-treated GSV tracts maintained their patency. ELs were herein used within a saphenous-sparing therapeutic plan, thanks to an accurate pre-operative hemodynamic assessment, which allowed the shrinkage of only the first saphenous trunk tract only. Proper technical and hemodynamic considerations are discussed.

Histologic and sonographic features of holmium laser in the treatment of chronic venous disease

“…29 The saphenous-sparing strategies' satisfying recurrence rate 30,31 together with the mini-invasiveness of the modern endovenous techniques 32 have progressively stimulated pioneering investigations regarding gSV competence restoration by means of endovenous devices. [33][34][35] In this environment, HOL offers the chance to switch from an ablative tool, as in laFoS strategy, to a potential means of GSV flow restoration without the need of any subsequent foam sclerotherapy. Further hemodynamics investigations on this topic are currently on-Collagen denatures between 50 °C and 60 °C.…”

Endovascular laser treatment of mixed shunt

“…Other Authors already reported EVLT according to CHIVA principles with good results. 7,8 In our case, performing a standard laser procedure of the GSV would be useless (proximal GSV and terminal valve were competent) and especially harmful, because interrupting OBS would meet unavoidable varicose veins recurrence, very difficult to manage.…”

CHIVA with endoluminal procedu res: Laser versus VNUS

“…This will allow more general use of this procedure in many countries where surgical interruption of the SFJ is reserved to hospi-tals. Further studies need to be carried out in this respect; one has already been published in Italy (18), as well as a study protocoll has been published for further investigation (19). There is also a need for studies to clarify how short a segment really needs to be closed, and how the recurrences over the anterior accessory saphenous vein described for endoluminal techniques will modify the results after endoluminal CHIVA.…”