Hemodynamic correction of varicose veins (CHIVA): An effective treatment?

CHIVA treatment is inadvisable fo short saphenous veins varices. Long saphenous veins post-operative thrombosis is related to development of recurrences

When CHIVA treatment could be videoguided.

CHIVA seems to be a more effective varicose vein treatment than high ligation and distal stab avulsion. It also preserves a higher rate of long saphenoius veins, suitable fo r bypass surgery

Angiovideo-assisted hemodynamic correction of varicose veins.

Intraoperative angioscopy is feasable and useful when the hemodynamic situation is complex and the Duplex map is difficult to be interpreted by the surgfeon. In this series the second look percentage rate has been minor compared to the pèercentage rates published so far by other authors

External valvuloplasty of the saphenofemoral junction.

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In vitro versus in vivo assessment of vein wall properties

Venous compliance reflects the mechanical properties of the vein wall. Clinical methods of measurement have not been validated by comparison with the accepted in vitro measurement. Despite this, clinical assessment of vein compliance may have a series of useful applications: (1) to assess the progression of chronic venous insufficiency and the related hemodynamic forces acting on the saphenous vein wall; (2) to determine the suitability of the saphenous vein for replacement of an arterial conduit by testing its mechanical properties; and (3) to select the saphenous vein with preferable mechanical performance for coronary artery bypass. The aim of this study is to assess the relationship between in vitro and two in vivo methods of compliance measurement. Compliance of the saphenous vein was determined in 20 patients, using both an invasive and a noninvasive (A and B, respectively) method. Duplex scanning was used for diameter measurement. Venous pressure was derived either intravenously with a needle transducer, or noninvasively with limb length measurement. Patients underwent saphenous excision with further in vitro compliance measurement of the same vein segment (method C). The compliance values obtained with the three methods showed different degrees of correlation (r= 0.516, p = 0.0001 for method A versus method C; r = 0.658, p = 0.0001 for method B versus method C; r = 0.993, p = 0.0001 for method A versus method B). The relationships with the in vitro measurements that were determined validate both in vivo methods for assessment of saphenous vein compliance. Due to its completely noninvasive design, method B appears to have potential use for clinical assessment of saphenous vein wall properties

Varicose vein stripping vs. haemodynamic correction (c.h.i.v.a.): a long term randomised trial.

OBJECTIVES: To compare the long-term results of stripping vs. haemodynamic correction (Ambulatory Conservative Haemodynamic Management of Varicose Veins, CHIVA) in the treatment of superficial venous incompetence resulting in chronic venous disease (CVD). DESIGN: Randomised comparative trial. PATIENTS: 150 patients affected by CVD, CEAP clinical class 2-6, were randomised to saphenous stripping or to CHIVA. METHODS: The clinical outcome was assessed by an independent observer who recorded the Hobbs clinical score for treated limbs. A subjective report of the outcome was provided by the patients. Recurrence of varices was assessed by both clinical examination and duplex ultrasonography. RESULTS: The mean follow-up was 10 years, 26 patients were lost to follow-up. The Hobbs score similar in the stripping and CHIVA groups. However recurrence of varicose veins was significantly higher in the stripping group (CHIVA 18%; stripping 35%, P<0.04 Fisher's exact test), without significant differences in the rate of recurrences from the sapheno-femoral junction. The associated risk of recurrence at ten years was doubled in the stripping group (OR 2.2, 95% CI 1-5, P=0.04). CONCLUSIONS: Recurrent varices occurred more frequently following saphenous stripping than after CHIVA treatment. The deliberate preservation of the saphenous trunk as a route of venous drainage in the CHIVA group may have been a factor reducing the recurrence rate

The relationship between in vitro and in vivo venous compliance measurement

OBJECTIVE: To assess the relationship between in vitro and in vivo venous compliance measurement. DESIGN: Prospective, blind study. MATERIALS AND METHODS: Patients affected by primary varicose veins and classified in accord with the new CEAP criteria (C2-6/S, Ep, AS1-4/p17-18, PR) underwent blind venous compliance measurements using two different methods. 1) In vivo assessment of the compliance of the greater saphenous vein by duplex scanning, for diameter, and a needle transducer, for venous pressure measurements. 2) In vitro standard compliance assessment of the same vein segment after its excision. RESULTS: The compliance values obtained with the two methods showed a significant degree of correlation, which improved with increasing intravenous pressures. CONCLUSIONS: In vivo compliance assessment of the saphenous vein was validated by the relationship with the standard in vitro measurement