Conservative hemodynamic surgery for varicose veins

Luján, S.; Izquierdo, Luis; Puras, E; Gutiérrez, Miguel; Fontcuberta, Juan

doi:10.1016/s0895-7967(02)70013-6

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…The addition of small 1.5-mm punch incisions allows for blood that collects in the vein tract to be flushed out with further tumescent anesthetic fluid. [184][185][186] Preservation of the GSV. Preservation of the saphenous vein and treatment of varicose tributaries by phlebectomy has been advocated by Francesci in the CHIVA (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatiore [ambulatory conservative hemodynamic management of varicose veins]) technique [186][187][188][189] and by Pittaluga in the ASVAL (ablation sélective des varices sous anesthésie locale [ie ambulatory selective varicose vein ablation under local anesthesia]) technique.…”

Section: Open Venous Surgerymentioning

confidence: 99%

“…The CHIVA technique is a hemodynamic approach to varicose veins based on the principles of preserving the saphenous vein and venous drainage into the deep system. 186,190 The goal of CHIVA is to decrease the hydrostatic pressure in the saphenous veins and tributaries by the ligations placed in specific areas in the superficial venous system and to maintain the drainage function of the superficial veins, usually via a reversed flow. 186 It represents a systematic approach to varicose veins rather than a single operative procedure.…”

Section: Open Venous Surgerymentioning

confidence: 99%

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The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Gloviczki

Comerota²,

Dalsing

et al. 2011

Journal of Vascular Surgery

1,298

952

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The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

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Section: Open Venous Surgerymentioning

confidence: 99%

Section: Open Venous Surgerymentioning

confidence: 99%

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Gloviczki

Comerota²,

Dalsing

et al. 2011

Journal of Vascular Surgery

1,298

952

View full text Add to dashboard Cite

show abstract

“…Conservative haemodynamic surgery for varicose veins (CHIVA) is described as a 'physiological surgery' technique, which involves identification (duplex ultrasound) and ligation of points of deep to superficial reflux rather than extensive, ablative surgery. 61 Communicating veins and saphenous veins are preserved and no phlebectomies are performed. Although haemodynamics improve and morbidity is low, recurrence rates may be as high as 35% at 3 years.…”

Section: Modifications Of Standard Surgical Techniquementioning

confidence: 99%