Fundamental principles of CHIVA (Conservatrice Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) strategy in treatment of chronic venous disease
Keywords:
chronic venous disease, hemodynamic disorders, venous shunt, CHIVAAbstract
Globally, varicose veins have a significant incidence. At the same time, there is no treatment technique that solves all problems related to chronic venous insufficiency – correction of hemodynamic disorders, improvement of symptoms, prevention of recurrence, etc. A special role in the arsenal of surgical interventions, applied in the treatment of chronic venous disease, belongs to operations with the preservation of saphenous veins. CHIVA strategies aim to correct the venous hemodynamic disorders of the lower limbs while preserving the superficial veins by applying minimally invasive techniques. The therapeutic approach in the sense of the CHIVA method involves the selection of individual surgical tactics according to the type of hemodynamic disturbances – the type of veno-venous shunt. Operative technique and volume are based on the results of a thorough duplex Doppler examination. During its 40 years of existence, CHIVA strategies have proven their effectiveness in the treatment of varicose veins in multiple specialized studies. Compared to saphenous stripping, CHIVA techniques are less traumatic, have a lower recurrence rate and significantly improve patients’ quality of life. At the same time, the success of these interventions is directly proportional to the experience of the surgeon who performs it.
References
1. MILONE M., SALVATORE G., MAIETTA P., et all. Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon›s experience. In: Il Giornale di chirurgia [on-line]. 2011, № 32(11-12):460-3. ISSN: 1971-145X. https://pubmed.ncbi.nlm.nih.gov/22217371/
2. LIQIN G., RONG H., DUNYONG Z., et all. Long-term efficacy of different procedures for treatment of varicose veins: A network meta-analysis. In: Medicine, 2019, № 98 (7), p.14495. ISSN: 1536-5964. https://www.ncbi.nlm.nih.gov/pmc/journals/2786/ https://doi.org/10.1097/MD.0000000000014495
3. ORIOL PARE'S J., JUAN J., TELLEZ R., et all. Varicose Vein Surgery. Stripping Versus the CHIVA Method: A Randomized Controlled Trial. In: Annals of Surgery. 2010, № 251 (4). ISSN: 1528-1140. https://www.ncbi.nlm.nih.gov/pmc/journals/230/ https://doi.org/10.1097/SLA.0b013e3181d0d0a3
4. JAVORUCKA-KACZOROWSKA A., OSZKINIS Grzegorz O., HUBER J., et all. Saphenous vein stripping surgical technique and frequency of saphenous nerve injury. In: Phlebology, 2015, № 30(3) 210-216. ISSN: 1758-1125. https://journals.sagepub.com/home/phl https://doi.org/10.1177/0268355514539316
5. CAPPELI M., MOLINO-LOVA R., GIANGRANDI I. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. In: Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2017, № 6 (2), P224-229, https://doi.org/10.1016/j.jvsv.2017.09.005
6. BELLMUNT-MONTOYA S., ESCRIBANO JM., DILME J., et all. CHIVA method for the treatment of varicose veins. In: Cochrane Database of Systematic Reviews. 2012 , Issue 2 . Art. No.: CD009648. CD009648 .ISSN: 1469-493X. https://www.cochranelibrary.com/cdsr/table-of-contents
https://doi.org/10.1002/14651858.CD009648
7. JUAN J.,ESCRIBANO JM., CRIADO E., et all. Haemodynamic surgery for varicose veins: surgical strategy. In: Phlebology, 2005, № 20 (1), p. 2-13. https://journals.sagepub.com/doi/abs/10.1258/0268355053300884 https://doi.org/10.1258/0268355053300884
8. PURICELLI FACCINI F., ERMINI S., FRANCESCHI C. CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and result. In: Jornal Vascular Brasileiro, 2019, № 18:e20180099, p.1-7. ISSN: 1677-7301. https://www.ncbi.nlm.nih.gov/pmc/journals/3331/ https://doi.org/10.1590/1677-5449.009918
9. ZAMBONI P., MENDOZA E., GIANESINI S. In: Saphenous Vein-Sparing Strategies in Chronic Venous Disease, 2018, p.131-143. ISBN 978-3-319-70638-2 (eBook) https://doi.org/10.1007/978-3-319-70638-2_1
10. MOWATT-LARSSEN E., SHORTELL C. CHIVA. In: Seminars in vascular surgery, 2010, № 23:118-122. ISSN: 1558-4518. http://www.sciencedirect.com/science/journal/08957967 https://doi.org/10.1053/j.semvascsurg.2010.01.008
11. DE MAESENEER M., KAKKOS S., AHERNE T., et all. Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. In: European Journal of Vascular and Endovascular Surgery, 2022, № 63, p.224. ISSN: 1532-2165. http://www.sciencedirect.com/science/journal/10785884
12. CARRIAZO G., DE LAS HERAS G., VAZQUEZ M., et all. Estudio de la insuficiencia venosa crónica mediante ecografía Doppler y realización de cartografía venosa. In: Radiología, № 2016, 58(1), 7-15. https://doi.org/10.1016/j.rx.2015.10.006
13. https://www.sciencedirect.com/journal/radiologia/vol/58/issue/1
14. ZMUDZINSKI M., MALO P., HALL C., et all. CHIVA - A prospective study of a vein sparing technique for the management of varicose vein disease. In: The American Journal of Surgery, 2017. ISSN: 1879-1883. https://www.sciencedirect.com/journal/the-american-journal-of-surgery https://doi.org/10.1016/j.amjsurg.2017.03.025
15. GIANESINI S., OCCHIONORELLI S., MENEGATTI E. CHIVA strategy in chronic venous disease treatment: instructions for users. In: Phlebology, № 0(0) 1-15. ISSN: 1758-1125. https://journals.sagepub.com/home/phl
16. FRANCESCHI C. So as to avoid any misunderstanding about Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA). In: Phlebology: The Journal of Venous Disease, 2010, № 25(4), 212-212. ISSN: 1758-1125. https://journals.sagepub.com/home/phl https://doi.org/10.1258/phleb.2009.009084
17. MAESO J., JUAN J., ESCRIBANO JM., et all. Comparison of Clinical Outcome of Stripping and CHIVA for Treatment of Varicose Veins in the Lower Extremities. In: Annals of Vascular Surgery, 2001,№ 15: 661-665. ISSN: 1615-5947. http://www.sciencedirect.com/science/journal/08905096 https://doi.org/10.1007/s10016-001-0009-8
18. IBORRA-ORTEGA E., BARJAU-URREA E., VILA-COLL R. Estudio comparativo de dos técnicas quirúrgicas en el tratamiento de las varices de las extremidades inferiores: resultados tras cinco años de seguimiento. In: Angiologia, 2006; № 58 (6): 459-468. ISSN 0003-3170. https://dialnet.unirioja.es/servlet/ articulo?codigo=2204017 https://doi.org/10.1016/S0003-3170(06)75009-X
19. MALDONADO-FERNA'NDEZ N., LINARES-PALOMINO JP., LO'PEZ-ESPADA C., et all. Resultados clı'nicos de una nueva estrategia quiru'rgica (CHIVA modificado) en el tratamiento de las varices dependientes de la vena safena magna accesoria anterior. In: Cirugia Espanola, 2016, № 94 (3), p. 144-150. ISSN: 1578-147X. http://www.sciencedirect.com/science/journal/0009739X https://doi.org/10.1016/j.ciresp.2015.10.010
20. GIANESINI S., OCCHIONORELLI S., MENEGATTI E. Femoral vein valve incompetence as a risk factor for junctional recurrence. In: Phlebology, № 0(0) 1-7. ISSN:1758-1125. https://journals.sagepub.com/home/phl
21. CARANDINA S., MARI C., DE PALMA M. Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a Long Term Randomised Trial. In: European Journal of Vascular and Endovascular Surgery, 2008, № 35, 230-237. ISSN: 1532-2165. http://www.sciencedirect.com/science/journal/10785884 https://doi.org/10.1016/j.ejvs.2007.09.011
22. CAPPELI M., MOLINO-LOVA R., GIANGRANDI I. Ambulatory Conservative Hemodynamic Management of Varicose Veins: Critical Analysis of Results at 3 Years. Annals of Vascular Surgery, 2000, № 14(4), 376-384. ISSN: 1615-5947. http://www.sciencedirect.com/science/journal/08905096 https://doi.org/10.1007/s100169910064
23. CHAN C.-Y., CHEN T.-C., HSIEH Y.-K., et all. Retrospective Comparison of Clinical Outcomes between Endovenous Laser and Saphenous Vein-sparing Surgery for Treatment of Varicose Veins. World Journal of Surgery, 2011, № 35(7), 1679-1686. ISSN: 1432-2323. https://link.springer.com/journal/268 https://doi.org/10.1007/s00268-011-1093-8
24. Luminița Vescu; doctorandă, asistent universitar, Catedra Chirurgie Generală Semiologie Nr. 3, USMF "Nicolae Testemiţanu"; tel.:068284737; e-mail: luminita.vescu@usmf.md
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
