Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

1996 ◽  
Vol 11 (3) ◽  
pp. 98-101 ◽  
Author(s):  
P. Zamboni ◽  
C.V. Feo ◽  
M. G. Marcellino ◽  
G. Vasquez ◽  
C. Mari
Keyword(s):  
Saphenous Vein ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Vein Thrombosis ◽  
Long Saphenous Vein ◽  
Group A ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein ◽  
Group B

Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

scholarly journals The measurement of venous pressure by Doppler: is it a hemodynamic evaluation ?

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Pier Luigi Antignani ◽  
Giampiero Peruzzi ◽  
Tommaso Spina
Keyword(s):  
Clinical Application ◽  
Saphenous Vein ◽  
Normal Values ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Average Pressure ◽  
Doppler Method ◽  
Vein Thrombosis ◽  
Posterior Tibial ◽  
Long Saphenous Vein

Since 1980 using the Doppler method, planned by Bartolo, we have studied several patients by means of the measurement of venous pressures, both in orthostatism and in clinostatism. In a normal subject, in orthostatism the value of average pressure is 60 mmHg in the posterior tibial vein, and 60 mmHg in the long saphenous vein. When there are varicose veins, the average pressure is 90 and 96 mmHg respectively in the deep veins and in the superficial ones. In the case of post-thrombotic syndrome, the average values are 101 and 102 mmHg in the deep and superficial veins, respectively. In clinostatism, the normal values are under 20 mmHg and in subjects with vein thrombosis the value increase to 30 mmHg and more. After more than 30 years we discuss the reliability of the method, the hemodynamic basis and its clinical application in phlebological practice.

scholarly journals Primary varicose veins: Frequency, clinical significance and surgical treatment

2004 ◽  
Vol 132 (11-12) ◽  
pp. 398-403
Author(s):  
Dragan Vasic ◽  
Lazar Davidovic ◽  
Zivan Maksimovic ◽  
Aleksandra Crni ◽  
Miroslav Markovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Varicose Veins ◽  
World Health ◽  
Superficial Thrombophlebitis ◽  
Perforating Veins ◽  
Long Saphenous Vein ◽  
Significant Difference ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein

INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV), but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men), average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A); the development of incompetence of long saphenous vein (LSV) and short saphenous vein (SSV) at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males). The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to discover any statistically significant difference between the age of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (51.98?9.97 years; 54.50?31.82 years; t=0.36; p>0.05), or any significant difference of BMI value, with regard to the obesity of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (28.02?4.61 kg/m2; 24.50?6.36 kg/m2; t=0.50; p>0.05). No statistically significant correlation was found between Color Duplex findings of insufficiency of both long saphenous vein and short saphenous vein (p=-0.21 ; p>0.05), nor any significant correlation of Color Duplex findings of perforating veins insufficiency in the basin of long saphenous vein and short saphenous vein (p=-0.115; p>0.05). CONCLUSION The incidence of insufficiency is significant: approximately every third patient has short saphenous vein insufficiency, while three third of patients have perforating veins insufficiency. Color Duplex limb's veins ultrasonography is highly reliable method for the examination and study of superficial veins diseases, which is very important for preoperative decision-making and selection of surgical technique as well as for postoperative follow-up.

Druckgradient in den Beinvenen während der Betätigung der Wadenpumpe

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Cestmir Recek ◽  
Pojer
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Standing Position ◽  
Quiet Standing ◽  
High Ligation ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Reflux Recurrence

Background: Neovascularization is an important cause of venous reflux recurrence after high ligation of the long saphenous vein. The pathogenesis of this phenomenon is so far obscure. It is possible that a hemodynamic factor – a pressure gradient between the femoral vein and the residual long saphenous vein – could be the trigger initiating the process of neovascularization. Patients and methods: Venous pressure measurements on eight patients with primary varicose veins were performed in the erect position in the insufficient long saphenous vein on the thigh. Mean pressures in the quiet standing position and ambulatory pressures were considered. By interrupting the saphenous reflux either distally or proximally to the point of measurement the pressure conditions either in the femoral or in the crural veins were simulated. Results: With the tourniquet placed distally to the point of measurement, the venous pressure in the upper interrupted segment of the long saphenous vein (equivalent to the pressure in the femoral vein) remained uninfluenced during ambulation. In contrast, by interrupting the reflux proximally to the point of measurement, a marked decrease of the ambulatory pressure in the lower part of the long saphenous vein (equivalent to the pressure in the crural veins) was noted. Conclusions: A pressure difference occurs between the veins of the thigh and the lower leg during the activation of the muscle venous pump. This fact may explain the tendency of recurrencies of varicose veins after high ligation of the long saphenous vein as well as the initiation of reflux.

Value of the Trendelenburg tourniquet test in the assessment of primary varicose veins

2004 ◽  
Vol 19 (2) ◽  
pp. 77-80 ◽  
Author(s):  
W H Hoffmann ◽  
I M Toonder ◽  
C H A Wittens
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Scanning ◽  
Observer Variability ◽  
Duplex Scan ◽  
Long Saphenous Vein ◽  
Inter Observer Variability ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein ◽  
Male Patients

Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphenous vein (SSV) or perforating vein incompetence. This study analyses the inter-observer variability of the Trendelenburg test and the results are compared with duplex scanning - the standard for venous incompetence analysis. Methods: A total of 54 legs of 43 patients with varicose veins were investigated (36 female and seven male patients; mean age 47 years [range: 17-75]). All legs were evaluated for valvular incompetence by Trendelenburg tourniquet tests performed by three different investigators. A duplex scan was also performed in all legs. The inter-observer variability of the tourniquet test was expressed in Kappa (κ <0.5 indicated poor agreement). The sensitivity and specificity of the tourniquet tests are determined using the duplex scan as standard. Results: The inter-observer variability of the Trendelenburg test in detecting valvular incompetence of the LSV, SSV, perforating veins in the upper leg (PVU) and lower leg (PVL), expressed in Kappa, were: 0.39, 0.42, 0.14 and 0.49, respectively. The sensitivity of the tourniquet test in detecting valvular incompetence of the LSV, SSV, PVU and PVL, in relation to duplex scanning was: 50, 35, 52 and 35% respectively, and the specificity was 59, 72, 46 and 80%, respectively. Conclusions: The evaluation of patients with varicose veins with the Trendelenburg tourniquet test is unreliable and therefore obsolete. In order to manage patients with varicose veins properly duplex investigation is mandatory.

Recurrent varicose veins assessed by colour-coded duplex scanning: own experience

Phlebologie ◽  
2000 ◽  
Vol 29 (03) ◽  
pp. 58-61 ◽  
Author(s):  
G. Madycki ◽  
P. Dabek ◽  
A. Gabrusiewicz ◽  
W. Staszkiewicz
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Preoperative Assessment ◽  
Duplex Scanning ◽  
Group Iii ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Group I ◽  
Short Saphenous Vein ◽  
Deep Vein

SummaryAim: Authors performed a retrospective analysis of causes of recurrent varicose veins following surgery. Methods: They evaluated 89 patients (65 women and 24 men, mean age 49.7 years). All patients previously underwent same surgical procedures (long saphenous vein stripping with/without local multiple avulsions). For the purpose of the study, colour/duplex examinations were applied (Siemens Sonoline Elegra unit). Results: Depending on the type and area of recurrent varicose veins, patients were classified into 4 groups. Group I – 22 patients (persistence of varicose tributaries of LSV in thigh or thigh perforator). Group II – 27 patients (recurrence along the LSV in the calf). Group III – 26 patients (recurrence due to left incompetent short saphenous vein). Group IV – 14 patients (isolated incompetent perforators). Authors conclude, that colour-coded duplex scanning is currently a method of choice in the diagnosis of recurrent varicose veins. High incidence of recurrence due to short saphenous vein incompetence should draw particular attention to this vein in the preoperative assessment of venous system. Recurrence of varicose veins at thigh level is not caused by deep vein insufficiency, but is related to inadequate vein surgery or might be linked to the problem of neovascularisation in this area.

Standard Stripping versus Long Saphenous Vein-Saving Surgery for Primary Varicose Veins: A Prospective, Randomized Study with the Patients as Their Own Controls

1996 ◽  
Vol 11 (2) ◽  
pp. 45-49 ◽  
Author(s):  
M. Campanello ◽  
J. Hammarsten ◽  
C. Forsberg ◽  
P. Bernland ◽  
O. Henrikson ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Return ◽  
Varicose Veins ◽  
Return Time ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Postoperative Discomfort

Objective: To compare the postoperative discomfort and long-term outcome following standard stripping and atter long saphenous vein-saving surgery. Design: Prospective, randomized case-control study with patients serving as their own controls. Setting: Department of Surgery, County Hospital, Varberg, Sweden. Patients: Eighteen patients with bilateral primary varicose veins. Interventions: The patients were randomized prospectively to stripping or long saphenous vein-saving surgery. The leg causing most discomfort was operated on first. The other leg was operated on using the alternative method. Main outcome measures: Postoperative discomfort was assessed after an interview with the patient. Long-term outcome was determined by clinical assessment and Plethysmographic venous return time. Results: After 4 years the legs subjected to long saphenous vein-saving surgery yielded equal clinical results and had as great a prolongation of the plethysmographic venous return time as legs operated on using standard stripping. More patients reported greater discomfort following stripping than after vein-saving surgery. The saved long saphenous vein in all legs operated on was patent, compressible, non-sclerotic and free of intraluminal echoes. Conclusion: The long-term results of long saphenous vein-saving surgery are as good as standard stripping, provided that incompetent perforators are throughly mapped preoperatively and ligated at surgery. Long saphenous vein-saving surgery causes less subjective postoperative discomfort than standard stripping. The saved long saphenous vein can probably be used for future arterial reconstruction.

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