Varicose veins surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Several techniques have been performed for over a century, from the more invasive named "saphenous stripping" up to mini invasives like superficial phlectomies and CHIVA cure.
Stripping
Stripping consists of the removal of the saphena vein main trunk from the groin down to the ankle. The complications include deep vein thrombosis (5.3%),[1] pulmonary embolism (0.06%), and wound complications including infection (2.2%). For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5-60%. In addition, since stripping removes the saphenous main trunks, they are no longer available for venous by-pass in the future (coronary and/or leg artery vital disease).[2]
CHIVA
CHIVA is the acronym for Conservative and Haemodynamic cure of Incompetent Varicose veins in Ambulatory patients translated from the French cure "Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire"[3] published in France in 1988.
Pathophysiological principles
CHIVA relies on an hemodynamic impairment assessed by data and evidences depicted through ultrasound dynamic venous investigations. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. For example, a varicose vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thrombosis) or arterio-venous fistulae...and so the treatment has to be tailored according the hemodynamic feature.
Procedure and outcomes
It generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them.[4] The patient is dismissed the same day. This method leads to an improvement of the venous function in order to:
- Cure the symptoms of venous insufficiency as varicose veins, legs swelling, ulcers.[5][6]
- Prevent varicose recurrence due to progressive enlargement of collateral veins which replace and overtake the destroyed veins: CHIVA vs Stripping: varicose recurrence divided by 2 to 5 at 10 years.[7]
- Preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery vital by-pass which increases with ageing.
Consequences
To be achieved properly, CHIVA method needs a comprehensive knowledge of both hemodynamics and ultrasound venous investigation.
Other Surgical Treatments
- Ambulatory phlebectomy
- Laser vein removal
- Vein ligation
References
- ↑ van Rij AM et al. Incidence of Deep Venous Thrombosis after Varicose Vein Surgery, Br J Surg 2004 Dec;91(12):1582-5
- ↑ Hammarsten J, Pedersen P, Cederlund CG, Campanello M. Department of Surgery and Radiology, Hospital of Varberg, Sweden Long saphenous vein saving surgery for varicose veins. A long-term follow-up. Eur J Vasc Surg. 1990 Aug;4(4):361-4.
- ↑ claude Franceschi, Cure CHIVA, 1988, Editions de L'Armançon, 21390 Precy-Sous-Thil France
- ↑ [1]
- ↑ Maeso and all, Comparision of clinical outcome of Stripping and CHIVA for Treatment of varicose veins in Lower Extremities, Ann Vasc Surg 2001; 15: 661-665
- ↑ " Zamboni and all: Minimally Invasive Surgical management of primary Venous Ulcers vs Compression Treatment: a randomized Clinical Trial. Eur J Vasc Endovsc Surg 00,1-6 (2003)
- ↑ Varicose Vein Stripping vs. Haemodynamic Correction (C.H.I.V.A.): a Long Term Randomised Trial S. Carandina and all; Eur J Vasc Endovasc Surg xx, 1e8 (2007) doi:10.1016/j.ejvs.2007.09.011, online http://www.sciencedirect.com