HEMODYNAMIC CORRECTION OF VARICOSE-VEINS (CHIVA) - AN EFFECTIVE TREATMENT

Objective: Evaluation of the feasibility and utility of haemodynamic c orrection of primary varicose veins (French acronym: CHIVA). Design: P rospective, single patient group study. Setting: Department of Surgery , University of Ferrara, Italy (teaching hospital). Patients: Fifty-fi ve patients with primary varicose veins and a normal deep venous syste m (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi w ere undertaken. Seven patients were treated for short saphenous vein v arices (group A) while 48 patients were treated for long saphenous vei n varices (group B). Main outcome measures: Clinical: presence of vari ces and reduction in symptoms. Duplex and continuous-wave Doppler dete ction of re-entry through the perforators and identification of recurr ences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years fo llowing surgery. Results: In group A, 57% short saphenous vein occlusi ons with no re-entry through the gastrocnemius and soleal veins were r ecorded. In group B the long saphenous vein thrombosis rate was 10%. I n 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. Statistic ally 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 th rombosis is related to development of recurrences