ANGIOVIDEO-ASSISTED HEMODYNAMIC CORRECTION OF VARICOSE-VEINS

Objective. Evaluation of the feasibility and utility of angioscopy in the hemodynamic correction (French acronyms is CHIVA) of primary varic ose veins disease. Experimental design. Prospective evaluation of 25 p atients, undergoing hemodynamic correction of primary varicose disease with intraoperative videoangioscopic guide. Patients have been select ed according to criteria emerged from a prospective study that we had previously conducted. Follow-up lasted 1 year (range 8-18 months). Set ting. Department of Surgery, University of Ferrara, Italy. Institution al practice. One-day surgery. Patients. Their selection has been carri ed out in our Vascular Laboratory. The adopted clinical criteria of se lection were: Primary varicose disease of the long saphenous Vein terr itory, no previous thrombophlebitis and/or sclerotherapy. Doppler cw a nd Duplex criteria followed were: competent deep venous system, long s aphenous vein diameter minor than 10 mm and incompetent perforating ve ins diameter minor than 4 mm. Interventions: 25 hemodynamic correction s according to the CHIVA method described by Franceschi. An angioscope , introduced through a distal collateral of the long saphenous vein, p ermitted the precise interruption of the venous-venous shunts and of t he superficial venous system, just below the perforators chosen as re- entry points in the deep venous system. Measures. Clinical: varices an d symptomatology reduction. Duplex and Doppler cw: detection of the su perficial blood flow re-entry, in the deep venous system, through the perforators and identification of recurrences or new refluxes. Pre and postoperative Ambulatory Venous Pressure and Refilling Time have also been measured. Results. In 20 patients symptoms and varices relief we re recorded (80%), in 5 patients varices reduction was observed only d uring walking (20%). In 2 of these latter patients there was no re-ent ry through the perforators, with a recurrent saphenofemoral reflux in 1 of them. Early complications recorded were: 2 long saphenous Vein th rombosis (8%); 7 ecchimosis (28%) when heparine/saline solution had be en used for angioscopic clearance. Conclusions. Intraoperative angiosc opy is feasible and useful when the hemodynamic situation is complex a nd the Duplex map is difficult to be interpreted by the surgeon. In th is series the second look percentage rate has been minor compared to t he percentage rates published so far by other authors.