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SERGI BELLMUNT, JM ESCRIBANO,
V FERNÁNDEZ-VALENZUELA, O. LAPIEDRA
ANGIOLOGÍA Y CIRUGÍA VASCULAR
INSTITUT QUIRÓN-DEXEUS
BARCELONA
¿Podemos combinar estrategias hemodinámicas con técnicas
ablativas?Can we combine hemodynamic and
ablation techniques?
Strategies/ Target Techniques/ Tools
Eliminate
Preserve CHIVA ASVAL
Open surgeryRadiofrequencyLaserSclerotherapyOther…
Concepts
CHIVA strategy
CuraHemodinámicaInsuficienciaVenosaAmbulatoria
- Disconnection of the scape
point
- Fragmentation
of the venous pressure column
-Preservationof the re-entry
perforators
-Disconnetion of venous-
venous shunts
-Abolitionof undrained superficial varicose
veins
J Juan, JM, Escribano, E Criado, J Fontcuberta.Haemodynamic surgery for varicose veins: surgical strategy Phlebology 2005; 20: 2–13
¿Why CHIVA?
Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ.CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD009648
CHIVA?
?
Recomendación
Recomendación CHIVA
Recommendation: CHIVA
2011
Ideal treatment
Noninvasive
Good long term results
Effective
Open surgery
Sclerotherapy
Endovenousablation
Techniques
Técnica Invasivity Efficacy* Control
Open surgery
XXX XXX XXX
Sclerotherapy
X XXX X
Endovenous ablation
XX XXX XXX
*Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapyversus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD005624. DOI: 10.1002/14651858.CD005624.pub3.
Objective
Evaluate the results of implementing
the CHIVA-method using
radiofrequency for closing the SFJ
scape point
Inclusion and exclusion criteria
Inclusion: Reflux at:
Sapheno-femoral junction (SFJ): terminal and pre-terminal valves
Sapheno-popliteal junction (SPJ) Visible varicose veins CEAP classification: C>=2
Exclusion: Anfractuous saphenous vein Saphenous diameter >20 mm
Technique
Radiofrequency (Vnous Closure®)Access:
Ultrasound guided puncture of the saphenous vein Using the varicose vein origin from the saphenous vein
Length of treatment of the saphenous vein: 2 cms from terminal valve 7-14 cm
Completion of a CHIVA method: Disconnection of shunts Abolition of undrained superficial varicose veins
(phlebectomy or sclerotherapy) Preservation of re-entry perforators
Results
August 2012 – March 2015
n= 34 patients/37 legs
26 women/ 8 men
Follow-up: 12 months (1-38 m.)
Results
Veins affected:
35 great saphenous veins / 2 short saphenous veins
3 recurrences: neovascularisation of the SFJ
Mean age: 58 y.
C2 (CEAP): 100%
Saphenous diameter: 6,3 mm
Short-term results (<30d)
Scape point closed: 100 %
DVT: 0 %
Groin complications(??): 0 %
Hematomas: 0 %
Nerve damage: 0 %
Medium-term results (1-38 m.)
Proximal saphenous vein treated: 37/37100%
Recurrence: Scape point (previous neovascularisation): 1/37
3% Tributary veins: 5/37
14%
Temporary occlusion between the treated saphenous and the access point of the catheter
Conclusiones
CHIVA es una estrategia
CHIVA puede ser aplicada mediante diferentes técnicas
El uso de RF en el tratamiento del punto de fuga nos ha aportado: Eficacia Seguridad Menor agresión
Faltan más datos y de mayor calidad metodológica
¿Podemos combinar estrategias hemodinámicas con técnicas
ablativas?Can we combine hemodynamic and
ablation techniques?
YES, WE CAN
¿Podemos combinar estrategias hemodinámicas con técnicas
ablativas?Can we combine hemodynamic and
ablation techniques?