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?