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[Ambulatory conservative hemodynamic correction of venous insufficiency. Technique, results]
A Bahnini1, M Bailly, L Chiche
1Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière.
Insights
Conservative haemodynamic intervention for venous insufficiency (CHIVA) corrects venous issues via precise ultrasound mapping and surgical correction. This outpatient procedure promotes walking and good results when performed accurately.
Area of Science:
- Vascular Surgery
- Medical Devices
- Ultrasound Technology
Background:
- Superficial venous insufficiency presents pathological haemodynamic effects, particularly when standing.
- Accurate assessment and targeted intervention are crucial for effective treatment.
- Existing treatments may not fully address the underlying haemodynamic causes.
Purpose of the Study:
- To describe the ambulatory conservative haemodynamic intervention for venous insufficiency (CHIVA) procedure.
- To highlight the importance of preoperative ultrasound mapping and marking.
- To evaluate the effectiveness of CHIVA in correcting superficial venous insufficiency.
Main Methods:
- Preoperative anatomical and haemodynamic mapping using duplex ultrasound.
- Ultrasound-guided marking for precise surgical intervention.
- Ligation-section of the superficial venous network to divide the hydrostatic pressure column and disconnect venovenous shunts.
Main Results:
- The CHIVA strategy aims to establish a superficial venous circuit that drains effectively into the competent deep venous network.
- The procedure is performed under local anaesthesia as an outpatient treatment.
- Immediate resumption of walking is facilitated, enhancing calf muscle pump activation and promoting good outcomes.
Conclusions:
- CHIVA is a highly effective technique for treating superficial venous insufficiency when precise preoperative ultrasound-guided marking and surgical execution are achieved.
- Failures are typically associated with inadequate haemodynamic assessment or procedural inaccuracies.
- The technique offers a conservative, ambulatory approach to managing venous insufficiency.
Abstract:
Ambulatory conservative haemodynamic correction of venous insufficiency (CHIVA) is a surgical treatment of superficial venous insufficiency designed to correct the pathological haemodynamic effects of superficial venous insufficiency apparent on standing. Surgical treatment is based on precise preoperative anatomical and haemodynamic mapping performed by duplex ultrasound, providing preoperative ultrasound-guided marking. Surgical treatment consists of dividing the hydrostatic pressure column and disconnecting venovenous shunts by ligation-section of the superficial venous network at precise points determined by the preoperative ultrasound-guided marking. This strategy should achieve a superficial venous circuit draining perfectly into the competent deep venous network. The operation is performed under local anaesthesia as an outpatient procedure and allows immediate resumption of walking, which promotes a good result due to activation of the calf muscle pump. The results of the technique are very good provided a reliable preoperative ultrasound-guided marking and a precise surgical procedure are performed. Failures are due to poor haemodynamic assessment or inappropriate surgical procedure.