Assessment of the CHIVA and the ASVAL Method

Abstract

In this article, the CHIVA and ASVAL methods are assessed from the hemodynamic point of view. The CHIVA method comprises complicated, unusual terminology and new perceptions, such as closed and open shunts, fractionation of the hydrostatic pressure, subdivision of the venous network. The principal part of the CHIVA theory is the drainage of venous blood from the thigh saphenous system into the deep lower leg veins through the preserved saphenous trunk after high ligation at the saphenofemoral junction, which is considered as a beneficial, physiological phenomenon. In reality, this is recurrent reflux producing ambulatory venous hypertension. The main impact of the CHIVA procedure is the elimination of the saphenous reflux by high ligation at the saphenofemoral junction; thus it can be presumed that the CHIVA procedure yields similar results like the crossectomy.

The ASVAL procedure is de facto the modification of the old Madelung method that was the prevalent surgical procedure before the Trendelenburg era in the 19th century. The results after ASVAL were not checked by plethysmography; there is a good case to suppose that the results after the ASVAL method would comply with those after sclerotherapy.

Keywords

reflux - varicose veins - CHIVA - ASVAL - hemodynamics - venous hemodynamics

Publikationsverlauf

Artikel online veröffentlicht:
12. Februar 2022

• References

• 1 Franceschi C. Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). J Mal Vasc 1992; 17 (04) 291-300
• 2 Recek C. The hemodynamic paradox as a phenomenon triggering recurrent reflux in varicose vein disease. Int J Angiol 2012; 21 (03) 181-186
• 3 Jeanneret C, Labs KH, Aschwanden M, Bollinger A, Hoffmann U, Jäger K. Physiological reflux and venous diameter change in the proximal lower limb veins during a standardised Valsalva manoeuvre. Eur J Vasc Endovasc Surg 1999; 17 (05) 398-403
• 4 Arnoldi CC. Venous pressure in the leg of healthy human subjects at rest and during muscular exercise in the nearly erect position. Acta Chir Scand 1965; 130 (06) 570-583
• 5 Recek C, Pojer H. Ambulatory pressure gradient in the veins of the lower extremity. Vasa 2000; 29 (03) 187-190
• 6 Bjordal R. Simultaneous pressure and flow recordings in varicose veins of the lower extremity. A haemodynamic study of venous dysfunction. Acta Chir Scand 1970; 136 (04) 309-317
• 7 Zamboni P, Cisno C, Marchetti F. et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. Eur J Vasc Endovasc Surg 2003; 25 (04) 313-318
• 8 Maeso J, Juan J, Escribano J. et al. Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities. Ann Vasc Surg 2001; 15 (06) 661-665
• 9 Zamboni P, Marcellino MG, Cappelli M. et al. Saphenous vein sparing surgery: principles, techniques and results. J Cardiovasc Surg (Torino) 1998; 39 (02) 151-162
• 10 Carandina S, Mari C, De Palma M. et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg 2008; 35 (02) 230-237
• 11 Parés JO, Juan J, Tellez R. et al. Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial. Ann Surg 2010; 251 (04) 624-631
• 12 Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2013; 3 (07) CD009648
• 13 Faccini FP, Ermini S, Franceschi C. CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results. J Vasc Bras. J Vasc Bras 2019; 18: e20180099
• 14 Perrin M, Guidicelli H, Rastel D. Surgical techniques used for the treatment of varicose veins: survey of practice in France. J Mal Vasc 2003; 28 (05) 277-286
• 15 Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg 2009; 50 (01) 107-118
• 16 Pittaluga P, Chastanet S. Persistent incompetent truncal veins should not be treated immediately. Phlebology 2015; 30 (Suppl. 01) 98-106
• 17 Zolotukhin IA, Seliverstov EI, Zakharova EA, Kirienko AI. Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease. Phlebology 2017; 32 (09) 601-607
• 18 Madelung O. The removal of varicose veins in the lower extremity. Verh Dtsch Ges Chir 1884; 13: 114-117
• 19 Trendelenburg F. Ligation of the great saphenous vein in lower leg varicose veins. Beitr Klin Chir 1891; 7: 195-210
• 20 Recek C. Late results after crossectomy and sclerotherapy. Phlebologie 2000; 29: 23-26