Abstract
CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site.
Highlights
CHIVA is the French acronym for “Cure conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire” (Conservative and Hemodynamic treatment of the Venous Insufficiency in the office). It is a saphenous-sparing therapeutic approach for lower limb chronic venous disease (CVD) based on hemodynamic concepts proposed by Claude Franceschi in 1988.1 The rationale behind this hemodynamic approach to treat the disease is that it is increased transmural pressure (TMP) that is responsible for the progression of the signs and symptoms of CVD, such as varicosities, edema, pain, itching, dermatitis and ulcers
TMP is increased because of higher hydrodynamic pressure caused by the absence of orthodynamic pressure fractionating and the presence of closed shunt
The CHIVA strategy is based on the hemodynamics of the venous system and aims to maintain the venous system in place, while correcting imbalances created by shunts between the deep and superficial venous systems.[1]
Summary
CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report. Felipe Puricelli Faccini[1], Ani Loize Arendt[1], Raphael Quintana Pereira[2], Alexandre Roth de Oliveira[3]
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