Clinical Results of a New Strategy (Modified CHIVA) for Surgical Treatment of Anterior Accessory Great Saphenous Varicose Veins

Abstract

IntroductionTraditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. MethodsThis non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. ResultsThe baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4–6. The new strategy was applied to all cases. Complications: 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4mm anterior saphenous to 3.4mm by one year (P<.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5mm and obesity were identified as predictors of worse clinical and haemodynamic outcome. ConclusionsThis modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively.