CHIVA with endoluminal procedu res: Laser versus VNUS

Summary

Introduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.

Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.

Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.

Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.

Keywords

CHIVA - endoluminal laser technique - VNUS ClosureFast™ - venous insufficiency - Great saphenous vein - GSV

• References

• 1 Franceschi C. Théorie et Pratique de la Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire. Précy-sous-Thil 1988 (Armançon)
• 2 Franceschi C, Cappelli M, Ermini S, Gianesini S, Mendoza E, Passariello F, Zamboni P. CHIVA: hemodynamic concept, strategy and results. International Angiology 2016; 35 (Suppl. 01) 8-30.
• 3 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 (Suppl. 02) 230-237.
• 4 Pares O, Juan J, Tellez R. et al. Varicose Vein Surgery: Stripping vs. the CHIVA method. A Randomized Controlled Trial. Ann Vascular Surg 2010; 251: 624-631.
• 5 Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of System. Rev. 2012 Issue 2, Art. No.: CD009648 DOI: 10.1002/14651858. CD009648.
• 6 Stücker M, Moritz R. et al. New concept: different types of insufficiency of the saphenofemoral junction identified by duplex as a chance for a more differentiated therapy of the great saphenous vein. Phlebology 2013; 28: 268-274.
• 7 Mendoza E. Der saphenofemorale Übergang im Ultraschall. Phlebologie 2014; 43: 42-45.
• 8 Mendoza E, Stücker M. Duplex-ultrasound assessment of the saphenofemoral junction (Review). Phlebological Review 2015; 23 (Suppl. 03) 1-8.
• 9 Lawrence PF, Chandra A, Wu M. et al. Classification of proximal endovenous closure levels and treatment algorithm. JVS 2010; 52: 388-392.
• 10 Mendoza E, Berger V, Zollmann C, Bomhoff M, Amsler F. Kaliberreduktion der V. saphena magna und der V. femoralis communis nach CHIVA. Phlebologie 2011; 40 (Suppl. 02) 73-78.
• 11 Mendoza E. Kaliberreduktion der V. saphena magna und der V. femoralis communis nach CHIVA – Langzeitergebnisse. Phlebologie 2013; 42: 65-69.
• 12 Mendoza E. CHIVA im Zeitalter der endovenösen Therapie. Vortrag auf DGP Dresden. 2016
• 13 Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomized clinical trial comparing endovenous Laser ablation with cryostripping for great saphenous varicose veins. Br J Surg 2011; 98: 1107-1111.
• 14 Flessenkämper I, Hartmann M, Hartmann K, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicenter randomized controlled trial with up to 6 years follow-up. Phlebology 2013; 31: 23-33.
• 15 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ. et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous Laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63: 420-428.
• 16 Siribumrungwong B, Noorit P, Wilasrusmee C, Attia J, Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vasc Endovasc Surg 2012; 44: 214-223.
• 17 Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev 2014; Jul 30 7: CD005624
• 18 Gianesini S, Menegatti E, Zuolo M. et al. Short endovenous LASER Ablation of the great saphenous vein in a modified CHIVA Strategy. Veins and Lymphatics 2013; 2: e21
• 19 Passariello F, Ermini S, Cappelli M. et al. The office based CHIVA. J of Vasc Diagn and Int 2013; 1: 13-20.