CHIVA IN FRANCE

 

 

Several studies in France showed that the results of the cure CHIVA is better versus stripping, but this conservative technic is seldom used in France. The surgeons who realise a cure CHIVA are specifically vascular surgeons who effect arterials revascularisations, and then to check whether the saphenous vein could be spared for possible future use as a bypass is a preoccupation. The interest of the conservation of the long saphenous vein has been really demonstrated, and more a study on intima-media thickness of the vein wall confirm the possibility of the vein wall to take again a normal structure after a resection of the saphenofemoral junction as during a cure CHIVA. This verification is possible because the trunk of the long saphenous vein permit the analyse before and after the surgery.

M. Bailly (J Mal Vasc, mars 1999,suppl A) reports that  a study on 266 CHIVA performed in 1991 reviewed in 1997 with clinical examination and colour duplex scanning to check on the venous state of the lower limb; mean follow-up was 5,9 years; and the results showed 80% spared varicose long saphenous usable at 6 years, and the experience of the author is that the cure CHIVA method was well adapted to sparing of the saphenous, even if varicose.

There are a few critical studies, specially P. Gorny (Phlebologie 1995, N°2,255) studed 321 patients who underwent two different methods preserving the long saphenous vein: cure CHIVA and resection of the saphenofémoral junction. After an average follow-up of 2,9 years, best results appeared in the second group, and surgical operation due to relapse have been three times more important in the first group and bad results four times more frequent. Nevertheless, the description of the two methods show that the first group is a method which is no more used now, and the resection saphenofémoral junction is the technic which is used in CHIVA, and not simple ligature or clip but a expand resection with the collaterals. More then, in the second group the author realised several phlebotomies like in CHIVA method. In fact, the author compared an old CHIVA method versus new CHIVA method, and finally the conclusion of this study is positive because it confirms that the reflexion on the interest of the CHIVA method progress, but some authors don’t progress yet.

The last study on CHIVA method, P. Caillard (J Mal Vasc, mars 2004,suppl 1) show the interest of the cure CHIVA after an average follow-up of 5 years: 114 long saphenous veins with a clinical examination according to CEAP classification, and colour duplex scanning with intima media thickness and diameters measures. The clinical score varied from 7,6 to 2,6 (p<0,0001), and the diameters varied from 5,32mm to 3,88mm (p<0,0001). The hemodynamic study showed 10 reflux with positive Valsalva from which six neo-saphenofemoral junctions and four perineal veins. A drainage reflux with negative Valsalva was observed in 51,5%.

In fact, several authors confirmed the interest of the CHIVA method in France. But the cure CHIVA is still debated in the daily practice. The principal reason seems to be the lack of understanding of hemodynamic physiopathology, specially the concept of the drainage reflux.

Despite, there is still a research for better results, with at the moment the study of the part of perineal veins, and specially perineal perforating veins (P point) which are the principal cause of long term relapse.