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Fausto Passariello
Eleven years ago, in the February 1987, I have been present in
Paris to the first examinations of Venous cartography effected by
Claude Franceschi. One year later, he published his book on the
CHIVA. From then much has been told and much has been written and
people excessively made polemics on the topic, with manifold
effects. From a side the pressing demand of CHIVA surgical
interventions from the patients determined the adhesion to this
therapeutic practice of many Surgeons, that didn't have still
gathered a technical baggage sufficient to put it in practise.
From the other side the scientific information on the topic has
moved on conflicting and not usual platforms. A group of CHIVA
operators has been constituted, who are extremely experienced in
the method and able to communicate between them by means of a
privileged circuit. In this context we must consider the
Societies born in several countries to guarantee CHIVA
Inside this restricted group the communication was possible and rich, facilitating the improvement of the techniques. Who ever has participated to the reunions (open to all, but yet not completely publicised) knows that the intellectual stimulus was intense. Everybody was asked to carry his own experience, often not written in any paper or book. And still today many original observations, fruitful as starting point of future research, have not found a definitive written form. So that at the distance of so many years we all CHIVA Operators feel the moral obligation of communicating to others all that was said in the closed of few boundaries or perhaps on a beach of the Corsica or also during a dinner, with an almost esoteric character (in the facts, also if not in the intentions). Today, being catastrophically restrictive, there certainly stays at least a value. Beyond of the polemics on the CHIVA in his entirety or on the validity of the therapeutic action, a point is essentially established: the CHIVA has been the point of departure of a revolutionary diagnostic technique, the VENOUS CARTOGRAPHY, which has taken the name of CARTHOGRAPHIE VEINEUSE in France, MAPPA VENOSA in Italy.
- It has allowed us to accumulate literally a mine of informations.
- In experienced hands, it is more precise and detailed of a phlebography.
- It can be performed with a minimal instrumentation, an ultrasound imager and a Doppler velocimeter (it doesn't matter if a continuous one, better if a pulsed or colour one), in a not invasive way.
- It can be repeated many times and deepened as you like and when you like, until and beyond the boredom.
- It is the point of departure for the automatic computerised planning of the surgical strategy and for the exchange in digital form of the haemodynamic data VNET_VENOUS_NET).
The information's of the Venous Carthography are so many that it is a true sin that they today are not easily retrievable by everyone. The communication has then proceeded trough two other roads, both to my seem criticisable.
- The first is that taken by some official circuits who do not adhere to the narrow entourage of CHIVA operators. It is rare that the phlebological operators of these circuits have been taking intrigues to study deeply this matter. The problem has been viewed mainly as the need to face the extensive demand of this intervention coming from the patients, in a moment in which these same operators were not sufficiently experienced to practise it. On the other hand the purpose was also trying to organise a convincing negative publicity towards this intervention to dissuade the consumers from requiring it. They in this way could be explained the writings or the lectures or in general the positions against the method coming from operators who never practised it (at least in a sufficient number of cases, reference to against conferences in 1989) or that still, to distance of years, do not have understood at all the haemodynamic founding ideas.
- Whoever has chosen this way has committed almost a sin of omission, trying In EACH WAY to oppose the diffusion of a surgical method and of a new physiopathologic vision of venous diseases.
- The other wrong road has been that of the forced popularisation toward the big public and on specialised magazines, though they were not of scientific character. This way finds its justification in the economic demands of the private Centres that have practised it. This way is criticizable, but simply trying to defend it, we can say that if it had not been conceived, perhaps it would have been necessary to invent it, as it is also the road that has pushed the a priori detractors to necessarily accept and face the emergent. Without it perhaps today there would be no one able to effect with competence a Venous Carthography.
All this reflects the situation mainly in Italy, less completely in France. As to other countries I don't know.
For reasons depending tightly on the bad French and Anglo-Saxon habit of simply ignoring each other, today the CHIVA method is diffused prevalently in the Latin countries. The reasons are several ones. Certainly nobody has never worried about giving life to a group in an Anglo-Saxon country. The CHIVA is present instead in Italy, France, Belgium, Spain, Portugal, Algeria, Tunisia, Argentina, Canada. Concluding this panning on the communication, today more that never there exists a demand of clear and precise information in the respects of the CHIVA method. Today, to distance of ten years from its birth, there exists the evident necessity that the method, just because it is valid and NOT ONLY A FASHION, must be communicated to everybody and practised by all, without any obligation of place trust to few super-specialised structures as well private as public ones. This wish of spreading the method in a capillary way necessarily requires a detailed and scientific information, that today must follow different roads than those undertook in the first years, when there was the need to face the wall of the a priori opposition. That's why it is very important to divulge broadly all that has been written or told on the topic, so that each one can approach it.
So there comes the demand of the CHIVA WORLD REFERENCES.
Though it has a world charachter, it is based on an initial nucleus, that includes the almost totality of the papers published in Italy. There are also quoted papers which also not having scientific validity, however have their value on the discursive piano, that is articles on magazines or newspapers or still partecipations in scientific reunions or congresses. There have been listed French and Spanish papers besides, as well the italian conferences and partially the French ones.
It is today a simple list of bibliographical citations. Generally text is not reported, with some exceptions owing to their availability in electronic format. It is organised like a papery document. Everybody can request a copy from the Author of this paper, to front of a modest reimbursement for expenses of consignment and photocopies. It is also available in electronic form, on compatible MSDOS diskette or AMIGA.
These files will be also available in different formats: Pure ASCII, Word and HYPERTEXT formats, where hypertext means a text that internally is able to reference and jump to other topics, images, sounds, animations. There are available the formats of AmigaGuide HyperText for the Amiga environment, RTF WinHelp for the Windows environment, HTML for the browers of the World Wide Web (WWW) on Internet.
The bibliography will be present also on the data bank AQUARIUS BBS from Naples, (phone +39 081 7144110) of the not professional FidoNets and AmigaNet circuits, and a copy of it is therefore obtainable simply by an interactive download or a filerequest. The download doesn't involve any economic share, due instead for the papery support or on diskette. Another possibility of connection through Internet is available to the address http:// www.eass.it/ isvb.html (obsolete, n.d.r.), with the courtesy of the Associations I.S.V.B. and E.A.S.S., European Association of Surgical Sciences. In this case the bibliography could be also read in line by means of a www browser, as Netscape, Mosaic or Internet Explorer. As to other informations concerning its activation on the net, it will be sufficient to send me a message at the address F.Passariello@agora.stm.it (this is an old address, do not use it! n.d.r.)
The bibliography is continuously updated. It can be updated on line on Internet and on the FidoNet BBS in a form by which it will be possible to insert new jobs and authors. The updated papery version instead will be released on a periodic base.
That's why the bibliography has been assigned a version and revision number.
The version 1 revision 00 (1.00) dates to 1996, version 1.02 was distributed in Paranà in october 1988. The actual version (1.04) includes Italian papers, French and Spanish ones, the list of the Italian Centres, of the conferences organised and some biographical notes on the CHIVA operators. There are also listed several papers as well scientific as publicising ones,which are clearly against the CHIVA. They are all listed in the MISCELLANEA section, complete of title, author and bibliographical reference.
The tendency is therefore that of providing a finally complete reference, which is not lined up from only one part.