.

1. S E R G I B E L L M U N T , J M E S C R I B A N O ,
V F E R N Á N D E Z - V A L E N Z U E L A , O . L A P I E D R A
A N G I O L O G Í A Y C I R U G Í A V A S C U L A R
I N S T I T U T Q U I R Ó N - D E X E U S
B A R C E L O N A
¿Podemos combinar estrategias
hemodinámicas con técnicas ablativas?
Can we combine hemodynamic and
ablation techniques?

2. Strategies/ Target Techniques/ Tools
 Eliminate
 Preserve
 CHIVA
 ASVAL
 Open surgery
 Radiofrequency
 Laser
 Sclerotherapy
 Other…
Concepts

3. CHIVA strategy
 Cura
 Hemodinámica
 Insuficiencia
 Venosa
 Ambulatoria

4. - Disconnection
of the scape point
- Fragmentation
of the venous
pressure column
-Preservation
of the re-entry
perforators
-Disconnetion
of venous-venous
shunts
-Abolition
of undrained
superficial
varicose veins
J Juan, JM, Escribano, E Criado, J Fontcuberta.
Haemodynamic surgery for varicose veins: surgical strategy Phlebology 2005; 20: 2–13

5. ¿Why CHIVA?
Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ.
CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD009648

8. Recomendación

9. Recomendación CHIVA

11. Recommendation: CHIVA

12. 2011

13. Ideal treatment
Noninvasive
Good long term
results
Effective

14. Open surgery
Sclerotherapy
Endovenous
ablation

15. Techniques
Técnica Invasivity Efficacy* Control
Open surgery XXX XXX XXX
Sclerotherapy X XXX X
Endovenous
ablation
XX XXX XXX
*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 of Systematic Reviews 2014, Issue 7. Art. No.:
CD005624. DOI: 10.1002/14651858.CD005624.pub3.

16. Objective
 Evaluate the results of implementing the
CHIVA-method using radiofrequency for
closing the SFJ scape point

17. Inclusion and exclusion criteria
 Inclusion:
 Reflux at:
 Sapheno-femoral junction (SFJ): terminal and pre-terminal valves
 Sapheno-popliteal junction (SPJ)
 Visible varicose veins
 CEAP classification: C>=2
 Exclusion:
 Anfractuous saphenous vein
 Saphenous diameter >20 mm

18. Technique
 Radiofrequency (Vnous Closure®)
 Access:
 Ultrasound guided puncture of the saphenous vein
 Using the varicose vein origin from the saphenous vein
 Length of treatment of the saphenous vein:
 2 cms from terminal valve
 7-14 cm
 Completion of a CHIVA method:
 Disconnection of shunts
 Abolition of undrained superficial varicose veins (phlebectomy
or sclerotherapy)
 Preservation of re-entry perforators

19. Results
 August 2012 – March 2015
 n= 34 patients/37 legs
 26 women/ 8 men
 Follow-up: 12 months (1-38 m.)

20. Results
 Veins affected:
 35 great saphenous veins / 2 short saphenous veins
 3 recurrences: neovascularisation of the SFJ
 Mean age: 58 y.
 C2 (CEAP): 100%
 Saphenous diameter: 6,3 mm

24. Short-term results (<30d)
 Scape point closed: 100 %
 DVT: 0 %
 Groin complications(??): 0 %
 Hematomas: 0 %
 Nerve damage: 0 %

25. Medium-term results (1-38 m.)
 Proximal saphenous vein treated: 37/37 100%
 Recurrence:
 Scape point (previous neovascularisation): 1/37 3%
 Tributary veins: 5/37 14%

26. Temporary occlusion
between the treated
saphenous and the
access point of the
catheter

27. Conclusiones
 CHIVA es una estrategia
 CHIVA puede ser aplicada mediante diferentes técnicas
 El uso de RF en el tratamiento del punto de fuga nos ha
aportado:
 Eficacia
 Seguridad
 Menor agresión
 Faltan más datos y de mayor calidad metodológica

28. ¿Podemos combinar estrategias
hemodinámicas con técnicas ablativas?
Can we combine hemodynamic and
ablation techniques?

29. YES, WE CAN
¿Podemos combinar estrategias
hemodinámicas con técnicas ablativas?
Can we combine hemodynamic and
ablation techniques?