[Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). Study of 96 patients operated on between June 1988 and June 1990]. / La cure hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA). Etude de 96 patients opérés de juin 1988 à juin 1990.

96 patients were treated in two years by Ambulatory and Hemodynamic Treatment of Varicose Veins (CHIVA cure), representing 131 legs that underwent surgery. 71 patients (74%) representing 102 CHIVA cures in the long saphena territory were followed up, with a maximum of 28 months of follow-up. The CHIVA cure represents a new and interesting therapy: ambulatory, painless, it allows a very early resuming of normal life. The follow-up shows that the aesthetic and functional results are especially satisfying and seem to be steady. The CHIVA cure certainly neglects the histological and parietal aspects of venous incompetence but the treatment of the hemodynamic factor is effective. It can be applied on every type of varicose veins concerning the long saphena territory, provided that the deep venous system is normal. The interest of CHIVA cure concerning the short saphena territory remains to be demonstrated. Arteritic patients, patients with coronary arteries diseases, sportmen, young patients with a brief evolutive potential, especially women, are the best indications. The CHIVA cure is a reliable strategy in the short and medium term, offering excellent aesthetic and functional results that still have to be confirmed in the long term and or a large scale.

[Endoscopic study of reflux of the saphenous valve]. / Etude endoscopique des reflux valvulaires saphéniens.

Saphenous venous endoscopy, invasive and non-physiological, enables the in vivo and in situ observation of the valve system. A saphenous vein has a preferential flattening axis parallel to the outside of the skin with two walls, internal and external, and two borders. A valve is inserted on one vein wall, with the valve horns being on the borders. The free borders of a bivalve are parallel with the surface of the skin. The valve system has an antireflux function. There are three main causes of reflux in the saphenous veins: 1. Transitory functional incompetence affecting valves of normal appearance. This incompetence results from valve inertia, flattening of the valve against the sinus wall and loss of co-adaptation. Do active factors producing closure of the valve cup exist against such transitory incompetence? 2. Incongruity between the vein wall and valves. The intercorneal or commissural space allows reflux on the border of the vein. This is the commonest cause of reflux in varicose disease of the vein wall. 3. Actual valve lesions. A distinction is drawn between lesions due to thinning, elongation, stretching, splitting or tearing and those due to thickening, retraction or adhesion. Endoscopy has enabled us to discover cases of varicose disease with predominantly valvular lesions in young individuales in whom early lesions of the valve cup cannot be explained by venous wall disease and has led us to complete the classification of varicose disorders.

[Venous endoscopy]. / Endoscopie veineuse.

The miniaturization of endoscopic equipment now allows exploring the superficial venous system and visualizing the endovein in situ and in vivo. This type of venous endoscopy is an ambulatory procedure, performed during a simple outpatient consultation of angiology, after which the patient is immediately discharged. Although this examination is invasive, non-physiological and expensive, it allows the video recording of the morphology, dynamics and kinetics of the values, of the endovein and of the liquid flows (blood, washing fluid and sclerosing products). The new examination has already enabled us to propose an functional classification of the parietal valves of the great saphenous vein. It makes an intraoperative three-dimensional mapping of the vessels possible, which is sometimes difficult in such particular anatomical regions as the popliteal fossa. It allows performing sclerosis with a visual control and following up the evolution of the immediate endoparietal lesions in situ.

[Ostial valves in a patient with varicose veins. Endoscopic examination]. / Les valvules ostiales du sujet variqueux. Examen endoscopique.

Twenty three endoscopies were performed, including six of the great saphenous region, fourteen of the small saphenous region and three involving the region of the medial gemellar perforators. Two types of valves may be seen on the basis of their endoscopic appearances: certain valves have a transparent appearance with very thin valvular tissue which tears easily when a catheter is passed against the direction of venous flow. These valves are located in the main saphenous veins and their collaterals, at a distance from bifurcations and the point of entry of perforating veins. The only type of lesion seen affecting these valves was tearing of their tissue. Their sole role appears to be to favourize the progression of venous flow in an anterograde direction. Other valves have an opaque appearance with valvular tissue thickened by an actual fibromuscular skeleton and strengthening of the free edge to form a lip. These resist counter-grade catheterisation and may prevent progression of the endoscope or of a stripper. These valves are located at the ostium of the terminal portions of the saphenous veins and directly proximal to the point of entry of certain collaterals and perforators. The latter, when reflux is present, behave as ostial valves, playing the role of an anti-reflux system as well as favourizing preferential hemodynamic circuits which explain certain varicose cartographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)