Resultados clínicos de una nueva estrategia quirúrgica (CHIVA modificado) en el tratamiento de las varices dependientes de la vena safena magna accesoria anterior / Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins

INTRODUCCIÓN: Tradicionalmente la insuficiencia de safena anterior se trataba mediante crosectomía y resección de los paquetes varicosos. El objetivo del trabajo es mostrar la seguridad y eficacia de una nueva estrategia terapéutica en las varices dependientes de la vena safena magna accesoria anterior. MÉTODOS: Estudio prospectivo no ramdomizado que incluyó 65 pacientes con varices dependientes de la safena anterior con safena interna anterógrada. La modificación en la técnica consiste en hacer solamente flebectomía de los paquetes varicosos, sin ligar el cayado de la safena. Se realizó un estudio hemodinámico venoso preoperatorio, al mes y al año, y para la valoración clínica se utilizó la escala de Fligelstone. RESULTADOS: Clasificación clínica basal CEAP: C2 58%, C3 26% y C4-6 15%. Complicaciones: 3 hematomas, 7 casos de trombosis parciales asintomáticas de safena anterior. Se observó una reducción del diámetro medio inicial de safena anterior de 6,4 mm a 3,4 mm al año (p < 0,001). A los doce meses mantenían un flujo anterógrado el 82% de los casos. Hubo una recidiva de varices visibles en el 8% de los casos. Todos los pacientes han reflejado una mejoría clínica en la escala de Fligelstone. El diámetro de safena anterior mayor de 7,5 mm y la obesidad se identifican como predictores de un peor resultado clínico y hemodinámico. CONCLUSIONES: La modificación de la estrategia quirúrgica sobre las varices dependientes de la safena anterior presenta un resultado clínico favorable al año de la intervención

INTRODUCTION: Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. METHODS: This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. RESULTS: The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. Complications: 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p < 0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. CONCLUSIONS: This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively

Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

INTRODUCTION: Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. METHODS: This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. RESULTS: The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. COMPLICATIONS: 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. CONCLUSIONS: This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively.

Popliteal venous aneurysms: results of surgical treatment.

BACKGROUND: Popliteal venous aneurysms are an uncommon clinical entity although they have been the subject of a number of published clinical cases. Herein we have conducted an updated review of reports of these aneurysms while also describing our own experience with 4 such cases over the last 10 years. METHODS: A systematic search was conducted on MEDLINE and Embase concerning popliteal venous aneurysms. We collected all information mentioned associated with their clinical morphology, diagnosis, treatment, and follow-up. The patients included consisted of all those from the literature reports for whom the presence of an aneurysm in the popliteal region was described, plus the 4 cases in our own series. RESULTS: The most significant contribution was made by Sessa et al. in 2000, who recommended that this disorder be actively searched for in conventional echo-Doppler studies and, once detected, surgical repair should be undertaken by tangential aneurysmectomy with lateral venorrhaphy to prevent repeat pulmonary embolisms. In conjunction with their series, we reviewed other publications over the last 10 years to determine whether these recommendations have undergone any changes based on the new findings. We found 91 cases in addition to the 117 cases described by Sessa and colleagues as well as the 4 contributed by our group. Most of these cases do not present any specific symptomatology and are discovered by chance via echo Doppler. They are sometimes detected as a palpable mass in the popliteal fossa, with a tendency toward growth, venous thrombosis, and repeat pulmonary embolisms. Phlebography is usually left to preoperative study, and NMR and CAT are rarely used. The objective of surgical treatment is to eliminate the aneurysm while maintaining venous drainage to the limb, with the technique employed most often being tangential aneurysmectomy with lateral venorrhaphy. There are very few postoperative complications and relapses are rare. CONCLUSIONS: The most recent publications confirm the recommendations made by Sessa et al. more than 10 years ago. Thus, no further changes should be made to the current approach to treatment of venous aneurysms.