[The role of hemodynamic assessment in the treatment of lower extremity varicose veins based on the CHIVA strategy].
Source: PubMed, NCBI / U.S. National Library of Medicine
Hemodynamic assessment in patients with lower limb varicose veins should be performed with the patient standing, the limb examined in a non-weight-bearing position, and reflux elicited by appropriate provocative maneuvers. Duplex ultrasound is used to identify reflux and localize the anatomical reflux pathways, with attention to pelvic and nonsaphenous venous pathways. Quantitative parameters, including peak reflux velocity, reflux volume or volume flow, ambulatory venous pressure, venous filling index, and ejection fraction, help assess reflux burden, calf muscle pump function, and venous hypertension. The Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) is a hemodynamic, vein sparing strategy for the outpatient treatment of lower limb varicose veins. It achieves hemodynamic correction by interrupting reflux entry points, preserving or remodeling re-entry points, and maintaining the saphenous trunk. Short-, mid-term, and long-term outcomes of CHIVA are not inferior to, and may in some settings be better than, those of conventional stripping or endovenous thermal ablation. Postoperative pain and ecchymosis are less pronounced, and the need for adjunctive sclerotherapy is lower. In selected patients with limited disease and only mild truncal change, ambulatory selective varices ablation under local anesthesia may be considered. Follow up and outcome assessment should move beyond closure alone. Imaging and functional endpoints should be
Abstract
Hemodynamic assessment in patients with lower limb varicose veins should be performed with the patient standing, the limb examined in a non-weight-bearing position, and reflux elicited by appropriate provocative maneuvers. Duplex ultrasound is used to identify reflux and localize the anatomical reflux pathways, with attention to pelvic and nonsaphenous venous pathways. Quantitative parameters, including peak reflux velocity, reflux volume or volume flow, ambulatory venous pressure, venous filling index, and ejection fraction, help assess reflux burden, calf muscle pump function, and venous hypertension. The Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) is a hemodynamic, vein sparing strategy for the outpatient treatment of lower limb varicose veins. It achieves hemodynamic correction by interrupting reflux entry points, preserving or remodeling re-entry points, and maintaining the saphenous trunk. Short-, mid-term, and long-term outcomes of CHIVA are not inferior to, and may in some settings be better than, those of conventional stripping or endovenous thermal ablation. Postoperative pain and ecchymosis are less pronounced, and the need for adjunctive sclerotherapy is lower. In selected patients with limited disease and only mild truncal change, ambulatory selective varices ablation under local anesthesia may be considered. Follow up and outcome assessment should move beyond closure alone. Imaging and functional endpoints should be evaluated together. A standardized postoperative surveillance strategy that integrates hemodynamic parameters with varicose veins scales may help reduce recurrence and improve quality of life.