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Surgical Treatment of Varicose Veins with the CHIVA Method
Review Operative Behandlung der Varikose nach der CHIVA-Methode Surgical treatment of varicose veins with the CHIVA method Autoren Erika Mendoza Institut und Spanien durchgesetzt, im Moment hält es seinen Einzug in Venenpraxis, Wunstorf China und in den osteuropäischen Ländern, primär dort, wo der Duplex als Grundlage für die phlebologische Diagnostik zählt Schlüsselwörter und eine kostengünstige Herangehensweise vom Gesundheits- Chronische venöse Insuffizienz, Saphenareflux, Venenerhalt, wesen gefordert wird. CHIVA Das Verfahren kann bei jeder Ausprägung der Varikose und jedem Stadium der chronischen venösen Insuffizienz ange- Key words wendet werden, wobei der Erhalt einer postthrombotisch ver- chronic venous insufficiency, reflux in saphenous vein, änderten Stammvene nicht anstrebenswert erscheint. Eine vein preservation, CHIVA Metaanalyse (Cochrane-Review) bescheinigt CHIVA weniger Rezidive bei gleichwertigem Erstergebnis und weniger Neben- eingereicht 09.11.2018 wirkungen im Vergleich zum Stripping, wobei weitere Studien akzeptiert ohne Revision 14.03.2019 mit höheren Patientenzahlen gefordert werden. Die neuen Techniken, wie endoluminale (Hitze-) Verfahren Bibliografie und schallgesteuerte Schaumverödung haben das Verfahren DOI https://doi.org/10.1055/a-0877-8781 noch minimal-invasiver gemacht, sodass die ohnehin geringe Online Publikation: 02.05.2019 Komplikationsrate und die kurze Arbeitsunfähigkeitszeit noch Phlebologie 2019; 48: 153–160 verkürzt werden kann. © Georg Thieme Verlag KG Stuttgart · New York ISSN 0939-978X ABSTRACT Korrespondenzadresse In 1988, just after the upcoming of duplex ultrasound, the Dr. Erika Mendoza French vascular surgeon and angiologist Claude Franceschi de- Venenpraxis veloped a hemodynamic strategy to treat venous insufficiency Speckenstr. 10 on ambulatory patients. He gave the treatment the name of 31515 Wunstorf the French acronym. CHIVA. E-Mail: [email protected] The strategy is based on the preservation of draining path- ways, specially the saphenous veins. -
Comparison of Three Measures of the Ankle-Brachial Blood Pressure Index in a General Population
555 Hypertens Res Vol.30 (2007) No.6 p.555-561 Original Article Comparison of Three Measures of the Ankle-Brachial Blood Pressure Index in a General Population Cheng-Rui PAN1), Jan A. STAESSEN2), Yan LI1), and Ji-Guang WANG1) The ankle-brachial blood pressure index (ABI) predicts cardiovasular disease. To our knowledge, no study has compared manual ABI measurements with an automated electronic oscillometric method in a population sample. We enrolled 946 residents (50.8% women; mean age, 43.5 years) from 8 villages in JingNing County, Zhejiang Province, P.R. China. We computed ABI as the ratio of ankle-to-arm systolic blood pressures from consecutive auscultatory or Doppler measurements at the posterior tibial and brachial arteries. We also used an automated oscillometric technique with simultaneous ankle and arm measurements (Colin VP- 1000). Mean ABI values were significantly higher on Doppler than auscultatory measurements (1.15 vs. 1.07; p<0.0001) with intermediate levels on oscillometric determination (1.12; p<0.0001 vs. Doppler). The differ- ences among the three measurements were not homogeneously distributed across the range of ABI values. Doppler and oscillometric ABIs were similar below 1.0, whereas above 1.2 Doppler and auscultatory ABIs were comparable. In Bland and Altman plots, the correlation coefficient between differences in Doppler minus oscillometric ABI and ABI level was 0.21 (p<0.0001). The corresponding correlation coefficient for Doppler minus auscultatory ABI was –0.13 (p<0.0001). In conclusion, automated ABI measurements are fea- sible in large-scale population studies. However, the small differences in ABI values between manual and oscillometric measurements depend on ABI level and must be considered in the interpretation of study results. -
How to Interpret Noninvasive Vascular Testing and Diagnose Peripheral Vascular Disease
How to Interpret Noninvasive Vascular Testing and Diagnose Peripheral Vascular Disease David Campbell, MA FRCS FACS. Vascular Surgeon, Beth Israel Deaconess Medical Center Associate Professor of Surgery Harvard Medical School Clinical Diagnosis • Claudication versus Spinal Stenosis • Ischemic Rest Pain versus Neuropathic Pain • Location of foot lesions –ischemic versus neuropathic • Absence of symptoms does not rule out significant ischemia Signs of PVD • Pulse examination. Frequently inaccurate due to calcified vessels. • Inflow versus outflow disease • Autonomic neuropathy • Dependent Rubor Non Invasive Studies in PVD • Many sophisticated tests available eg Ankle Brachial Indices, Segmental pulse volume recordings, Duplex ultrasound, Transcutaneous oxygen, Xenon flow studies. • Most useful and cost effective is a hand held Doppler to assess wave form ~ ~ Hand Held Doppler Interpreting the Ankle–Brachial Index ABI Interpretation 0.90–1.30 Normal 0.70–0.89 Mild 0.40–0.69 Moderate 0.40 Severe >1.30 Noncompressible vessels Adapted from Hirsch AT. Family Practice Recertification. 2000;22:6-12. INDIRECT TESTING IDENTIFICATION WITH INDIRECT TESTING CAPABILITY INDIRECT TESTING COMPONENTS : Reliable & Inexpensive ABI (Ankle – Brachial Index) Multiple Level Segmental Pressures Using Doppler / Pneumatic Cuffs Multiple / Single Level Pulse Volume Plethsymography (PVR) Digital Pressures / Plesthythmography (PPG) TBI (Toe – Brachial Index) or DBI (Digital – Brachial Index) Maneuver Measurements Transthoracic Outlet Examination Cold Immersion Testing -
Lower Extremity Arterial Physiologic Evaluations
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Lower Extremity Arterial Physiologic Evaluations This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound (SVU) as a template to aid the vascular technologist/sonographer and other interested parties. It implies a consensus of those substantially concerned with its scope and provisions. The guidelines contain recommendations only and should not be used as a sole basis to make medical practice decisions. This SVU Guideline may be revised or withdrawn at any time. The procedures of SVU require that action be taken to reaffirm, revise, or withdraw this Guideline no later than three years from the date of publication. Suggestions for improvement of this Guideline are welcome and should be sent to the Executive Director of the Society for Vascular Ultrasound. No part of this Guideline may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Sponsored and published by: Society for Vascular Ultrasound 4601 Presidents Drive, Suite 260 Lanham, MD 20706-4831 Tel.: 301-459-7550 Fax: 301-459-5651 E-mail: [email protected] Internet: www.svunet.org Copyright © by the Society for Vascular Ultrasound, 2019. ALL RIGHTS RESERVED. PRINTED IN THE UNITED STATES OF AMERICA. VASCULAR PROFESSIONAL PERFOMANCE GUIDELINE Updated January 2019 Lower Extremity Arterial Physiologic Evaluation 01/2019 PURPOSE Segmental pressures, pulse volume recordings, Doppler and photoplethysmography -
CX Venous Programme 25–28 APRIL 2017, OLYMPIA GRAND, LONDON, UK ORGANISING BOARD: Ian Franklin, Stephen Black, Alun Davies and Andrew Bradbury
Vascular & Endovascular Consensus Update Pathways of Care CONTROVERSIES CHALLENGES CONSENSUS CX Venous Programme 25–28 APRIL 2017, OLYMPIA GRAND, LONDON, UK ORGANISING BOARD: Ian Franklin, Stephen Black, Alun Davies and Andrew Bradbury Peripheral Acute Aortic Venous Arterial Stroke Consensus Consensus Consensus Consensus 25 APRIL 26–27 APRIL 28 APRIL CX Venous Consensus CX Venous Workshop Update – NEW CX Venous Edited CX Venous Abstracts Plenary Programme Cases Register at WWW.CXSYMPOSIUM.COM Early bird registration ends: 26 February 2017 EDUCATION INNOVATION EVIDENCE [email protected] CX Symposium @cxsymposium CX Venous Consensus Update – Plenary Programme 25 April 2017, Lower Main Auditorium Investigations of superficial and deep venous Pelvic vein congestion and reflux anatomy Prevalence of pelvic vein venous reflux and criteria for treatment Kathleen Gibson, Bellevue, United States WHETHER to intervene Prevalence of pelvic vein incompetence in women with chronic pelvic pain The best imaging modality – the implication of cost and influence on quality of life – scoring systems Alun Davies, London, United Kingdom Charles McCollum, Manchester, United Kingdom Computed tomography (CT) venography and magnetic resonance (MR) venography are performed in the horizontal position – suitability for assessing venous function Andrew Wigham, Oxford, United Kingdom Varicose vein management Value of fusion imaging to treat deep venous thrombosis INTERVENTION METHOD and outcomes Adrien Hertault, Lille, France Endovenous adhesive vs. radiofrequency -
The Predictive Capacity of Toe Blood Pressure and the Toe Brachial Index
Sonter JA et al. The predictive capacity of toe blood pressure and the toe brachial index for foot wound healing and amputation The predictive capacity of toe blood pressure and the toe brachial index for foot wound healing and amputation: A systematic review and meta-analysis Sonter JA, Ho A & Chuter VH ABSTRACT Foot wounds are a growing international concern, as the incidence of risk factors such as diabetes, obesity, vascular disease and advancing age rises. This systematic review and meta-analysis was performed to determine the prognostic capabilities of toe blood pressure and the toe brachial index for predicting chronic foot wound healing or progression to amputation. MEDLINE, CINAHL, EMBASE, PubMed Central and the reference lists of retrieved studies were systematically searched in June 2014. Two authors independently reviewed selected studies reporting original research. Methodological quality was assessed using STROBE and CASP appraisal tools. Ten studies were reviewed; six investigated wound healing and four investigated amputation as the outcome. Study quality was inconsistent; most failed to report aspects of their methodology and used different equipment or techniques. Meta-analysis indicated a cut-off toe blood pressure of 30 mmHg was associated with a relative risk of 3.25 (95% CI: 1.96, 5.41) for non-healing, however, significant heterogeneity was found. Additionally, serial assessments or grading of toe blood pressure values may improve accuracy and utility. Toe blood pressure and related indices may be useful in predicting the outcome of chronic foot wounds; however, further high-quality research is required before clinical utility is confirmed. Keywords: Toe brachial index, toe blood pressure, peripheral arterial disease, wound healing, ischaemic ulcers. -
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Veins and Lymphatics 2014; volume 3:1919 Multiple ligation of the Introduction Correspondence: Roberto Delfrate, Figlie di San proximal greater saphenous Camillo Hospital, via Fabio Filzi 56, 26100 vein in the CHIVA treatment The sapheno-femoral junction (SFJ) is a key Cremona, Italy. point for the venous drainage of the lower limb Tel.: +39.0372.421111 – Mobile: +39.334.9089110. of primary varicose veins E-mail: [email protected] from the foot up to the hip and gluteus, the Roberto Delfrate,1 Massimo Bricchi,1 lower abdominal wall and lower genital tract. Key words: saphenous-femoral disconnection, Claude Franceschi,2 Matteo Goldoni3 Moreover, the disconnection of the incompe- saphenous-femoral junction, neovascularization tent SFJ is a fundamental procedure to most recurrences, primary varicose vein surgery. 1 Surgery Unit, Figlie di San Camillo open superficial venous surgery.1-5 2 Hospital, Cremona, Italy; Angiology Unfortunately, most varicose recurrences are Received for publication: 11 September 2013. Consultant, Saint Joseph Hospital, Paris, due to SFJ neovascularization (recurrences) Revision received: 11 February 2014. France; 3Department of Consulting of observed in 25% to 94% of recurrent varicose Accepted for publication: 6 March 2014. Clinical Medicine, Nephrology and Health 6 veins. Conservative saphenous-femoral dis- This work is licensed under a Creative Commons Sciences, University of Parma, Italy connection is a very common surgical practice Attribution 3.0 License (by-nc 3.0). according to the conservative hemodynamic correction of venous insufficiency (CHIVA) ©Copyright R. Delfrate et al., 2014 method.7-12 For more than a decade we have Licensee PAGEPress, Italy Abstract tested a technique that requires a division of Veins and Lymphatics 2014; 3:1919 the SFJ and others that require only peculiar doi:10.4081/vl.2014.1919 Saphenous femoral disconnection is the key ligatures without division of the incompetent point of most surgical techniques in the treat- saphenous femoral tract. -
Corso Di Formazione
lli Clinic 015 2 , 16 1st International Haemodynamic Aula Magna of the Mangiaga Symposium on Venous Disorders - Haemodynamic aspects of physiopathology, diagnosis and therapy of the venous disease October 15 and , e Policlinico Hospital of Milan M i l a n Maggior Introduction In recent decades we have Scientific Board witnessed a great revolution in the approach to venous diseases thanks to the increasing understanding of the physiopathologicical mechanisms that cause the typical pathological signs of venous insufficiencies. The introduction of no n-in vasive Prof. Livio Gabrielli diagnostics with the continuous wave Doppler and subsequently with the Echo Color Doppler enabled us to acquire detailed information on the physiological mechanisms of venous circulation and consequently on the physiopathological m echanism s . This allowed for a new close examination of the events and Prof. Claude Franceschi hemodynamic changes that trigger the onset of the clinical abnormalities characteristic of venous insufficiencies. This development has greatly benefitted diagnosis and therapy not only of the superficial venous insufficiencies but also of the deep venous Dott. Roberto Delfrate insufficiencies, which are common in post-thrombosis syndrome. In the last twenty-five years, non -in vas ive hemodynamic ultrasound diagnostics together with technological developments have broade ned therapeutic options. These include conservative hemodynamic therapy and also the progressive development of different forms of m inim ally- invasive therapies which intend to offer alternatives to stripping that are easier to implement. The hemodynamic CH IVA strategy (Conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire) codified by Claude Franceschi, a pioneer who played a major role in the development and spreading of the Doppler ultrasound vascular investigation both in the arterial a nd venous districts, appeared in 1988 as an alternative to demolition therapies. -
Diagnostic Accuracy of Resting Systolic Toe Pressure for Diagnosis Of
Tehan et al. Journal of Foot and Ankle Research (2017) 10:58 DOI 10.1186/s13047-017-0236-z RESEARCH Open Access Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study Peta Ellen Tehan1,2*, Alex Louise Barwick3, Mathew Sebastian4,5 and Vivienne Helaine Chuter1 Abstract Background: The resting systolic toe pressure (TP) is a measure of small arterial function in the periphery. TP is used in addition to the ankle-brachial index when screening for peripheral arterial disease (PAD) of the lower limb in those with diabetes, particularly in the presence of lower limb medial arterial calcification. It may be used as an adjunct assessment of lower limb vascular function and as a predictor of wound healing. The aim of this study was to determine the diagnostic accuracy of TP for detecting PAD in people with and without diabetes. Methods: This was a retrospective case-control study. Two researchers extracted information from consecutive patient records, including TP measurements, colour Duplex ultrasound results, demographic information, and medical history. Measures of diagnostic accuracy were determined by receiver operating curve (ROC) analysis, and calculation of sensitivity, specificity, and positive and negative likelihood ratios. Results: Three hundred and nintey-four participants with suspected PAD were included. In the diabetes group (n = 176), ROC analysis of TP for detecting PAD was 0.78 (95%CI: 0.69 to 0.84). In the control group (n = 218), the ROC of TP was 0.73 (95%CI: 0.70 to 0.80). -
1 the Ultrasound Scanner 1 2 Anatomy of the Superficial Veins 19
1 The Ultrasound Scanner 1 Hans-Peter Weskott, Erika Mendoza, and Christopher R. Lattimer 2 Anatomy of the Superficial Veins 19 Alberto Caggiati, Erika Mendoza, Renate Murena-Schmidt, and Christopher R. Lattimer 3 Pathophysiology of the Superficial Venous System 49 Erika Mendoza, Claude Franceschi, Birgit Kahle, and Christopher R. Lattimer 4 Ultrasound-Based Classifications of Varicose Veins 67 Erika Mendoza and Christopher R. Lattimer 5 Duplex Ultrasound Examination of Superficial Leg Veins.... 93 Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 6 Flow Provocation Manoeuvres for the Diagnosis of Venous Disease Using Duplex Ultrasound 105 Erika Mendoza and Christopher R. Lattimer 7 Examination of the Great Saphenous Vein 119 Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 8 Examination of the Small Saphenous Vein 171 Erika Mendoza and Christopher R. Lattimer 9 Perforating Veins 187 Erika Mendoza and Christopher R. Lattimer 10 Tributaries 201 Erika Mendoza and Christopher R. Lattimer 11 Superficial Vein Thrombosis 217 Erika Mendoza and Christopher R. Lattimer 12 Ultrasound in Varicose Vein Treatment 227 Erika Mendoza, Thomas M. Proebstle, Achim Mumme, Franz Xaver Breu, Nick Morrison, and Christopher R. Lattimer http://d-nb.info/1038119928 xii 13 Ultrasound After Venous Intervention 247 Erika Mendoza,-Achim Mumme, Andreas Hildebrandt, Nick Morrison, and Christopher R. Lattimer 14 Deep Leg Veins 267 Hans-Joachim Kruse, Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 15 Examination of Superficial Veins in the Presence of Deep Venous Disease 279 Erika Mendoza and Christopher R. Lattimer 16 Differential Diagnosis of Leg Oedemas of Venous and Lymphatic Origin 285 Erika Mendoza and Christopher R. -
Non-Invasive Diagnosis of Chronic Venous Disorders
162 NEWS IN ANGIOLOGY • ChrONIC vENOuS dISEASES nTheon-invasive mem-neT programdiagnosis 12 for chronicof cerebro-spinalchronic venous venous disorders insufficiency 43 color flow dopplerP.l. antignani imaging assessmenT s . Mandolesi, a. d’alessandro Chronic venous insufficiency (CVI) is the con- of investigation is the color Doppler ultrasound dition in which one or more veins become unable imaging (CDUI)). For more proximal vessels such to fulfill their three specific functions:1 as those of the pelvis magnetic resonance imaging – drainage from the tissues of toxic substances; (MRI) is very reliable for the detection of throm- – filling of the heart cavities; bosis. – thermoregulation of tissues; In 1988 with the birth of the conservative he- in any physical activity or position of the subject. modynamic ambulatory treatment of varicose What is the event that causes the CVI? veins, Claude Franceschi has realized the first Any condition that poses an obstacle to the cartographic maps of venous hemodynamics of drainage of one or more veins it is the cause that the lower limbs.1 In 1992, the authors showed for in time will determine the appearance of clinical the first time the venous compression syndrome disorders manifested as CVI. (VCS) of the lower limbs 2 and in 2011 that of the The CVI has been studied mainly for its effects veins draining cerebral spinal flow.3 The VCS has on the circulation of the lower limbs. Specifically, widened the field of interest of the phlebologists lower limb varicose veins are characterized first by and lead to static and dynamic biomechanic stud- the dilation of the veins and gradually, over the ies. -
Development of a Deep Vein Valve Replacement
Development of a Deep Vein Valve Replacement Thesis submitted to Imperial College London for the degree of Doctor of Philosophy Miss Hayley Moore MA (Cantab), MBBS (AICSM), MRCS (Eng) Registration 1st October 2010 Supervisors Professor Alun H Davies (Vascular Surgery) Professor Molly Stevens (Biomedical Materials) Professor Yun Xu (Biofluid Mechanics) Mr Manj Gohel (Vascular Surgery) 1 CONTENTS Contents ........................................................................................................................................................................ 2 Abstract ......................................................................................................................................................................... 8 Acknowledgements .................................................................................................................................................... 10 Statement of Originality ............................................................................................................................................ 11 List of Tables .............................................................................................................................................................. 12 List of Figures ............................................................................................................................................................. 14 Abbreviations.............................................................................................................................................................