Title a new articole: Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins

Authors: Roberto Delfrate, Massimo Bricchi, Claude Franceschi, Matteo Goldoni

Key words: saphenous-femoral disconnection,
saphenous-femoral junction,
neovascularization recurrences,
primary varicose vein surgery.

©Copyright R. Delfrate et al., 2014
Licensee PAGEPress, Italy
Veins and Lymphatics 2014; 3:1919
doi:10.4081/vl.2014.1919

Abstract
Saphenous femoral disconnection is the key point of most surgical techniques in the treatment of primary varicose vein surgery.
The aim of this study is to compare and analyze different techniques for conservative saphenousfemoral ligation or disconnection.
These techniques can be to perform mini invasive open surgery and are suitable for implementation of the conservative hemodynamic correction of
venous insufficiency (CHIVA) method.
The aim was to present the follow-up by retrospective analysis of three different ligation-disconnection techniques of the proximal great
saphenous vein (GSV) according to the CHIVA method at the GSV end, i.e. between the very end of the GSV and the first arch tributary, according to the CHIVA method.
The first thecnique consisted of a surgical division (crossotomy).
The other two consisted of triple superposed ligation with No. 2 non-absorbable braided coated suture without division labeled
TSFL (triple saphenous flush ligation) and No. 0 polypropylenene ligation TPL (triplepolypropylene ligation). The difference
between TSFL and TPL was in the thickness and type of material of the thread, though both
were non-absorbable. The follow up of 56 TPL procedures, 61 crossotomy procedures, and 82
TSFL procedures was analysed. The follow-up consisted of checking the sapheno-femoral junction occlusion with Duplex color ultra
sound. The incidence rates of neovascularization (new vessels in the ligation or surgical disconnection site with saphenous-femoral
reflux during the Valsalva maneuver) were: 4.9% for the crossotomy group, 6.1% for the
TSFL group and 37.5% for the TPL group. The data analysed show satisfactory results with
both crossotomy and TSFL. Crossotomy has proven to be an effective technique for performing
saphenous-femoral disconnection, but TSFL could also be a reliable, safe and low-cost
varicose mini-invasive surgery in outpatients. TPL appeared to be less reliable.