Hemodynamic surgery of varicose veins of the lower extremities with the introduction of modern technologies

Abstract

Minimaly invasive and pathogenetically based methods are currently prevalent in phlebology, as they are in other fields of surgery. CHIVA (Сure conservatrice et hemodynamiу que de l’insuffisance veineuse en ambulatoire) hemodynamic surgery is one of these popular minimally invasive surgical procedures. The execution technique relies on the findings of a duplex ultrasound scan that is used to analyse the hemodynamics of the superficial venous network. The CHIVA strategy aims to preserve the venous material while also restoring normal distal venous pressure and venous function. However, this technique has a number of disadvantages, including the possibility of vein recanalisation and relapses, as well as the fact that the immediate cosmetic outcome is not always satisfactory.

Objective — to compare the outcomes of lower extremity varicose vein treatment based on the employed method: the CHIVA method executed via open surgery versus the CHIVA method combined with other minimally invasive methods (sclerotherapy, endovenous laser coagulation (EVLC)).

Materials and methods. A randomised prospective study was conducted on 52 patients with varicose veins of the lower extremities categorised as C1‑C3 according to the CEAR classification. The patients were divided into 2 groups of 26 patients each, with one group undergoing the CHIVA procedure using the classic open technique, and the other group receiving a combination of CHIVA with EVLC and sclerotherapy. To evaluate the results, we used Hobb’s criteria, measured the diameter of the great saphenous vein via ultrasound, analysed alterations in the Venous Clinical Severity Scoring (VCSS) , studied data from the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ 20), and determined the incidence of relapses.

Results. After CHIVA and CHIVA + EVLC + sclerotherapy, the normalisation of hemodynamics and interruption of the venous shunt led to a substantial reduction in the diameter of the great saphenous vein within 6 months after the operation (p<0.01). Both groups had an improvement in VCSS 6 months after surgery. No statistical difference was observed between the treatment groups. All methods had a positive impact on the quality of life of patients, as shown by the CIVIQ 20 questionnaire. Of the 52 operated patients, there were 4 relapses (7.7%). No relapses were noted in the group receiving CHIVA with EVLC and sclerotherapy (p=0.039). As evaluated by Hobb’s criteria, patients exhibited greater satisfaction with the outcomes of hemodynamic surgery combined with EVLC and sclerotherapy due to its better and faster aesthetic outcomes (р=0.012 and 0.05).

Conclusions. All 52 patients exhibited favourable treatment outcomes, demonstrating a reduction in CVI symptoms during a comprehensive clinical assessment using ultrasound within 6 months and 1 year. The combination of CHIVA with EVLC and sclerotherapy showed distinct advantages in the treatment of varicose veins, yielding the most favourable cosmetic outcomes according to Hobb’s criteria and achieving a reccurence rate of 0%.