Regarding these two articles published in this Journal by Zamboni P et al. (Eur J Vasc Endovasc Surg 2001;21:361–369) and Escribano JM et al. (Eur J Vasc Endovasc Surg 2003;25(2):159–163) about the haemodynamic venous surgery (CHIVA) we wanted to remark the following questions: (i) CHIVA in case of type III shunt1 is always planned and accepted by patients in two steps, and Escribano study fully confirm this assumption. (ii) Zamboni article is mainly the experimental demonstration of the role of the gradient in reflux development. Zamboni f-up is shorter than Escribano one. The latter demonstrates in long term the surgical possibility of transforming the shunt presentation from type III to type I. The same was previously observed by Zamboni.2 Thus, the two CHIVA studies are not in contrast. (iii) Moreover, the criteria for defining a type III shunt are larger in Escribano group as compared to Zamboni group. Consequently, the number of cases shifting from type III to type I were proportionally higher in the former. For example, Zamboni tests each visible perforator on the saphenous trunk with the Doppler sample, while pressing the origin of all the insufficient tributaries. If in this condition the tested perforator demonstrates an in-ward flow Zamboni considers it a type I shunt so excluding the patients from CHIVA in two steps operation.
Regarding 'reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery' and 'durability of reflux-elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3-year prospective case study
ZAMBONI, Paolo;
2004
Abstract
Regarding these two articles published in this Journal by Zamboni P et al. (Eur J Vasc Endovasc Surg 2001;21:361–369) and Escribano JM et al. (Eur J Vasc Endovasc Surg 2003;25(2):159–163) about the haemodynamic venous surgery (CHIVA) we wanted to remark the following questions: (i) CHIVA in case of type III shunt1 is always planned and accepted by patients in two steps, and Escribano study fully confirm this assumption. (ii) Zamboni article is mainly the experimental demonstration of the role of the gradient in reflux development. Zamboni f-up is shorter than Escribano one. The latter demonstrates in long term the surgical possibility of transforming the shunt presentation from type III to type I. The same was previously observed by Zamboni.2 Thus, the two CHIVA studies are not in contrast. (iii) Moreover, the criteria for defining a type III shunt are larger in Escribano group as compared to Zamboni group. Consequently, the number of cases shifting from type III to type I were proportionally higher in the former. For example, Zamboni tests each visible perforator on the saphenous trunk with the Doppler sample, while pressing the origin of all the insufficient tributaries. If in this condition the tested perforator demonstrates an in-ward flow Zamboni considers it a type I shunt so excluding the patients from CHIVA in two steps operation.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
