Jornal Vascular Brasileiro
http://www.jvb.periodikos.com.br/article/doi/10.1590/1677-5449.007718
Jornal Vascular Brasileiro
Case Report

CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report

CHIVA para preservar as safenas magna e parva após cirurgia ressecando por erro a safena magna normal: relato de caso

Felipe Puricelli Faccini; Ani Loize Arendt; Raphael Quintana Pereira; Alexandre Roth de Oliveira

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Abstract

Abstract: CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site.

Keywords

wrong-site surgery, CHIVA, venous operation, saphenous vein sparing

Resumo

Resumo: Cure conservatrice et hemodynamique de l’insufficience veineuse en ambulatoire (CHIVA) é um tipo de cirurgia de varizes que evita a destruição da veia safena e colaterais. Este relato apresenta uma paciente que foi submetida a CHIVA em duas safenas para poupá-las. A paciente teve uma safena magna normal retirada em uma cirurgia no sítio cirúrgico errado, as safenas com refluxo foram mantidas, e uma normal foi ressecada. A paciente estava sintomática e foi realizada CHIVA na safena parva direita e na magna esquerda. O pós-operatório transcorreu bem com resultado clínico e estético satisfatório. Esse caso mostra que cirurgias que poupam a safena têm papel importante no tratamento da insuficiência venosa crônica. Além disso, os protocolos de cirurgia segura não cobrem adequadamente as cirurgias de varizes devido a duas safenas possíveis e por serem frequentemente cirurgias bilaterais. A realização de eco-Doppler rotineiramente pela equipe cirúrgica pode prevenir problemas relacionados ao sítio operatório.
 

Palavras-chave

cirurgia em sítio errado, CHIVA, safena, preservação

References

Franceschi C, Cappelli M, Ermini S, et al. CHIVA: hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8-30. PMid:26044838.

Franceschi C, Ermini S. The evaluation of essential elements defining varicose vein mapping. Veins and Lymphatics [on-line]. 2014 [cited 2018 aug 25];3(5). http://dx.doi.org/10.4081/vl.2014.4922.

Friedberg BL. The effect of a dissociative dose of ketamine on the bispectral index (BIS) during propofol hypnosis. J Clin Anesth. 1999;11(1):4-7. http://dx.doi.org/10.1016/S0952-8180(98)00117-2. PMid:10396711.

Rollo HA, Giannini M, Yoshida WB. Preservação da veia safena magna na cirurgia de varizes dos membros inferiores. J Vasc Bras. 2009;8(2):154-65. http://dx.doi.org/10.1590/S1677-54492009000200010.

Feldner A, Otto H, Rewerk S, Hecker M, Korff T. Experimental hypertension triggers varicosis-like maladaptive venous remodeling through activator protein-1. FASEB J. 2011;25(10):3613-21. http://dx.doi.org/10.1096/fj.11-185975. PMid:21685329.

Pfisterer L, König G, Hecker M, Korff T. Pathogenesis of varicose veins - lessons from biomechanics. Vasa. 2014;43(2):88-99. http://dx.doi.org/10.1024/0301-1526/a000335. PMid:24627315.

Cappelli M, Molino-Lova R, Giangrandi I, Ermini S, Gianesini S. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. J Vasc Surg Venous Lymphat Disord. 2018;6(2):224-9. http://dx.doi.org/10.1016/j.jvsv.2017.09.005. PMid:29290602.

Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2015;(6):CD009648. PMid:26121003.

Iborra-Ortega E, Barjau-Urrea E, Vila-Coll R, Ballón-Carazas H, Cairols-Castellote MA. Estudio comparativo de dos técnicas quirúrgicas en el tratamiento de las varices de las extremidades inferiores: resultados tras cinco años de seguimiento. Angiologia. 2006;58(6):459-68. http://dx.doi.org/10.1016/S0003-3170(06)75009-X.

Parés JO, Juan J, Tellez R, et al. Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial. Ann Surg. 2010;251(4):624-31. http://dx.doi.org/10.1097/SLA.0b013e3181d0d0a3. PMid:20224376.

Carandina S, Mari C, De Palma M, et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg. 2008;35(2):230-7. http://dx.doi.org/10.1016/j.ejvs.2007.09.011. PMid:17964822.

Zamboni P, Cisno C, Marchetti F, et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. Eur J Vasc Endovasc Surg. 2003;25(4):313-8. http://dx.doi.org/10.1053/ejvs.2002.1871. PMid:12651168.

Hanchanale V, Rao AR, Motiwala H, Karim OMA. Wrong site surgery! How can we stop it? Urol Ann. 2014;6(1):57-62. http://dx.doi.org/10.4103/0974-7796.127031. PMid:24669124.
 

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