https://doi.org/10.4081/vl.2024.13043

Factors affecting the evolution of type III shunts of the greater saphenous vein after the first step of the CHIVA 2 strategy

Vol. 13 (2024): Early Access
Submitted: 6 September 2024
Accepted: 2 October 2024
Published: 11 November 2024
Varicose veins, CHIVA 2 strategy, Greater Saphenous Vein, venous hemodynamics
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Authors

Massimo Cappelli
mascappelli@gmail.com
https://orcid.org/0000-0002-9166-0172
Private Practice, Florence, Italy.
Raffaele Molino Lova
https://orcid.org/0000-0001-9835-9262
Private Practice, Florence, Italy.
Mauro Pinelli
https://orcid.org/0000-0003-0941-9759
Private Practice, Avezzano (AQ), Italy.
Claude Franceschi
Hôpital Saint Joseph, Paris, France.

The CHIVA 2 strategy is a two-step surgical procedure for treating type III venous-venous shunts in the territory of the Greater Saphenous Vein (GSV). The first step consists of disconnecting the incompetent GSV tributary, either N3 or N4. Once a new N2 re-entry perforator vein has developed, or the GSV incompetence has reached the pre-existing N2 re-entry perforator vein, both documented by the re-appearance of GSV reflux during the follow-up, the second step of the CHIVA 2 strategy, i.e. the closure of the saphenous-femoral junction, can be performed.

In this paper we addressed the intriguing question of whether it was possible to identify the pre-operative factors able to favourably affect the hemodynamic stability of type III shunts of the GSVs treated by the only first step of the CHIVA 2 strategy.

Our data show that the pre-operative GSV anterograde flow, detectable all along the GSV course even soon after the first step of the procedure, plays a pivotal role in ensuring the hemodynamic stability of the treated GSV, which may not need the second step up to 45% of cases.

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How to Cite

Cappelli, M., Molino Lova, R., Pinelli, M., & Franceschi, C. (2024). Factors affecting the evolution of type III shunts of the greater saphenous vein after the first step of the CHIVA 2 strategy. Veins and Lymphatics, 13. https://doi.org/10.4081/vl.2024.13043
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