The troubled course of the CHIVA Cure through clinical studies: a critical review
The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2023-10-01
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| Series: | Veins and Lymphatics |
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| Online Access: | https://www.pagepressjournals.org/index.php/vl/article/view/11886 |
| _version_ | 1797662194303762432 |
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| author | Massimo Cappelli Raffaele Molino Lova Mauro Pinelli Claude Franceschi |
| author_facet | Massimo Cappelli Raffaele Molino Lova Mauro Pinelli Claude Franceschi |
| author_sort | Massimo Cappelli |
| collection | DOAJ |
| description |
The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases.
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| first_indexed | 2024-03-11T18:56:33Z |
| format | Article |
| id | doaj.art-89e7cba6eaec40c1af8fed719e7643af |
| institution | Directory Open Access Journal |
| issn | 2279-7483 |
| language | English |
| last_indexed | 2024-03-11T18:56:33Z |
| publishDate | 2023-10-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Veins and Lymphatics |
| spelling | doaj.art-89e7cba6eaec40c1af8fed719e7643af2023-10-10T23:00:56ZengPAGEPress PublicationsVeins and Lymphatics2279-74832023-10-0112110.4081/vl.2023.11886The troubled course of the CHIVA Cure through clinical studies: a critical reviewMassimo Cappelli0Raffaele Molino Lova1Mauro Pinelli2Claude Franceschi3Private Practice, FlorencePrivate Practice, FlorencePrivate Practice, Avezzano (AQ)Hôpital Saint Joseph, Paris The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases. https://www.pagepressjournals.org/index.php/vl/article/view/11886Superficial Venous Insufficiencylower limbs venous hemodynamicsvaricose veins hemodynamic correctionsaphenous vein autologous arterial graft |
| spellingShingle | Massimo Cappelli Raffaele Molino Lova Mauro Pinelli Claude Franceschi The troubled course of the CHIVA Cure through clinical studies: a critical review Veins and Lymphatics Superficial Venous Insufficiency lower limbs venous hemodynamics varicose veins hemodynamic correction saphenous vein autologous arterial graft |
| title | The troubled course of the CHIVA Cure through clinical studies: a critical review |
| title_full | The troubled course of the CHIVA Cure through clinical studies: a critical review |
| title_fullStr | The troubled course of the CHIVA Cure through clinical studies: a critical review |
| title_full_unstemmed | The troubled course of the CHIVA Cure through clinical studies: a critical review |
| title_short | The troubled course of the CHIVA Cure through clinical studies: a critical review |
| title_sort | troubled course of the chiva cure through clinical studies a critical review |
| topic | Superficial Venous Insufficiency lower limbs venous hemodynamics varicose veins hemodynamic correction saphenous vein autologous arterial graft |
| url | https://www.pagepressjournals.org/index.php/vl/article/view/11886 |
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