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Deutsche Gesellschaft für CHIVA e.V.
Literatur und Studien

Vergleichsstudie CHIVA vs. Stripping

J.O. Parés · J. Juan · R. Tellez · A. Mata · C. Moreno · F. Quer · Xavier · D. Suarez · I. Codony · J. Roca

Details

Ver­gleichs­stu­die CHIVA vs. Strip­ping

Verlag

Annals of Surgery

Sprache

Englisch

Jahr

2010

Inhalt

Objec­tive: The objec­tive of this ran­do­mi­zed study was to com­pare the effi­cacy of the CHIVA method for the tre­at­ment of vari­cose veins with respect to the stan­dard tre­at­ment of strip­ping.

Con­text: Vari­cose veins are a sign of chro­nic venous dis­or­der. For over a cen­tury, vari­cose veins have been trea­ted with sur­gi­cal abla­tive tech­ni­ques, with strip­ping being the stan­dard tre­at­ment. Cur­rently, post­sur­gi­cal vari­cose veins recur­rence (20% – 80%) is a common, com­plex, and costly pro­blem. Ambu­la­tory Con­ser­va­tive Hemo­dy­na­mic Manage­ment of Vari­cose Veins (CHIVA) is a new option for trea­ting chro­nic venous dis­or­der.

Methods: In this open-label, ran­do­mi­zed con­trol­led trial, 501 adult pati­ents with pri­mary vari­cose veins were trea­ted in a single center. They were assi­gned to an expe­ri­men­tal group, the CHIVA method (n = 167) and 2 con­trol groups: strip­ping with clinic mar­king (n = 167) and strip­ping with duplex mar­king (n = 167). The out­come mea­sure was cli­ni­cal recur­rence within 5 years, asses­sed cli­ni­cally by pre­viously trai­ned inde­pen­dent obser­vers. Duplex ultra­so­no­gra­phy was also used to assess recur­ren­ces and causes.

Results: In an inten­tion-to-treat ana­ly­sis, cli­ni­cal out­co­mes in the CHIVA group were better (44.3% cure, 24.6% impro­ve­ment, 31.1% failure) than in both the strip­ping with clinic mar­king (21.0% cure, 26.3% impro­ve­ment, 52.7% failure) and strip­ping with duplex mar­king (29.3% cure, 22.8% impro­ve­ment, 47.9% failure) groups. The ordi­nal odds ratio bet­ween the strip­ping with clinic mar­king and CHIVA groups, of recur­rence at 5 years of follow-up, was 2.64, (95% con­fi­dence inter­val [CI]: 1.76 – 3.97, P < 0.001). The ordi­nal odds ratio of recur­rence at 5-years of follow-up, bet­ween the strip­ping with duplex mar­king and CHIVA group, was 2.01 (95% CI: 1.34 – 3.00, P < 0.001). This trial is regis­te­red at ISRCTN and car­ries the fol­lo­wing ID number: ISRCT­N52861672, avail­able at: http://​isrctn​.org.

Con­clu­si­ons: The pre­sent results indi­cate that, thanks to spe­ci­fic venous hemo­dy­na­mic eva­lua­tion, the CHIVA method is more effec­tive than strip­ping with cli­ni­cal mar­king or strip­ping with duplex mar­king to treat vari­cose veins. When car­ry­ing out a strip­ping inter­ven­tion, Duplex mar­king does not improve the cli­ni­cal results of this abla­tive tech­ni­que.

Über den Autor

From the Depart­ment of Angio­logy and Vas­cu­lar Sur­gery, Hos­pi­tal Gene­ral de Vic, Vic, Spain; Depart­ment of Angio­logy, Vas­cu­lar and Endo­vas­cu­lar Sur­gery of the Hos­pi­tal Uni­ver­si­tari Vall d’Hebron, Uni­ver­si­tat Autò­noma de Bar­ce­lona, Bar­ce­lona, Spain; Epi­de­mio­logy and Assess­ment Unit, Hos­pi­tal Gene­ral de Vic., Vic. Epi­de­mio­logy and Assess­ment Unit, Fund­a­ció Parc Taulí, Insti­tut Uni­ver­si­tari Parc Taulí, Uni­ver­si­tat Autò­noma de Bar­ce­lona, Saba­dell, Spain; Depart­ment of Gene­ral Sur­gery, Hos­pi­tal Gene­ral de Vic, Vic, Spain; and Epi­de­mio­logy and Assess­ment Unit, Fund­a­ció Parc Taulí, Insti­tut Uni­ver­si­tari Parc Taulí, Uni­ver­si­tat Autò­noma de Bar­ce­lona, Saba­dell, Spain.