pittaluga 150625 site barcelona asval-chiva-short2

P. Pittaluga, S. Chastanet

Is the ASVAL technique really overcoming the CHIVA limitations?

P. Pittaluga, S. Chastanet

Is the ASVAL technique really overcoming the CHIVA limitations?

Two options for a saphenous sparing strategy

I do not have any relevantfinancial relationshipswith any commercial interest

DISCLOSURE OF INTEREST

2 options for a saphenous sparing strategy

The ASVAL method

Is only the name different ?

The CHIVA cure

SIMILARITY

SIMILARITY

Franceschi C. Théorie et Pratique de la Cure Conservatrice Hémodynamique de l’Insuffisance Veineuse en Ambulatoire, Percy sous thil, Editions de l’Armaçon,1988

CHIVA

SIMILARITY

Pittaluga P, Chastanet S,Rea B, Barbe R. Phlébologie 2005;58:175-61

ASVAL

SIMILARITY

SIMILARITY

No need of device

No support from the industry

For all the rest, they are totally opposed !!!

The ASVAL methodThe CHIVA cure

THERAPEUTIC PRINCIPLE

CHIVA Saphenous vein -> efficient way of drainage




Fragmentation of the column pressure & disconnection of the venous shunts with ligations


Perform a system well-drained• All isolated superf. segment drained in deep

veins


Fragmentation of the column pressure & disconnection of the venous shunts with ligations

ASVAL Restore the saphenous vein competence


INDICATIONS

CHIVA Universal method +++

INDICATIONS

All kind of reflux patterns have a CHIVA solution• Precise preop echo-Duplex mapping• Set a good strategy of treatment -> system well-drained


INDICATIONS

All patients from C1 to C6 can be treated



INDICATIONS

A failure is always consecutive to a bad performance• Requires expert ultrasonographers and expert surgeons +++

All patients from C1 to C6 can be treated



ASVALSelected indications for ASVAL +++

INDICATIONS


Hemodynamic or anatomical criteria• Limited SV dilatation (<10 mm for GSV; 6mm for SSV)• Competent junction, segmental SV reflux • Voluminous varicose tributary at the thigh• Reversibility test + (compression of the varicose tributary)

Clinical criteria• Nulliparity +++• Young age• Cosmetic concern, few symptoms

INDICATIONS


Hemodynamic or anatomical criteria• Limited SV dilatation (<10 mm for GSV; 6mm for SSV)• Competent junction, segmental SV reflux • Voluminous varicose tributary at the thigh• Reversibility test + (compression of the varicose tributary)

Clinical criteria• Nulliparity +++• Young age• Cosmetic concern, few symptoms

Worse hemodynamic or clinical stages• There is still indications for saphenous ablation / stripping• Represents only 20% of the cases

INDICATIONS

EVIDENCES

EVIDENCES

CHIVA

EVIDENCES

• Follow up 5 years• CHIVA > stripping for recurrence• (31.1% vs 52.7% P<0.001)

• Follow up 10 years• CHIVA > stripping for recurrence• (8% vs 35% P=0.0038)

• Follow up 3 years• CHIVA > compression for ulcer healing

(100% vs 96% P<0.02) and ulcer recurrence (9% vs 38% P<0.05)

CHIVA

EVIDENCES

ASVAL

EVIDENCES

ASVAL vs CHIVA: which is better ?

FIGHT

Rigid theory• Excludes all other techniques• Locks up into a unique approach• Difficult to apply to a chaotic system

CHIVA’s weaknesses

FIGHT

Not obvious to understand• Limited to a community of experimented

physicians Worsens the disease if not well done• Explains its failure to be spread during 90’s

Intellectual attractiveness• Smart theory

CHIVA’s strengths

FIGHT

Ambulatory & cheap

Strong community• Big chief (Franceschi)• Enables to conduct studies with different teams

ASVAL’s weaknesses

Limited indications• Further experiences/studies to confirm the good

indications Requires thorough ablation of the varicose reservoir• Multiple phlebectomies, boring for the physician

Absence of strong community• Open approach, no big chief• More difficult to induce studies in other teams

Simple to understand

ASVAL’s strengths

Leaves a place to other techniques• Open to a larger number of physicians

Ambulatory & cheap

Doesn’t worsen the disease when it fails• Secondary phlebectomy/ablation possible

CONCLUSION

CHIVA & ASVAL are two saphenous sparing strategies

CHIVA and ASVAL have two opposite theoretical and therapeutic principles

ASVAL seems to us more likely to be performed by a large number of physicians since ASVAL is easier to understand and to perform, it doesn’t exclude other techniques and it doesn’t worsen the disease if it fails

CHIVA and ASVAL are supported by publications but with a limited level of recommendation in the guidelines because of a lack of strong scientific evidences

Thank you for your attention

pittaluga 150625 site barcelona asval-chiva-short2

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