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A Journal on Phlebology
Acta Phlebologica 2013 April;14(1):25-30
GSV calibre reduction and reflux elimination by tributaries disconnection: evidences and hypotheses
Centro Diagnostico Aquarius, Naples, Italy
A simple incompetent tributary disconnection can achieve a GSV/SSV reflux elimination in selected hemodynamic patterns. The disconnection achieves the reduction of the GSV/SSV calibre above the tributary confluence and the flow inversion (reflux elimination). If the reflux reappears, it happens often 6-12 months after the intervention, so that a competent GSV/SSV at 1 year can be regarded as a stable hemodynamic effect. Calibre reduction is a persistent effect, being visible at 3 years, even if the reflux reappears, while the distal calibre doesn’t change significantly after the intervention. In some selected cases ASVAL and Chiva 2 are the same procedure, i.e. a Muller phlebectomy. The difference however is in what is planned later. Strategy schemes are drawn for ASVAL, Chiva 1 and Chiva 2. Details are given of Chiva Crossotomy. The goal of Chiva 2, the spontaneous transformation of the anterograde system into a refluxing Sh I, is explained thoroughly. If reflux develops again in the saphenous system, it is the achievement of the planned goal, to be treated with a different strategy not available before. Reflux elimination by tributary disconnection is an promising procedure. Several hypotheses are proposed to explain this phenomenon.