title: Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.
abstract: BACKGROUND
  Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins.
  
  
  METHODS
  This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale.
  
  
  RESULTS
  The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases.
  
  
  RESULTS
  3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome.
  
  
  CONCLUSIONS
  This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Complejo Hospitalario de Jaén, Hospital Universitario Médico-Quirúrgico , Jaén, España.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Maldonado-Fernández
authors.affiliation: Departamento de Cirugía, Universidad de Granada, Granada, España. Electronic address: jlinaresp@ugr.es.
authors.forename: Jose Patricio
authors.initials: JP
authors.lastname: Linares-Palomino
authors.affiliation: Departamento de Cirugía, Universidad de Granada, Granada, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: López-Espada
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Complejo Hospitalario de Jaén, Hospital Universitario Médico-Quirúrgico , Jaén, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martínez-Gámez
authors.affiliation: Departamento de Cirugía, Universidad de Granada, Granada, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ros-Díe
mesh_terms: D006439:Hemodynamics; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000601:surgery*; D014648:Varicose Veins / Q000601:surgery*
keywords: Anterior accessory great saphenous vein; CHIVA technique; Cirugía de varices; Cirugía hemodinámica venosa; Haemodynamic venous surgery; Técnica CHIVA; Varicose veins surgery; Vena safena magna accesoria anterior