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全球CHIVA治療靜脈曲張的循證醫(yī)學(xué)之路：證據(jù)、挑戰(zhàn)與前景

2024-08-04 17:29:09　來源: 張強(qiáng)醫(yī)生的靜脈百科

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下肢靜脈曲張是一種常見的慢性靜脈功能不全（CVI）疾病，影響全球大量人群的生活質(zhì)量。傳統(tǒng)治療方法主要包括硬化劑注射、靜脈剝脫術(shù)，而近十年來激光、射頻消融、膠閉合隱靜脈主干的技術(shù)也得到應(yīng)用。但近年來，CHIVA（基于血流動(dòng)力學(xué)分析的保留靜脈的門診局麻治療）作為一種保留靜脈的微創(chuàng)療法，因其在降低復(fù)發(fā)率和改善患者生活質(zhì)量方面的優(yōu)勢(shì)備受關(guān)注。

通過MEDLINE、Embase 和 Cochrane 三個(gè)全球知名的數(shù)據(jù)庫中大量搜索文獻(xiàn)，總共發(fā)現(xiàn)超過39 項(xiàng) RCT研究，共涉及超過 6000 條肢體，最終用于定量分析。

研究重點(diǎn)關(guān)注不同靜脈曲張治療方法的長期療效。選擇了成功治療率（successful treatment rate, STR）和復(fù)發(fā)率（recurrence rate, RR ）兩個(gè)作為最終數(shù)據(jù)合成分析的客觀指標(biāo)。STR 被定義為解剖學(xué)和功能學(xué)上的完整性，即通過超聲確認(rèn)完全消融、閉合或剝脫。RR 被定義為初始治療后再次出現(xiàn)的任何明顯可見的靜脈曲張或病理性返流情況。

分別探討消融術(shù)、CHIVA、硬化劑治療、結(jié)扎術(shù)和剝脫術(shù)，以及 4 種額外的聯(lián)合治療 (消融術(shù) + 剝脫術(shù)、消融術(shù) + 結(jié)扎術(shù)、硬化劑治療 + 結(jié)扎術(shù)、結(jié)扎術(shù) + 剝脫術(shù))。結(jié)果顯示成功治療率：CHIVA > 硬化劑治療 + 結(jié)扎術(shù) > 消融術(shù) + 剝脫術(shù)。長期復(fù)發(fā)率 (RR)：CHIVA < 消融術(shù) + 剝脫術(shù) < 剝脫術(shù)。 CHIVA 在 1 年以上隨訪中具有最高的成功治療率 (P 值為 0.37)。對(duì) 1 年隨訪后的復(fù)發(fā)率進(jìn)行分析，結(jié)果表明 CHIVA 具有最低的復(fù)發(fā)率 (P 值為 0.61)。

高位結(jié)扎加大隱靜脈剝脫術(shù)（HLS）曾經(jīng)是治療靜脈曲張的手術(shù)“金標(biāo)準(zhǔn)”。它可以改善部分生活質(zhì)量，并在術(shù)后短期內(nèi)顯示出療效。然而，傳統(tǒng)手術(shù)的創(chuàng)傷性偏大，存在高并發(fā)癥和復(fù)發(fā)率的風(fēng)險(xiǎn)，因此可能無法保持長期的臨床益處，有研究顯示傳統(tǒng)抽剝手術(shù)的復(fù)發(fā)率為20-50%，與醫(yī)生經(jīng)驗(yàn)相關(guān)。

與傳統(tǒng)手術(shù)相比，一些微創(chuàng)技術(shù)可能帶來較小的創(chuàng)傷，比傳統(tǒng)手術(shù)更安全。這些技術(shù)主要包括消融術(shù)（激光或射頻消融）+外科剝脫+硬化劑治療聯(lián)合，這些方法已被證明是安全有效的，目前在三甲醫(yī)院紛紛開展微創(chuàng)技術(shù)。然而，消融術(shù)和硬化療法仍然屬于廢除靜脈的治療方法，這也可能造成靜脈網(wǎng)絡(luò)的破壞和帶來相關(guān)的并發(fā)癥。對(duì)于長期隨訪而言，微創(chuàng)技術(shù)也并不能從根本上防止靜脈曲張復(fù)發(fā)，有研究顯示消融術(shù)的復(fù)發(fā)率為10-20%，同樣與醫(yī)生經(jīng)驗(yàn)相關(guān)。

CHIVA超微創(chuàng)治療的革命性之處在于，通過精細(xì)的血流動(dòng)力學(xué)評(píng)估，可以有效治療靜脈曲張的同時(shí)保留健康的靜脈網(wǎng)絡(luò)。在實(shí)踐中，CHIVA 治療通過阻斷異常返流、分隔壓力柱、保留回流點(diǎn)等方式來降低靜脈內(nèi)壓力，靜脈曲張會(huì)逐漸縮小，同時(shí)繼續(xù)發(fā)揮其引流血液至深靜脈的作用。

這種革命性的方法顛覆了傳統(tǒng)的以去除或破壞靜脈曲張為中心的治療理念，因此，CHIVA治療可以在根源上降低靜脈高壓，最大程度避免了手術(shù)創(chuàng)傷帶來的問題。

盡管靜脈瓣膜功能損傷是不可逆的，但CHIVA治療后靜脈通路仍然可以發(fā)揮運(yùn)輸血液的作用，同時(shí)也可以引流皮下靜脈網(wǎng)絡(luò)的血液，減少對(duì)正常靜脈的干擾。這種新的平衡可以進(jìn)一步降低靜脈曲張的復(fù)發(fā)。這些特點(diǎn)可能是揭示CHIVA治療具有更好的臨床長期療效和更低復(fù)發(fā)率的關(guān)鍵因素。

有研究顯示，CHIVA治療的復(fù)發(fā)率為5-10%，醫(yī)生的經(jīng)驗(yàn)也決定復(fù)發(fā)率高低，值得注意的是，幾乎所有治療后復(fù)發(fā)的案例都可以通過血流動(dòng)力學(xué)的方法（CHIVA）進(jìn)行修復(fù)。

規(guī)范CHIVA數(shù)據(jù)對(duì)于循證結(jié)果的重要性

高質(zhì)量和一致的數(shù)據(jù)對(duì)于CHIVA的循證醫(yī)學(xué)研究至關(guān)重要。然而，由于CHIVA技術(shù)的復(fù)雜性和不同地區(qū)的實(shí)踐差異，獲取一致性的數(shù)據(jù)是一個(gè)挑戰(zhàn)。這可能導(dǎo)致不同研究結(jié)果的可比性下降，影響循證醫(yī)學(xué)的可信度。因此，標(biāo)準(zhǔn)化的數(shù)據(jù)收集和報(bào)告標(biāo)準(zhǔn)，以及國際數(shù)據(jù)共享平臺(tái)的建立，將有助于促進(jìn)全球范圍內(nèi)的數(shù)據(jù)交流和比較，確保研究結(jié)果的準(zhǔn)確性和可比性。

張強(qiáng)醫(yī)生集團(tuán)和美國Inteloes發(fā)起的全球CHIVA培訓(xùn)和認(rèn)證項(xiàng)目，是提升醫(yī)生技術(shù)水平和推動(dòng)數(shù)據(jù)規(guī)范化的重要一步。通過系統(tǒng)的培訓(xùn)和認(rèn)證，確保醫(yī)生掌握標(biāo)準(zhǔn)化的CHIVA操作流程，從而提高臨床效果，減少技術(shù)差異帶來的影響。這一項(xiàng)目還推動(dòng)了統(tǒng)一的研究標(biāo)準(zhǔn)和方法，確保CHIVA與傳統(tǒng)手術(shù)方法的比較研究更加科學(xué)、嚴(yán)謹(jǐn)。

全球CHIVA項(xiàng)目的意義

全球CHIVA培訓(xùn)和認(rèn)證項(xiàng)目不僅有助于提升醫(yī)生的技術(shù)水平和經(jīng)驗(yàn)積累，還推動(dòng)了CHIVA技術(shù)在全球范圍內(nèi)的規(guī)范化和標(biāo)準(zhǔn)化。通過這一項(xiàng)目，可以建立統(tǒng)一的研究標(biāo)準(zhǔn)和操作規(guī)范，確保各國研究機(jī)構(gòu)的數(shù)據(jù)可比性，從而提供更為可靠的循證醫(yī)學(xué)證據(jù)。此外，該項(xiàng)目還促進(jìn)了國際間的數(shù)據(jù)共享和學(xué)術(shù)交流，有助于推動(dòng)CHIVA技術(shù)在全球范圍內(nèi)的推廣和應(yīng)用。

CHIVA相關(guān)的學(xué)術(shù)著作

Global CHIVA 全球?qū)＜椅瘑T會(huì)成員

Dr. Maria Caminati
Dr. Massimo Cappelli
Dr. Roberto Cuaranta
Dr. Michel Dadon
Dr. Jianping Deng
Dr. Luca De Siena
Dr. Roberto Delfrate
Dr. Xin Du
Dr. Stefano Ermini
Dr. José María Escribano
Dr. Felipe Puricelli Faccini
Dr. Davide Foresti
Dr. Guglielmo Fornasari
Dr. Claude Franceschi
Dr. Gelfrido Galizi
Dr. Sergyi Kryzhanovskyi
Dr. Andres Jorge Kupelian
Dr. Thanh-Phong Le
Dr. Erika Mendoza
Dr. Domenico Migaldi
Dr. Fausto Passariello
Dr. Mauro Pinelli
Dr. Juha Pitkaenen
Dr. Manuel Eugenio Senín Fernández
Dr. Qiang Zhang
Dr. Xiaoyin Zhu

ARTICLES FOCUSING ON THE PRESENTATION OF CHIVA THERAPY

（關(guān)于 CHIVA 的研究文獻(xiàn)）

Franceschi, C. (1989). The conservative and hemodynamic treatment of ambulatory venous insufficiency. Phlebologie, 42(4), 567.
FRANCESCHI,, & FRANCO, G. (1989). La cure CHIVA Discussion. Phlébologie, 42(4),567-568.
Mandolesi,, Ballo, M., Galeandro, I., Filippo, S., Migaldi, D., Spinelli, F., … & Passariello,
(1990). The 1st national multicenter study of the CHIVA (Conservative Therapy and HemodynamicsinVenous Insufficiency in Outpatient Departments) method of treatment of varices. One-year follow-up. Annali italiani di chirurgia, 61(4), 425-427.
CONSIGLIO L., GIORGI G.: Terapia di exeresi o conservativa?Minerva Ang. 1991;16, sup.1: pp. 442–3.
Melliere, D., Cales, B., Martin-Jonathan, C., & Schadeck, M. (1991). Necessity of reconciling the objectives of the treatment of varices and arterial surgery. Practical consequences. Journal des maladies vasculaires, 16(2), 171-178.
Franceschi C. La cure conservatrice hémodynamique de l’insuffisance veineuse ambulatoire (chiva) [Conservative hemodynamic ambulatory treatment of venous insufficiency]. Soins Chir. 1992;(133):29-31.
Franceschi La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA) [Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure)]. J Mal Vasc. 1992;17(4):291-300.
Bailly M. La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA).Présentationd’un cas particulier [Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). Report of an atypical case]. J Mal Vasc. 1992;17(3):241-249.
Hugentobler JP, Blanchemaison P. La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA). Etude de 96 patients opérés de juin 1988 à juin 1990 [Ambulatoryand hemodynamic treatment of venous insufficiency (CHIVA cure). Study of 96 patients operated on between June 1988 and June 1990]. J Mal Vasc. 1992;17(3):218-223.
Bailly, (1993). Cartographie CHIVA. Encyclopédie Médico-Chirurgicale. Paris 43-161-B: 1–4.
Franceschi, (1993). La cure CHIVA et la critique: 14 réponses et 1 conclusion. STV. Sang thrombose vaisseaux, 5(7), 491-497.
ZamboniP, Murgia AP, Vasquez G, Zandi G, Mari C, Liboni La chirurgia venosa videoassistita [Video-assisted venous surgery]. Ann Ital Chir. 1995;66(3):379-386.
Zamboni,, Feo, C. V., Marcellino, M. G., Vasquez, G., & Mari, C. (1996). Haemodynamic correction of varicose veins (CHIVA): An effective treatment?. Phlebology, 11(3), 98-101.
di Chirurgia Generale, U. O. ILTRATTAMENTO DELLE VARICI DEGLI ARTI INFERIORI MEDIANTE CHIVA 2. NOSTRA ESPERIENZA.
A BANHINI,C Franceschi, X Mouren, P Caillard et : Superficial venous insufficiency JOURNAL DES MALADIES VASCULAIRES, 1996
FRANCESCHI, C.: Physiopathologie hémodynamique de l’insuffisance veineuse des membres inférieurs (1997) Actualités Vasculaires Internationales, 22, pp. 17-27
FRANCESCHI C. La Cure Hemodynamique de l’Insuffisance Veineuse en Ambulatoire.: Journal des Maladies Vasculaires. 1997 ; 22 (2) :91-95
CAPPELLI et Al.: Criteri di scelta della Strategia CHIVA Arch. Soc. Ital. Chirurgia 4, 118, 1998
Cappelli, M., Lova, R. M., Ermini, S., Turchi, A., Bono, G., & Franceschi, C. (1999). POSTERS-Conservative surgery of the saphenous trunks. Journal des Maladies Vasculaires, 24, 103-103.
Mendoza, E. (2002). Einteilung der Rezirkulationen im Bein: anatomische und physiologische Grundlagen der CHIVA-Methode. Phlebologie, 31(01), 01-08.
Criado, E., Luján, S., Izquierdo, L., Puras, E., Gutierrez, M., & Fontcuberta, J. (2002, March). Conservative hemodynamic surgery for varicose veins. In Seminars in Vascular Surgery (Vol. 15, No. 1, pp. 27-33). WB Saunders.
Mendoza, (2002). CHIVA-Alternative oder Erganzung zum Stripping. VASOMED-BONN-, 14(1), 6-17.
Hach, (2002). Was ist CHIVA?. Gef?sschirurgie, 7(4), 244-250.
Mendoza, E. (2002). Einteilung der Rezirkulationen im Bein: anatomische und physiologische Grundlagen der CHIVA-Methode. Phlebologie, 31(01), 01-08.
JUAN-SAMSO’ J.: Venous haemodynamic surgery in the treatment of varicose syndrome (2003) Angiologia, 55 (5), pp. 460-475.
Cappelli, M., Molino Lova, R., Ermini, S., Franceschi, C., & PERRIN, M. (2002). Nouvelle approche de la physiopathologie de l’insuffisance veineuse superficielle: Conséquences thérapeutiques. Discussion: Indications thérapeutiques et nouvelles techniques de traitement en phlébologie. Phlébologie, 55(1), 27-31.
Criado,, Juan, J., Fontcuberta, J., & Escribano, J. M. (2003). Haemodynamic surgery

for varicose veins: rationale, and anatomic and haemodynamic basis. Phlebology, 18(4), 158-166.

Criado, E., Juan, J., Fontcuberta, J., & Escribano, J. M. (2003). Haemodynamic surgery for varicose veins: rationale, and anatomic and haemodynamic basis. Phlebology,18(4), 158-166.
PITTALUGA, P. (2008). MISE AU POINT CONCERNANT les COMMENTAIRES sur la CURE CHIVAdans l’ARTICLE des Drs P. PITTALUGA et S. CHASTANET:?TECHNIQUE et TRAITEMENT des VARICES: COMMENT CHOISIR??. Phlébologie, 61(4), 428-430.
Passariello, (2008). Suppression of the sapheno-femoral reflux by pure non-saphenous phlebectomy and anatomical structure of the reflux. Acta Phlebologica, 9(3), 105-7.
Franceschi, C. (2008). Hémodynamique de la maladie postphlébitique: conséquences diagnostiques et thérapeutiques. Journal des Maladies Vasculaires, 33, S5.
Franceschi, C. (2008). Hémodynamique de la maladie postphlébitique: conséquences diagnostiques et thérapeutiques. Journal des Maladies Vasculaires, 33, S5.
Mowatt-Larssen E, Shortell C. CHIVA. Semin Vasc Surg. 2010;23(2):118-122. doi:10.1053/j.semvascsurg.2010.01.008.
Mowatt-LarssenE, Shortell Treatment of primary varicose veins has changed with the introduction of new techniques. Semin Vasc Surg. 2012;25(1):18-24. doi:10.1053/j.semvascsurg.2012.02.002
Casian, D. (2012). Metode contemporane de tratament al maladiei varicoase. Buletinul Academiei de ?tiin?e a Moldovei. ?tiin?e Medicale, 33(1), 319-322.
Onida, S., & Davies, A. H. (2015). CHIVA, ASVAL and related techniques–Concepts and evidence. Phlebology, 30(2_suppl), 42-45.
Gianesini, S., Occhionorelli, S., Menegatti, E., Zuolo, M., Tessari, M., Spath, P., … & Zamboni, P. (2015). CHIVAstrategy in chronic venous disease treatment: instructions for users. Phlebology, 30(3), 157-171.
Zamboni, P., & Gianesini, S. (2016). Surgical technique for deep venous reflux suppression in femoral vein duplication. EJVES Short Reports, 30, 10-12.
PUSKáS A. et Al.:HAEMODYNAMIC MAPPING OF CHRONIC VENOUS INSUFFICIENCY:THECONCEPT OF SHUNTS VéNáK BETEGSéGEI érbetegségek,XXIII. évfolyam 4. szám, 2016/4.
Faccini FP, Arendt AL, Pereira RQ, de Oliveira AR. CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report. J Vasc Bras. 2019;18:e20180077. Published 2019 Jan 7. doi:10.1590/1677-5449.007718

第二部分：

ARTICLES CONCERNING SUBJECTES OF CHIVA PROCEDURE NOT IN TERMS OF RECURRENCES / CLINIC DATA BUT OF BIOCHEMICAL, HEMODYNAMIC PARAMETERS, THROMBOSES AND COMPLICATIONS

（關(guān)于 CHIVA 治療的生物力學(xué)、血流動(dòng)力學(xué)、血栓及并發(fā)癥方面的臨床數(shù)據(jù)）

CAPPELLI et Al.: Considerazioni sul ruolo fisiopatologico delle perforanti nella varicosi essenziale, quale presupposto alla concezione terapeutica dell’intervento CHIVA Ospedali d’Italia – Chirurgia nov–dic 1991, vol. XLIV n°6, pp.425–438.
ZamboniP, Marcellino MG, Feo CV, et Alternative saphenous vein sparing surgery for future grafting. Panminerva Med. 1995;37(4):190-197.
Mendoza, E. (2018). Perioperative Management in Saphenous Sparing Surgery. In SaphenousVein-Sparing Strategies in Chronic Venous Disease (pp. 239-250). Springer,
Zamboni P, Cisno C, Marchetti F, Quaglio D, Mazza P, Liboni A. Reflux elimination without any ablation or disconnection of the saphenous vein. Ahaemodynamic model for venous surgery. Eur J Vasc Endovasc Surg. 2001;21(4):361-369.
FRANCESCHI: CHIVA effectiveness score: the correct one is below.Eur J Vasc Endovasc Surg. 2012 Sep;44(3):351; author reply 352.
Maldonado-Fernández,, López-Espada, C., Martínez-Gámez, F. J., Mata-Campos, J. E., Galán-Zafra, M., & Sánchez-Maestre, M. (2010). Complicaciones postoperatorias de la estrategia CHIVA para el tratamiento de la insuficiencia venosa crónica. Angiología, 62(3), 91-96.
MENDOZA, BERGER V., ZOLLMANN C., BOMHOFF M., AMSLER F., Calibrereduction of great saphenous vein and common femoral vein after CHIVA Phlebologie, 2011, 40(2): pp. 73–78
MENDOZA, Diameter reduction of the great saphenous vein and the common femoralvein after CHIVA Long–term results, Phlebologie, 2013, 42: pp. 65–69
MENDOZA: Crossectomy of the great saphenous vein with the CHIVA method (2004) Vasomed, 16 (2), pp. 46-48.
DELFRATE, BRICCHI M., FRANCESCHI C., GOLDONI M., Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins, Veins and Lymphatics, 2014, 3: pp. 19–22
MENDOZAE, AMSLER , CHIVA with endoluminal procedures: LASER versus VNUS –treatment of the saphenofemoral junction, Phlebologie, 2017, 46: pp. 5–12.
PASSARIELLO F. et: The office based CHIVA Journal of Vascular Diagnostics 26 September 2013 Volume 2013:1 Pages 13—20
Gianesini, S., Menegatti, E., Zuolo, M.,Tessari, M., Ascanelli, S., Occhionorelli, S., & Zamboni, (2013). Short endovenous laser ablation of the great saphenous vein in a modified CHIVA strategy. Veins and Lymphatics, e21-e21.
Gianesini, S., Menegatti, E., Malagoni, M., Occhionorelli, S., & Zamboni, P. (2017). Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options. Phlebology, 32(4), 249-255.
Gianesini, S., Menegatti, E., Malagoni, M., Occhionorelli, S., & Zamboni, P. (2017). Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options. Phlebology, 32(4), 249-255.
Tisato, V., Zauli, G., Gianesini, S., Menegatti, E., Brunelli, L., Manfredini, R., … & Secchiero, P. (2014). Modulation of circulating cytokine-chemokine profile in patients affectedby chronic venous insufficiency undergoing surgical hemodynamic correction. Journal of immunology research, 2014.
Gianesini,, Menegatti, E., Zuolo, M., Tessari, M., Spath, P., Ascanelli, S., … & Zamboni,
(2015).Laser-assisted strategy for reflux abolition in a modified CHIVA approach. Veins and Lymphatics, 4(2).
Zamboni,, Spath, P., Tisato, V., Tessari, M., Dalla Caneva, P., Menegatti, E., … & Secchiero, P. (2016). Oscillatory flow suppression improves inflammation in chronic venous disease. Journal of Surgical Research, 205(1), 238-245.
Delfrate, R. (2019). Thanks to the CHIVAstrategy, may the histoarchitecture of great saphenous vein-sparing, make it suitable as graft for bypasses?. Veins and Lymphatics, 8(1).
ZAMBONI et Al.: Alternative saphenous vein sparing surgery for future grafting. Panminerva Med. 1995 Dec;37(4):190-7.
Mendoza, M. Cappelli : Sclerotherapy technique in CHIVA strategy Phlebologie 2017; 46(02): 66-74
FERRACANI: A Change of a Paradigm Under the Scope of a Cardiovascular Surgeon. Remodeling of the Great Saphenous Vein Instead of Ablation for Preservation of the Patient Anatomical Capital Cardiology December 30, 2019 ecronicon.com open access
MENDOZA : Does the suture material influence the outcome after high ligation of great saphenous vein? Vasa (2020), 49 (2), 153–155

第三部分：

ARTICLES CONCERNING THE RESULTS OF CHIVA PROCEDURE IN TERM OF RECURRENCES / CLINIC DATA WITHOUT COMPARISON WITH OTHER METHODS

（關(guān)于 CHIVA 治療的復(fù)發(fā)率/臨床數(shù)據(jù)的非對(duì)照臨床研究）

FICHELLEJM, Carbone P, Franceschi : Results of ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure) J Mal Vasc. 1992;17(3):224-8.
BAILLY: Resultats de la cure Chiva In techniqueset stratégie en chirurgie vasculaire. Jubilé de J.M. Cormier. Edition A.E.R.C.Paris 1992: 255-71
HUGENTOBLERP., BLANCHMAISON P.: CHIVA cure. Etude de 96 patients opres de juin1988 a juin 1990 J. Mal. Vasc., 1992, 17: pp. 218–23.
QUINTANA et Al.:The CHIVA cure of varices of the lower extremities. La Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire Angiologia. 1993 Mar-Apr;45(2):64, 66-7
ZAMBONI: When CHIVA treatment could be video guided. Dermatol Surg. 1995 Jul;21(7):621-5.
ZAMBONI et AL.: Angiovideo-assisted hemodynamic correction of varicose veins. Int Angiol. 1995 Jun;14(2):202-8.
BAHNINIA, Bailly M, Chiche L, Franceschi C.: Ambulatory conservative hemodynamic correction of venous insufficiency. Technique, results. Ann Chir. 1997;51(7):749-60.
CAPPELLI et Al.: I risultati della cura CHIVA. Osp Ital Chir 1998; 4: 615-8.
ZAMBONI, MARCELLINO M.G., CAPPELLI M., FEO C.V., BRESADOLA V.,

VASQUEZ G., LIBONI A., Saphenous vein sparing surgery: principles, techniques and results, J.. Cardiovasc. Surg., Torino 1998 Apr, 39(2): pp. 151–62.

CAPPELLI M. et Al. “Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years” ANNALS OF VASCULAR SURGERY 2000 Vol 14 n°4 pag 376-384
ESCRIBANOM., JUAN J., BOFILL R., MAESO J., RODRíGUEZ–MORI A., MATAS M.,

Durability of reflux–elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3–year prospective case study, Eur. J. Vasc. Endovasc. Surg., 2003, 25: pp. 159–63.

ZAMBONI P, ESCRIBANO JM.: Regarding ‘Reflux Elimination Without anyAblation or Disconnection of the Saphenous A Haemodynamic Model for Venous Surgery’ and ‘Durability of Reflux-elimination by a Minimal Invasive CHIVA Procedure on Patients with Varicose Veins. A 3-year Prospective Case Study’. Eur J Vasc Endovasc Surg. 2004 Nov;28(5):567.
ESTEBAN-GRACIA et Al.: Application of the CHIVA strategy. A prospective study at one year Angiologia 2004, 56 (3), pp. 227-235.
LINARES-RUIZ, P., Bonell-Pascual, A., Llort-Pont, C., Romera, A., Lapiedra-Mur, O. : Mid-term results of applying the CHIVA strategy to the external saphenous vein. Angiologia 2004 , 56 (5), pp. 481-490.
ZAMBONI, GIANESINI S.,MENEGATTI E., TACCONI G., PALAZZO A., LIBONI A.,

Great saphenous varicose vein surgery without saphenofemoral junction disconnection, Br. J. Surg., 2010 Jun, 97(6): pp. 820–5.EVA et Al.: CHIVA – ECOGRAPHIC ASPECTS AND SURGICAL RESULTS

Maxilo-facial surgery volume 18 ? issue 1 January / March 2014 ? pp. 64-70EVA,, TIUTIUCA, R., & STANCIU, C. (2014). CHIVA-ECOGRAPHIC ASPECTS AND

SURGICAL RESULTS. International Journal of Medical Dentistry, 18(1).

MALDONADO-FERNANDEZet : Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins. Cir Esp. 2016 Mar;94(3):144-50.
ZMUDZINSKI M,MALO P, HALL C, HAYASHI , CHIVA – A prospective study of a vein sparing technique for the management of varicose vein disease, Am. J. Surg., 2017, 213: pp. 967–969.
FRANCESCHIC, Bahnini A, Cappelli M, Cuaranta RL, Dadon M, Delfrate R, Ermini S, Gianesini S, Mendoza E, Passariello F, Puskas : Commentary on the article “A prospective study of a vein sparing technique for the management of varicose vein disease” by M Zmudzinski et al. Am J Surg. 2018 Nov;216(5):1035.
Faccini, F. P., Ermini, S., & Franceschi, C. (2019). CHIVAto treat saphenous vein insufficiency in chronic venous disease: characteristics and Jornal Vascular Brasileiro, 18.

第四部分：

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATAWITH OTHER PROCEDURESEMPLOING NOT RANDOMIZED STUDIES

（比較 CHIVA 與其他術(shù)式的復(fù)發(fā)率/臨床數(shù)據(jù)的非隨機(jī)研究）

Gorny, P., Blanchemaison, P., Chahine, D., Hutinel, B., & Chanvallon, C. (1995). Chirurgie conservatrice et ambulatoire: étude comparative entre Chiva et crossectomie chez 321 patients opérés de la saphène interne. Discussion. Phlébologie, 48(2), 255-259.
CAPPELLI,MOLINO LOVA R., ERMINI S., TURCHI A., BONO G., BAHANINI A.,FRANCESCHI C.I., La Cure CHIVA dans le traitement de la Maladie Variqueuse: analyse critique des résultats après trois ans, Ann. Chir. Vasc., 1996.
MAESO, JUAN J., ESCRIBANO J., ALLEGUEN.M.,DIMATTEO A.,GONZALEZE.,MATAS M.: Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities Ann. Vasc. Surg., 2001, 15: pp. 661–5.
NOPPENEY, T., Noppeney, J., Kurth, I.: Results of standard varicose vein surgery (2002) Zentralblatt fur Chirurgie, 127 (9), pp. 748-751.
MARIA et Al. : Varicose disease of lower limbs: What kind of treatment? Personal experience Chirurgia 2008, 21 (4), pp. 195-198.
Solís, V., Ribé, L., Portero, J. L., & Rio, J. (2009). Stripping saphenectomy, CHIVA and laser ablation for the treatment of the saphenous vein insufficiency. Ambul Surg, 15(1), 11-4.
Franceschi, (2010). “Stripping versus the CHIVA Method” par Claude Franceschi. Angéiologie, 62(4).
MILONE, SALVATORE G.,MAIETTA P., SOSA FERNANDEZL.M.,MILONE F.,Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience, G. Chir., 2011, p. 32.
CHANCY et : Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins. World J Surg. 2011 Jul;35(7):1679-86.
DKELLEHER, T R A Lane, I J Franklin and A H Davies : Treatment options, clinical outcome (quality of life) and cost benefit (quality-adjusted life year) in varicose vein treatment Phlebology 2012;27 Suppl 1:16–22.
DE FRANCISCIS S. et Al. : Hemodynamic surgery versus conventional surgery in chronicvenous disease: a multicenter retrospective ACTA PHLEBOL. 2013; 14; 109-114
WANG, CHEN Q., FEI Z., ZHENG E., YANG Z., HUANG X., HEMODYNAMIC CLASSICATION AND CHIVA TREATMENT OF VARICOSE VEINS IN LOWER EXTREMITIES(VVLE) Int. J. Clin. Exp. Med., 2016, 9(2): pp. 2465–2471.

第五部分：

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATAWITH OTHER PROCEDURESEMPLOING RANDOMIZED STUDIES (RCT)

（比較 CHIVA 與其他術(shù)式的復(fù)發(fā)率/臨床數(shù)據(jù)的隨機(jī)研究）

ZAMBONI,CISNO C.,MARCHETTIF.,MAZZA P.,FOGATO L.,CARANDINA S.,DE PALMA M., LIBONI A., Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial, Eur. J. Vasc. Endovasc. Surg., 2003 Apr, 25(4): pp. 313–8.CARANDINA, MARI C., DE PALMA M., MARCELLINO M.G., CISNO C., LEGNAROA., LIBONI A., ZAMBONI P., Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial, Eur. J. Vasc. Endovasc. Surg., 2008 Feb, 35(2):

230–7.IBORRA–ORTEGA, BARJAU–URREA E., VILA–COLL R., BALLóN–CARAZASH.,CAIROLS–CASTELLOTE M.A., Estudio comparativo de dos técnicas quirúrgicas en el tratamientode las varices de las extremidades inferiores: resultados tras cinco a?os de seguimiento, ANGIOLOGíA, 2006, 58(6): pp. 459468.PARéSO., JUAN J., TELLEZ R., MATA A., MORENO C., QUER F.X., SUAREZ D.,CODONY I., ROCA J., Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial, Ann. Surg., 2010 Apr, 251(4): pp. 624–31.

第六部分：

REVISIONI COCHRANE e METANALISI

（關(guān)于 CHIVA 的系統(tǒng)性回顧以及 Meta 分析）

BELLMUNT–MONTOYA, ESCRIBANO J.M., DILME J., MARTINEZ–ZAPATA M.J.,

CHIVA method for the treatment of chronic venous insufficiency, Cochrane Database Syst. Rev., 2013 Jul 3, (7): CD009648.

BellmuntMontoya,, Escribano, J. M., Dilme, J., &MartinezZapata, M. J. (2015).CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews, (6).
Guo et Al.: Long-term efficacy of different procedures for treatment of varicose veins A network meta-analysis Medicine (2019) 98:7

第七部分：

ARTICLES OF GENERAL REVIEW

（關(guān)于 CHIVA 的綜述類文章）

Mendoza,: CHIVA 1988-2008: Review of studies on the CHIVA method and its development in different countries (2008) Gefasschirurgie, 13 (4), pp. 249-256
AGUS G.B.: Thirtyyears of new venous hemodynamic concept and teaching Acta Phlebologica 2019 mese;20(0):000–000
Mendoza, (2017). Primum non nocere. Veins and Lymphatics, 6(2).
CFRANCESCHI : CHIVA 30 years later. Scientific and ethical considerations Veins and Lymphatics, 2019 – pagepressjournals.org

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