CHIVA Strategy Shows Potential for Sparing Great Saphenous Vein as Bypass Graft, Study Finds

Histological Examination Reveals Promising Results for Vein Graft Patency and Architecture


Dr. Roberto Delfrate

A recent study conducted at Casa di Cura Figlie di San Camillo in Cremona, Italy, suggests that the CHIVA strategy may offer a viable option for preserving and utilizing the great saphenous vein (GSV) as a graft for bypass surgeries. Led by Dr. Roberto Delfrate, the study examined the histological structure of preserved GSV segments in patients who underwent the CHIVA 1 strategy.

Traditionally, autologous saphenous veins have been favored as graft material for femoropopliteal bypasses below the knee due to their superior primary patency rates compared to synthetic materials like PTFE, HUV, or Dacron. Despite the growing trend of endovascular interventions, surgical bypasses continue to provide effective and durable outcomes with low postoperative complications and mortality rates.

The CHIVA strategy, known for its effectiveness in treating venous insufficiency, has raised questions about whether the preserved GSV can serve as a suitable bypass graft. The study included 22 patients who underwent hydrostatic column fractionation one year after saphenous femoral disconnection using the CHIVA 1 strategy.

Histological examinations of short GSV segments were performed, revealing promising findings.

In 21 out of the 22 cases, the preserved GSV demonstrated maintained histoarchitecture, including intact endothelial layers, well-represented smooth muscle layers with mild hypertrophy and hyperplasia, vessel networks supplying muscular cells, and an adventitial layer with nerves and multiple endothelial cells surrounded by smooth muscle cells. B-mode examinations confirmed a regular venous appearance in these veins.

Dr. Delfrate noted that the preserved GSV exhibited better histological structure and B-mode appearance compared to a normal GSV, potentially attributed to increased internal pressure levels before the CHIVA treatment, similar to the arterialization observed in vein grafts. These findings suggest that the spared GSV, following CHIVA saphenous sparing surgery, could be a viable graft material for bypass surgeries.

While further research and clinical studies are needed to validate these findings, the study highlights the potential of the CHIVA strategy in expanding graft options and improving outcomes for patients requiring bypass procedures. If confirmed, this could contribute to advancements in vascular surgery and enhance patient care.

This study underscores the ongoing efforts to optimize surgical techniques and graft selection for bypass surgeries, aiming to provide patients with the most effective and suitable treatment options available.

Note: This news article is based on the research article authored by Roberto Delfrate and published in Veins and Lymphatics 2019; 8:8227. The content has been adapted and summarized for the purpose of this news report.