The Impact of Non-Absorbable Silk Sutures on CHIVA Recurrence: An Analysis of SFJ Ligation Failures

The saphenofemoral junction (SFJ) is a crucial anatomical site in the treatment of varicose veins. CHIVA (Conservative and Hemodynamic Cure of Venous Insufficiency in Outpatient Care) is an advanced, conservative treatment method that aims to preserve and redirect blood flow without removing the affected veins, thus avoiding the destruction associated with traditional vein stripping surgery.

However, in clinical practice, some patients experience recurrence of varicose veins after CHIVA treatment. One potential reason for this recurrence is the reopening of the SFJ after ligation with non-absorbable sutures. This article explores the mechanisms behind this issue and its impact on the effectiveness of CHIVA.

What is CHIVA?

CHIVA is a surgical technique designed to preserve venous function by redirecting blood flow through hemodynamic assessment under ultrasound guidance. By maintaining functional veins and reducing pressure in affected regions, CHIVA offers a less invasive alternative to traditional vein stripping, leading to faster recovery and minimal damage to healthy tissue.

Risks of Non-Absorbable Sutures in SFJ Ligation

In some CHIVA procedures, non-absorbable sutures are used to ligate the SFJ to prevent abnormal reflux into the great saphenous vein. However, the use of these sutures can lead to issues regarding long-term outcomes, including varicose vein recurrence.

While non-absorbable sutures are intended to permanently block abnormal blood flow, clinical observations have shown that some may reopen over time, leading to recurrence. This may be due to the fact that certain "non-absorbable" sutures are not entirely resistant to changes within the body. Over time, these materials may alter, losing their initial fixation strength, which can result in the reopening of the ligated area.

Furthermore, some non-absorbable sutures may gradually integrate with surrounding tissue or be partially absorbed, deviating from their intended permanent fixation. Such characteristics can cause loosening and reopening of the ligation point, increasing the risk of recurrence after CHIVA treatment.

Non-Absorbable Sutures vs. Prolene Vascular Sutures

Strength and Durability

Prolene sutures, made of polypropylene, maintain their strength over time within the body, making them ideal for vascular ligation and other applications requiring long-term stability. In contrast, some other non-absorbable sutures may gradually lose strength, leading to loosening of the ligation and potential reopening of the site.

Degradability

While non-absorbable sutures degrade very slowly, some may become brittle under physiological conditions. Prolene sutures, however, are highly resistant to degradation and brittleness, making them a preferable choice for maintaining long-term ligation efficacy.

Addressing Reopening of the Ligated SFJ

To reduce the risk of recurrence after CHIVA treatment, careful consideration should be given to the choice of ligation materials and techniques for the SFJ. Although non-absorbable sutures are intended for permanent occlusion, not all materials achieve this effect in practice. The following measures may help:

- Use of Reliable Non-Absorbable Materials: Selecting highly stable and durable non-absorbable suture materials, such as Prolene, can reduce the risk of reopening by maintaining long-term efficacy within the body.

- Enhancing Fixation Strength: During ligation, adding additional layers of sutures or employing other fixation methods may enhance stability, reducing the risk of suture loosening or migration.

- Regular Ultrasound Follow-Up: Regular postoperative ultrasound examinations are essential to detect any signs of SFJ reopening early. Timely intervention can prevent the progression of varicose veins and improve long-term outcomes.

Recommendations for Prevention and Improvement

- Accurate Hemodynamic Assessment: The success of CHIVA surgery depends on precise hemodynamic assessment and guidance. Preoperative ultrasound should clearly identify venous pressure and reflux pathways to ensure optimal redistribution of blood flow during surgery.

- Utilization of Stable Ligation Materials: Preference should be given to suture materials that have been clinically proven to offer long-term stability, thereby reducing the risk of ligation failure.

- Standardized Surgical Training: CHIVA surgery requires a high level of skill. It is recommended that physicians performing CHIVA undergo systematic hemodynamic training, especially in material selection and ligation techniques, to ensure adherence to the conservative principles of CHIVA.

Conclusion

The reopening of the SFJ after ligation with non-absorbable sutures is an important factor contributing to recurrence after CHIVA treatment. This issue may be related to the long-term stability of the ligation materials used. To ensure the long-term success of CHIVA, it is essential to carefully select ligation materials, perform scientific hemodynamic assessments, adhere to standardized surgical procedures, and conduct regular postoperative follow-ups. Prolene sutures, with their high durability and stability, may be a more suitable choice. As the global CHIVA training program continues to expand, it is hoped that more physicians will master this technique, reducing unnecessary recurrences and providing better outcomes for patients with varicose veins.

Originally contributed by Dr. Qiang Zhang on the Veinsights . Original Link: https://veinsights.blogspot.com/2024/10/the-impact-of-non-absorbable-silk.html