Distal outpatients hemodynamic treatment of chronic venous insufficiency of the lower limbs: a new proposal.

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Sandro Mandolesi
Luca Revelli
Alessandro d’ Alessandro
Saverio Sandro Fabiani Fabiani


The etiology of the venous insufficiency of the lower limbs is related to the increase of the district pressure. This occurs in case of pressure overload of the afferent compartment with a progressive increase of the gradient until the reversal of the flow direction. Varicose veins would be the effect and not the cause of the pressure overload which must always be researched in the efferent (draining) compartment. The gradient inversion in a compartment causes a reflux circuit (venous shunt) only if - in addition to the escape point - one re-entry point is also active, The closure of the escape point does not solve the etiological moment of the district pressure overload. It is therefore a symptomatic treatment that cannot reduce the potential of the system to cause recurrences. During walking, reflux will cause Transmural Pressure Peaks (PPT): in diastole if the reflux is systolic; in systole if the reflux is diastolic; in diastole and in systole if the reflux is diastolic-systolic. On this basis, it has been proposed CHIVA 2 distal outpatient treatment without CHIVA 1 with interesting haemodynamic effects. In the subcutaneous area by the pressure overload block it improves compartment drainage, reduces the peak of trans-mural pressure and the caliber of the varicose veins. In the intrafascial district: reduces peak and trans-mural walking pressure; does not change the drainage of the reflux; can restore an antegrade flow

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How to Cite
Mandolesi, Sandro, et al. “Distal Outpatients Hemodynamic Treatment of Chronic Venous Insufficiency of the Lower Limbs: A New Proposal”. Annali Italiani Di Chirurgia, vol. 94, no. 6, Nov. 2023, pp. 549-56, https://annaliitalianidichirurgia.it/index.php/aic/article/view/3138.