Mininvasive Laser Approach Chiva II in type III shunt chronic venous insufficiency in bariatric patients.

Author(s): Domenico Parmeggiani, Ignazio Verde, Giancarlo Moccia, Francesco Torelli, Francesco Miele, Pasquale Luongo, Pasquale Sperlongano, Alfredo Allaria, Antonella Sciarra, Nadia De Falco, Maddalena Claudia Donnarumma, Chiara Colonnese, Paola Bassi, Ludovico Docimo and Massimo Agresti

The authors report their experience on the use of Endo-Vascular Laser Treatment (modified type II CHIVA) (Conservatrice et Emodinamique de l'Insuffisance Veneuse en Ambulatorie) in patients with Chronic Venous Insufficiency with a Type III Shunts in patients with severe obesity (BMI>40). The authors affirm that Laser type II CHIVA in Type III shunts still offers several advantages, for the echo guided localization of the vein in bariatric patients, resulting a time saving procedure with better compliance and lower rate of mayor complications. Since January 2021 to December 2022, we have treated 30 patients, all of them with a confirmed echography diagnosis of Chronic Venous Insufficiency-Type III shunt, m.a. 45.2 years old, with a medium BMI of 42.3 with a medium follow up of 52.2 months. We selected patients with pathological obesity and chronic venous insufficiency who presented a Type III SHUNT on the hemodynamic examination with echo-color-doppler. It has been observed varicose vein recurrence only in 5 patients after six month 16.6% and in 9 patients two years later 30%. Bruises was the prevalent side effect observed in 14 patients 46.6%, we didn’t observe any limb infections, no superficial vein thrombosis and of course no nerve damages. The procedure was less invasive than surgical preparation in bariatric patients. 18 patients received a laparoscopic sleeve gastrectomy in the 2 years from our treatment and in none of them we have observed any complication related to chronic venous insufficiency. It's well known the advantages of CHIVA vs Traditional Stripping in term of recurrence, side effects like bruises and especially nerve damages; the Endo-Vascular Laser Treatment in this kind of modified Type II CHIVA seems to improve limb infections incidence, especially in bariatric patients, reducing for this complication the gap versus stripping and of course improving the traditional EVLT with the Hemodynamic principles of CHIVA Treatment. We suggest this type of technique especially in patients with severe obesity, where the clinical and metabolic condition added to local more complicated conditions, and due especially to the enormous fat panicle, make difficult any surgical approach.