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Re: “Preservation of the Great Saphenous Vein and the 2022 European Society for Vascular Surgery Guidelines”

      We would like to thank Dr Muñoz for his letter
      • Muñoz A.
      Preservation of the Great Saphenous Vein and the 2022 European Society for Vascular Surgery Guidelines.
      regarding the recently published European Society for Vascular Surgery (ESVS) guidelines on the management of chronic venous disease (CVD) of the lower limbs.
      • De Maeseneer M.G.
      • Kakkos S.K.
      • Aherne T.
      • Baekgaard N.
      • Black S.
      • Blomgren L.
      • et al.
      European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs.
      The author not only emphasises the importance of preservation of the great saphenous vein trunk, but also wonders why recommendation 51 about conservative haemodynamic treatment of venous incompetence (CHIVA) has not been upgraded in the present guidelines. Recommendation 51 states: “For patients with superficial venous incompetence requiring treatment, ambulatory conservative haemodynamic treatment of venous incompetence (CHIVA) may be considered, if performed by physicians experienced in this treatment strategy”. This is a Class IIb recommendation with Level of Evidence B. It is mainly based on a Cochrane Review from 2021 including six randomised controlled trials (RCTs) with 1 160 participants.
      • Bellmunt-Montoya S.
      • Escribano J.M.
      • Pantoja Bustillos P.E.
      • Tello-Díaz C.
      • Martinez-Zapata M.J.
      CHIVA method for the treatment of chronic venous insufficiency.
      For this Cochrane update, the authors identified only two new additional studies, where CHIVA was compared with endovenous thermal ablation and high ligation/stripping. They judged the certainty of the evidence for the studied outcomes as “low to very low” due to inconsistency, imprecision caused by the low number of events, and risk of bias. Based on their conclusions, the level of evidence obviously remained “Level B” and hence the guidelines writing committee decided to maintain the same strength of recommendation as in the previous ESVS guidelines on the management of CVD.
      • Wittens C.
      • Davies A.H.
      • Baekgaard N.
      • Broholm R.
      • Cavezzi A.
      • Chastanet S.
      • et al.
      Editor's Choice – Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS).
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      References

        • Muñoz A.
        Preservation of the Great Saphenous Vein and the 2022 European Society for Vascular Surgery Guidelines.
        Eur J Vasc Endovasc Surg. 2022; 63: 778
        • De Maeseneer M.G.
        • Kakkos S.K.
        • Aherne T.
        • Baekgaard N.
        • Black S.
        • Blomgren L.
        • et al.
        European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs.
        Eur J Vasc Endovasc Surg. 2022; 63: 184-267
        • Bellmunt-Montoya S.
        • Escribano J.M.
        • Pantoja Bustillos P.E.
        • Tello-Díaz C.
        • Martinez-Zapata M.J.
        CHIVA method for the treatment of chronic venous insufficiency.
        Cochrane Database Syst Rev. 2021; 9: CD009648
        • Wittens C.
        • Davies A.H.
        • Baekgaard N.
        • Broholm R.
        • Cavezzi A.
        • Chastanet S.
        • et al.
        Editor's Choice – Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS).
        Eur J Vasc Endovasc Surg. 2015; 49: 678-737

      Linked Article

      • Preservation of the Great Saphenous Vein and the 2022 European Society for Vascular Surgery Guidelines
        European Journal of Vascular and Endovascular SurgeryVol. 63Issue 5
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          The great saphenous vein (GSV) is the conduit of choice for peripheral arterial and venous reconstructions. Varicose veins (VV) are usually located in its tributaries, not the GSV trunk itself, where focal dilatation (FD) is the most common abnormality rather than diffuse dilatation or aneurysms.1 By performing resection of FDs and anastomosis, or by external prosthetic reinforcement, a dilated GSV, may make a good graft, due to its endothelial lining, obtaining similar results to normal vein.2
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