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Claude Franceschi | |
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| Born | October 12, 1942 |
| Occupation(s) | Internal medicine Hemodynamics |
| Notable work | Doppler Ultrasound and arteries, veins, lymphatic diseases |
Claude Franceschi (born October 12, 1942) is an angiologist French MD.
After Shigeo Satomura who detected for the first time the blood flow with a Doppler Ultrasound machine, [1] Gene Strandness measured the blood pressure at the ankle (1967), Léandre Pourcelot proposed the Arterial resistivity index (1974), and Gosling the Pulsatility index (1974).
Claude Franceschi then tried to analyze more exactly the hemodynamic meaning of the Doppler signal wave from normal and diseased vessels. He published the results at numerous conferences [2] and in the French book "L'Investigation vasculaire par ultrasonographie Doppler" ("Vascular Doppler ultrasound investigation") in 1977. [3]
Franceschi's major work was to match the principles of fluid mechanics [4] with arterial and venous hemodynamics. After studying the correlations between the Doppler ultrasound, radiological and surgical data, he laid down the methodological and semiotic bases of vascular Doppler ultrasound.
According to this theory, varicose veins are not, as well as edema and ulcers, the cause of the venous insufficiency, but the result of venous valves incompetence instead and/or obstacles to the flow. Furthermore, destroying varices in impeding the natural drainage of the skin, would be responsible for relapses by a compensation effect (vicarious shunts). The CHIVA method removes the overload flow and pressure, resulting in ulcer healing and returning the normal caliber of the veins, including varicose veins. It merely consists in the accurate splitting of the gravitational hydrostatic pressure of the venous column and in the disconnection of closed shunts (depending on the particular configuration of each patient). From 1 to 5 divisions/ligatures are performed under local anesthetics and without hospitalization (ambulatory). In addition, the saphenous veins are saved, a considerable advantage since these veins are the best material for by-passing the peripheral arteries, and completing Coronary artery bypass surgery, more and more necessary for the aging population. [16] Several randomized controlled trials and a Cochrane Library review have demonstrated CHIVA superiority in certain specific anatomical situations to conventional removal (stripping) of the saphenous vein. [17] [18] [19] [20] [21] [22] [23] [24] The CHIVA technique as a treatment of venous insufficiency is now accepted as the standard of care in those situations where it applies. The CHIVA technique (Guidelines) and Results with Chiva (Guidelines), . [25]
Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itching, and nighttime leg cramps. These veins typically develop in the legs, just under the skin. Their complications can include bleeding, skin ulcers, and superficial thrombophlebitis. Varices in the scrotum are known as varicocele, while those around the anus are known as hemorrhoids. The physical, social, and psychological effects of varicose veins can lower their bearers' quality of life.
Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.
The great saphenous vein (GSV) or long saphenous vein is a large, subcutaneous, superficial vein of the leg. It is the longest vein in the body, running along the length of the lower limb, returning blood from the foot, leg and thigh to the deep femoral vein at the femoral triangle.
Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously monitors and adjusts to conditions in the body and its environment. Hemodynamics explains the physical laws that govern the flow of blood in the blood vessels.
Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.
Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. The portal vein and its branches supply most of the blood and nutrients from the intestine to the liver.
Telangiectasias, also known as spider veins, are small dilated blood vessels that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. These dilated blood vessels can develop anywhere on the body, but are commonly seen on the face around the nose, cheeks and chin. Dilated blood vessels can also develop on the legs, although when they occur on the legs, they often have underlying venous reflux or "hidden varicose veins". When found on the legs, they are found specifically on the upper thigh, below the knee joint and around the ankles.
Endovenous laser treatment (ELT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or vascular surgeon.
Sclerotherapy is a procedure used to treat blood vessel malformations and also malformations of the lymphatic system. A medication is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat spider veins, smaller varicose veins, hemorrhoids, and hydroceles.
The small saphenous vein is a relatively large superficial vein of the posterior leg.
The term venous translucence has been used in phlebology since 1996 by surgeon Pedro Fernandes Neto during ambulatory clinical exams in Brazil. His results were published in the annals of the national and international congresses of angiology. Venous translucence is the process of reflective image visualization of veins by light, which reaches up to the superficial venous system. It is a non-invasive method. Since it is a simple, low-cost technique it can be repeated as needed, which is useful in disease-process monitoring. It is a new diagnostic procedure, still undergoing investigation; more analysis is necessary to hone its technical aspects. Venous translucence is based on optical physics. It is caused by the refraction, absorption and reflection of light. The color which is not absorbed is reflected, and is the one that is seen. Therefore, venous translumination is based on the incidence of luminosity on the vein, where part of the light is absorbed and another reflected.
Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
Andrew Nicolaides is a British-Greek Cypriot surgeon, and an expert in cardiovascular disease and stroke prevention.
Ovarian vein syndrome is a rare condition in which dilation of the ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.
Paolo Zamboni is an Italian doctor and scientist. He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.
Perforator veins are so called because they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain.
Ultrasonography of suspected or previously confirmed chronic venous insufficiency of leg veins is a risk-free, non-invasive procedure. It gives information about the anatomy, physiology and pathology of mainly superficial veins. As with heart ultrasound (echocardiography) studies, venous ultrasonography requires an understanding of hemodynamics in order to give useful examination reports. In chronic venous insufficiency, sonographic examination is of most benefit; in confirming varicose disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It has become the reference standard for examining the condition and hemodynamics of the lower limb veins. Particular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and the small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein. These veins are deep veins. Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described, (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as the saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen. The ASV which is often responsible for varicose veins, can be located at the 'alignment sign', where it is seen to align with the femoral vessels.
The Giacomini vein or cranial extension of the small saphenous vein is a communicating vein between the great saphenous vein (GSV) and the small saphenous vein (SSV). It is named after the Italian anatomist Carlo Giacomini (1840–1898). The Giacomini vein courses the posterior thigh as either a trunk projection, or tributary of the SSV. In one study it was found in over two-thirds of limbs. Another study in India found the vein to be present in 92% of those examined. It is located under the superficial fascia and its insufficiency seemed of little importance in the majority of patients with varicose disease, but the use of ultrasonography has highlighted a new significance of this vein. It can be part of a draining variant of the SSV which continues on to reach the GSV at the proximal third of the thigh instead of draining into the popliteal vein. The direction of its flow is usually anterograde but it can be retrograde when this vein acts as a bypass from an insufficient GSV to SSV to call on this last one to collaborate in draining. Many discussions exist about this vein, some of them confusing to a non-expert reader. Insufficiency in the Giacomini vein can present in isolation but is mostly seen together with a GSV insufficiency. It has been shown to be effectively treated either with endovenous laser ablation or by ultrasound guided sclerotherapy.
Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids, and their relative velocity to the probe. By calculating the frequency shift of a particular sample volume, for example, flow in an artery or a jet of blood flow over a heart valve, its speed and direction can be determined and visualized.
CHIVA method is a type of surgery used to treat varicose veins that occur as a result of long term venous insufficiency. The term is a French acronym for Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire.
