Claude Franceschi

Claude Franceschi (born October 12, 1942) is an angiologist French MD.

Claude Franceschi
Born (1942-10-12) October 12, 1942
Calenzana, Corsica
OccupationInternal medicine
Hemodynamics
Notable work
Doppler Ultrasound and arteries, veins, lymphatic diseases

Background

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]

Works

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.

  • In 1977, he published the very first book in the world on Vascular Doppler Exploration (Vascular investigation by Doppler ultrasound) [5] then translated into Italian and Spanish, in which he describes the hemodynamic principles and their expression in terms of Doppler signal.[6] This data remains the undisputed reference for the stenosis quantification and a quality diagnostic.[7] In particular, he worked on the criteria of arterial stenosis of limbs and carotids, Carotid pre-thrombosis, the Pressure-Perfusion Index (Franceschi Index),[8] the Carotid Ratio and the exploration of the Circle of Willis.
  • In 1978, he published the first observations of carotid plaque regression.[9]
  • In 1980 he described the Fistula Flow Ratio (French 'RDF') to assess the flow of arteriovenous fistulas, especially in renal dialysis.[10]
  • In 1981, he invented an interface process [11] which allows for the first time the visualization of supra-aortic arteries by B-Mode echography.[12] A Doppler method for exploring the compensatory ways of the cerebro-cervical vasculature was published the same year.
  • In 1986, he published the first book of vascular ultrasound imaging Précis d'échotomographie vasculaire [13] translated into Italian: « Compendio di ecotomografia vascolare »
  • In 1988, he published the book La cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire: CHIVA [14] also translated into English and Italian, where he offers a new approach to the physiology of deep and superficial venous circulation, introducing new concepts such as « Dynamic hydrostatic pressure fractioning », the veno-venous shunts and vicarious evolution of varices.[15][16]

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.[17] 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.[18][19][20][21][22][23][24][25] 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), .[26]

  • In 1997, he describes the dynamic index of venous reflux (DRI), the Paranà Maneuver [27] and the diagnosis of the plantar vein thrombosis by Duplex Ultrasound.[28]
  • In 2010, he published the book Principles of venous hemodynamics detailing hemodynamic concepts of the venous insufficiency and their diagnostic and therapeutic consequences.[29]

References
  1. Study of blood flowing vessels by ultrasonics 1959
  2. Among which: Réunion de chirurgie vasculaire Hôpital Saint Joseph Vélocimétrie par Ecographie Doppler, Apr. 29–30 April 1976 Marseille, France; Fourth Réunion de chirurgie vasculaire Saint Joseph Hospital, Oct. 29-30 1979 Marseille, France; Corso di alta formazione Dalla diagnosi clinica al trattamento delle malattie vascolari Oct. 5 2006, Bari Italy; Primeras jornadas internacionales de eci-doppler vascular. Colegio de medicos de Rosario, Nov. 16-17 2007, Roasario, Argentina; College Français de Pathologie Vasculaire, Mar. 2008, Paris, France; Congrès national de l'Association des Internistes Libéraux Algériens, Oct. 29-30 2009,.Algiers Algeria; First American Hemodynamics Conference, Feb. 7-9 2009 Phoenix Arizona USA; Controversies and updates in vascular surgery, Jan. 22-23 2010, Paris, France; L’Arte della Compressione Ferrara University, Nov. 30, Dec. 1st 2012. Motegrotto Terme Italy; Centre Franco-ukrainien de formation en échographie, chronic venous insufficiency, Apr. 28 2013, Kiev, Ukraine; Charing Cross International Symposium Varicose vein treatment consensus update Apr. 5–8 April 2014 London UK; 26th World Congress of the International Union of Angiology. CHIVA: principles and clinical outcomes, Dadon Aug. 10-14 2014, Sydney, Australia
  3. C.Franceschi, L’Investigation vasculaire par ultrasonographie Doppler, Masson Editeur Paris. 1977
  4. Definition of the venous hemodynamics parameters and concepts
  5. C.Franceschi. L’Investigation vasculaire par ultrasonographie Doppler, Masson Editeur Paris 1977
  6. https://copy.com/Pfx1OChnfsgK
  7. F.Luizy. Le Doppler continu, historique. EDV Echodoppler Vasculaire Avril 2009 N°1
  8. C. Franceschi (indice de) Les Noms en Médecine Vasculaire. Les noms en médecine vasculaire - Congrès relation Beaufour Ipsen, 2002 https://copy.com/iA1CtMZDS6tn
  9. https://copy.com/Rs8zuqzZ2ivS
  10. Franceschi, C. Luizy F.; Vadrot, D. (1990). "L'effet Doppler, 2ème partie : notions pratiques sur le recueil du signal doppler". Rev. Im. Med. 2: 55–57.
  11. (INPI registration N° 81 22294) https://copy.com/keb1YUZa6MGa
  12. Première médicale « Une artériographie non sanglante des troncs supra-aortiques » MCV 1981 https://copy.com/taYNmiwJFK6d
  13. C. FRANCESCHI, G.FRANCO, F.LUIZY, M.TANITTE. PRÉCIS D’ECHOTOMOGRAPHIE VASCULAIRE. Vigot, Paris, 1986
  14. C.Franceschi. La cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire CHIVA Editions de L’Armançon. Precy sous Thil France
  15. C.FRANCESCHI. Dynamic fractionizing of hydrostatic pressure, close and open shunt, vicarious varicose evolution: how have these concepts made the treatment of varices evolve? Éditions phlébologiques françaises,vol 56,n°1/2003. P.6
  16. C.FRANCESCHI Insuffisance veineuse et fractionnement dynamique de la colonne de pression hydrostatique. Venous insufficiency and dynamic fractionating of the hydrostatic pressure column STV. Sang thrombose vaisseaux 2001, 13, 307 – 310 STV. Sang thrombose vaisseaux A. 2001, vol. 13, n° 5, pp. 307-310
  17. Link Capital veineux et patient arthéromateux
  18. Carandina, S; Mari, C; De Palma, M; Marcellino, MG; Cisno, C; Legnaro, A; et al. (2008). "Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a long term randomised trial". European Journal of Vascular and Endovascular Surgery. 35 (2): 230–7. doi:10.1016/j.ejvs.2007.09.011. PMID 17964822.
  19. Parés JO, Juan J, Tellez R, Mata A, Moreno C, Quer FX,et l. Varicose vein surgery: stripping versus the CHIVA Method: a randomized controlled trial. Annals of Surgery 2010;251(4):624–31.
  20. Iborra-Ortega E, Barjau-Urrea E, Vila-Coll R, Ballon-Carazas H, Cairols-Castellote MA. Comparative study oftwo surgical techniques in the treatment of varicose veins of the lower extremities: results after five years of followup. Estudio comparativo de dos técnicas quirúrgicas en el tratamiento de las varices de las extremidades inferiores: resultados tras cinco años de seguimiento]. Angiología 2006; 58(6):459–68.
  21. P.Zamboni et al.: Minimally Invasive Surgical management of primary venous Ulcer vs. Compression. Eur J vasc Endovasc Surg 00,1 6 (2003)
  22. Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA Method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews 2012; Issue 2. Art. No.: CD009648. doi:10.1002/14651858.CD009648
  23. Hemodynamic classification and CHIVA treatment of varicose veins in lower extremities (VVLE) Department of Vascular Surgery, Xinhua Hospital, China
  24. Marta Zmudzinski, BSc, Pierre Malo, MD, FCSP, Christine Hall, MD, FRCPC, Allen Hayashi, MD, FRCSC CHIVA, A prospective study of a vein sparing technique for the management of varicose vein disease The American Journal of Surgery - 21 March 2017
  25. Rutherford's Vascular Surgery and Endovascular Therapy; Edition 9, section 23 "Chronic Venous Disorders" "Saphenous Sparing Operations" page 2030
  26. Passariello, F.; Gammuto, P. (2014). "Office based CHIVA: A conceptual variation of CHIVA. The OB CHIVA survey". Reviews in Vascular Medicine. 2 (4): 123–126. doi:10.1016/j.rvm.2014.07.003.
  27. Franceschi, C. (May 1997). "[Measures and interpretation of venous flow in stress tests. Manual compression and Parana manoeuver. Dynamic reflux index and Pstakis index]". J Mal Vasc. 22 (2): 91–5. PMID 9480337.
  28. Franceschi C. Thrombophlébite des veines plantaires. Act Vasc Int 1997 ; 47 : 29-30
  29. C.Franceschi, P.Zamboni Principles of Venous Hemodynamics. Novapublishers.com. New York City, 2010
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