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Claude Franceschi

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Claude Franceschi
Born (1942-10-12) October 12, 1942 (age 82)
Calenzana, Corsica
Occupation(s)Internal medicine
Hemodynamics
Notable workDoppler Ultrasound and arteries, veins, lymphatic diseases

Claude Franceschi (born October 12, 1942) is an angiologist French MD. He is considered as a pioneer of Doppler ultrasound vascular investigation. His works are recognized worldwide, bringing a significant contribution to hemodynamics, pathophysiology, diagnosis and treatment of diseases of the arteries, veins and lymphatics.

In the 1980s, he revolutionized the concept of venous disease with a new hemodynamic approach that led, instead of veins ablation, to conservative and hemodynamic ambulatory treatment of venous insufficiency (CHIVA).

Biography

Claude Franceschi studied at the Faculté de Medicine de Paris in 1960 and especially neuropsychiatry at the Salpêtrière (Paris) with Dr. Cyril Coupernik, and in Melun Psychiatric Hospital with Dr. Tosquelles. His interest in the cerebral circulation led him to work in the neurology laboratory of Dr. Jaquinot (Salpêtrière hospital) where he used one of the first Doppler ultrasonic machines (Delalande Electronique).

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 decipher more deeply and in detail 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 » (Eng. Vascular Doppler ultrasound investigation) in 1977.[3]

Works

Veins and arteries

Claude Franceschi's major contribution 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] Among this data, one will note more particularly 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]

These concepts have since radically changed the diagnostic and therapeutic approach of varicose veins, ulcers and venous edema. 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 over conventional removal (stripping) of the saphenous vein.[18][19][20][21][22][23][24] A retrospective study CHIVA vs Laser shows similar results.[25] Another retrospective study shows the need for specific training for phlebologists and surgeons to successfully perform CHIVA [26] The acceptance of the CHIVA technique as a treatment of venous insufficiency is not linked to its quality, now widely recognized. See The CHIVA technique (Guidelines) and Results with Chiva (Guidelines), but rather to health care insurance reimbursement rates.[27]

  • In 1991, he proposed a new pathophysiology of the hemorrhoid disease. According to this theory, the inferior rectal veins are not the cause of the hemorrhoids disease but instead, the victims of what he called the Fourth factor. The latter would be the physical and chemical aggression of the mucosa of the anal canal. According to this hypothesis he invented a device designed for preventing and treating the disease both by facilitating the bowel evacuation and removing its debris out of the anal canal. The device is made of an external water spray issuing a jet able to penetrate water into the channel up to the lower rectum, without any contact with the anus.[28] Its effectiveness was validated by an hospital randomized study [29][30][31]
  • In 1994, he provides an hemodynamic classification of vascular malformations.[32] The same year he designed a prosthetic venous valve introduced via a catheter.[33]
  • In 1997, he describes the dynamic index of venous reflux (DRI), the Paranà Maneuver [34] and the diagnosis of the plantar vein thrombosis by Duplex Ultrasound.[35]
  • In 2005 using Duplex Ultrasound he found and defined the anatomy of perineal, inguinal and clitoral venous leaking points, responsible for a significant proportion of varicose veins and other venous disorders of women.[36] The same year he also designed a surgical instrument for fast and easy control of bleeding vascular wounds: the Franceschi’s Hemostator.[37]
  • In 2006, he advocated a mixture of Vaseline 40% + sugar 60% to clean out and sanitize wounds, including leg ulcers. This compound has the advantage of low cost, single weekly application, and the exemption from curettage. The results strongly suggest that this process is equivalent, or likely more effective than the most recent local dressings. The first results are being published.
  • In 2010, he published the book Principles of venous hemodynamics detailing hemodynamic concepts of the venous insufficiency and their diagnostic and therapeutic consequences.[38]

Lymphatics

Patents

  • 1981: Device enabling the visualization of superficial vessels and organs: « Dispositif pour la transmission d’ultrasons pour une sonde d’echotomographie » (a device for ultrasound transmission for an Ultrasound probe) [41]
  • 1982: Mobile Ultrasound Cup for breast exploration [42]
  • 1983: Device for Doppler guided puncture of vessels [43]
  • 1983: Filter placed in the inferior vena cava, to prevent pulmonary embolism [44]
  • 1990: Chair-bed stretcher convertible by only shifting the center of gravity of the patient without motorization [45]
  • 1990: Remote water injection process into the anal canal (without body contact) [46]
  • 1994: Prosthetic Valve for blood vessels [47]
  • 2005: Device to stop and control the venous and arterial hemorrhage [48]

Movie

Education film award: Entretiens de Bichat 1977 « Le Doppler Vasculaire en pratique courante » (Vascular Doppler in common practice).[49]

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.
  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. ^ [1] 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. ^ Chan. "Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins (2011)". World Journal of Surgery. 35 (7): 1679–1686. doi:10.1007/s00268-011-1093-8.
  26. ^ Milone M, Salvatore G, Maietta P, Sosa Fernandez LM, Milone Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon's experience. F. G Chir. 2011 Nov-Dec;32(11-12):460-3
  27. ^ "Office based CHIVA: A conceptual variation of CHIVA. The OB CHIVA survey". Reviews in Vascular Medicine. 2: 123–126. doi:10.1016/j.rvm.2014.07.003.
  28. ^ INPI Patent; National Registration Nr. 07624 90
  29. ^ Hôpital d’Instruction des Armées Bégin Vincennes Etude IJ 301 (Accord du CCPPRB Pitié Salpétrière Novembre 1993)
  30. ^ Évaluation de l'efficacité et de la tolérance d'un nouveau procédé de traitement des hémorroïdes symptomatiques
  31. ^ C.Franceschi. Hémorroïdes : maladie des veines ou d’un quatrième facteur. Essai d’analyse physiopathologique. Conséquences thérapeutiques. Actualités Médicales Internationales. Angiologie (8), n° 145, décembre 1991 https://copy.com/xalDrOJfWXlU
  32. ^ https://www.angio.info/1994%20malformations%20vasculaires.%20%20Claude%20Franceschi.pdf
  33. ^ (INPI Patent Nr. 94 15391) https://www.angio.info/IMG_20140822_150318.jpg
  34. ^ "[Measures and interpretation of venous flow in stress tests. Manual compression and Parana manoeuver. Dynamic reflux index and Pstakis index]". J Mal Vasc. 22: 91–5. May 1997. PMID 9480337.
  35. ^ Franceschi C. Thrombophlébite des veines plantaires. Act Vasc Int 1997 ; 47 : 29-30
  36. ^ C.Franceschi, A.Bahnini. Treatment of lower extremity venous insufficiency due to pelvic leak points in women, Annals of Vascular surgery 2005;19;1-6
  37. ^ Hemostator de Franceschi INPI Patent Nr 0509671: 22 sept 2005 manufactured by Landanger France https://www.angio.info/Hemostator.pdf
  38. ^ C.Franceschi, P.Zamboni Principles of Venous Hemodynamics. Novapublishers.com. New York City, 2010
  39. ^ Pathologie du canal thoracique: intérêt de l'échographie-Doppler. STV. Sang thrombose vaisseaux. 2004, Vol : 16, Num : 1, p. : 61 – 63
  40. ^ The recurrent cervical swelling syndrome. C Franceschi et al., DOI: 10.1258/phleb.2011.011006. Phlebology 2011;00:1–3
  41. ^ (INPI National Registration Nr.: 22294 81) https://copy.com/keb1YUZa6MGa
  42. ^ « Cuvette mobile d’échographie » (INPI National Registration No.: 16663 82) https://copy.com/h2EfPu9VtrRb
  43. ^ « Procédé de ponction des vaisseaux sanguins associant un propulseur d’aiguille à un ultrasonographe Doppler qui le guide » (Blood vessels puncture process involving a Doppler guided needle thruster). INPI National Registration No. 18794 83
  44. ^ « Filtre contre les embolies et son procédé de mise en place » (Filter against embolism and its introduction process). INPI National Registration No. 03315 83 https://copy.com/1NySXdQXePpM
  45. ^ « Fauteuil-lit-brancard transformable par le seul déplacement du centre de gravité du patient sans motorisation » INPI National Registration No. 90 13220, https://copy.com/HNcaVqoYpBiK
  46. ^ « Dispositif d’hygiène et de traitement » (Hygiene and treatment device) INPI National Registration N° 90 07624
  47. ^ « Valve artificielle pour vaisseaux sanguins » (INPI No. 94 15391)
  48. ^ « Un dispositif pour arrêter et contrôler les hemorragies d’oigine veineuse et arterielle » (INPI Nr 05 09671) https://copy.com/arLO0fydgvxU
  49. ^ https://copy.com/UVHlGZNYIzFy
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