The Doppler Revolution: From Auscultation to Quantification

Before Claude Franceschi’s contributions, vascular exploration relied primarily on clinical examination and invasive angiography. In 1977, he published the world’s first book dedicated to Doppler vascular exploration. This work laid the groundwork for modern hemodynamics by establishing strict correlations between the acoustic and visual Doppler signals and the pathophysiological states of the vessels.

Innovation in Arterial Diagnosis

The data published by Franceschi in the late 1970s remains an indisputable reference today for the quantification of arterial stenosis. His research defined precise criteria for diagnosing carotid and lower limb pathologies, introducing standardized measurement tools.

Tool / Index	Publication Date	Clinical Application
Pressure-Perfusion Index (Franceschi Index)	1977	Evaluation of peripheral perfusion and ischemia severity.
Carotid Ratio	1977	Precise quantification of the degree of internal carotid artery stenosis.
Fistula Flow Ratio (RDF)	1980	Evaluation of blood flow in arteriovenous fistulas, crucial for dialysis patients.
Circle of Willis Exploration	1977	Evaluation of cerebral collateral circulation and intracranial hemodynamics.

 

In 1978, he challenged the dogmas of the time by publishing the first documented observations of carotid plaque regression, suggesting that atherosclerosis might not be purely progressive but a dynamic, influenceable process. His capacity for innovation was also evident technically: in 1981, he filed a patent (INPI No: 81 22294) for an interface process that allowed, for the first time, the visualization of the carotids and supra-aortic trunks via ultrasound, marking the dawn of modern duplex Doppler.

The CHIVA Treatment: An Epistemological Break in Phlebology

Claude Franceschi’s most emblematic innovation remains the development, in 1988, of the Conservative and Hemodynamic Treatment of Venous Insufficiency in Outpatients (CHIVA). This concept offers a radical alternative to traditional ablative methods such as stripping or, more recently, thermal treatments like laser or radiofrequency.

Fundamental Hemodynamic Principles

The CHIVA method is based on the idea that varicose veins are not the disease itself, but the symptom of a hemodynamic disorder characterized by pressure and flow overload in the superficial venous system. Instead of destroying the dilated veins, the strategy aims to restore physiological circulation by correcting reflux points identified through precise duplex Doppler mapping.

The physical foundation of this approach lies in managing transmural pressure (), defined as the difference between the internal hydrostatic pressure of the vein () and the external tissue pressure ():

In venous insufficiency, valvular dysfunction leads to an increase in  due to the weight of the blood column, causing the venous wall to dilate. The CHIVA treatment aims to fractionate this pressure column through strategic ligations, returning the veins to a normal caliber without removing them.

Comparative Advantages of the Conservative Strategy

Analysis of clinical results and randomized studies highlights several major benefits of the CHIVA method compared to ablative techniques.

Feature	Stripping / Thermal Ablation	CHIVA Treatment
Vein Destruction	Systematic (the vein is removed or burned).	None (the vein is preserved in place).
Anesthesia	Often general, spinal, or tumescent.	Local only.
Pain and Hematomas	Significant in the immediate postoperative period.	Very low, immediate return to activity.
Nerve Damage	Real risk (saphenous/sural nerve) due to heat or surgery.	Near-zero risk as the conscious patient can alert the surgeon.
Future Utility	Irreversible loss of the graft for potential bypass.	Saphenous vein preserved for cardiac or arterial bypass.
Recurrence Rate	Often linked to neovascularization induced by trauma.	Generally lower in the long term according to some studies.

 

The argument for saphenous preservation is particularly crucial. Franceschi insists that even in a varicose patient, the saphenous vein almost always remains usable for vital bypasses (coronary or lower limbs) if it has not been destroyed.

Diversification of Research and Peripheral Innovations

Beyond lower limb phlebology, Claude Franceschi has applied his hemodynamic principles to various medical fields, proposing solutions that are often iconoclastic but scientifically grounded.

Hemorrhoidal Disease and the “Fourth Factor”

In 1991, he proposed a new approach to hemorrhoidal pathology, suggesting that the veins are not the original culprits but the victims of physical and chemical aggression on the anal canal mucosa, a concept he calls the “Fourth Factor”. This theory led him to design a preventive treatment based on hydro-mechanical hygiene via a specific external showerhead, the effectiveness of which was validated by a randomized hospital study.

Vascular Malformations and the Lymphatic System

In 1994, he developed a hemodynamic classification of vascular malformations, allowing for better therapeutic choices between surgery, embolization, or observation. Simultaneously, he designed an artificial venous valve introduced via catheter (Patent INPI no 94 15391), anticipating current research on endovascular valve substitutes.

His work on the lymphatic system led him, in 2004, to identify a new pathology: intermittent obstruction of the terminal thoracic duct. Using duplex Doppler at the neck, he was able to diagnose this rare but treatable cause of unexplained abdominal or thoracic chylous effusions.

Innovations in Wound Care and Hemostasis

Dr. Franceschi has also contributed to the development of pragmatic clinical tools and protocols:

• Franceschi Hemostator (2005): A surgical instrument designed to quickly and easily control accidental or operative vascular wounds.
• Vaseline-Sugar Mixture (2006): For treating leg ulcers, he advocates a mixture of 40% vaseline and 60% sugar. This extremely low-cost compound uses the osmotic properties of sugar to sanitize the wound and promote healing without the need for painful debridement.

Teaching, International Reach, and Advisory Activities

The transmission of knowledge holds a central place in Claude Franceschi’s career. His influence extends well beyond French borders, particularly in Italy and Latin America.

Academic Engagement and International Schools

He has directed and continues to participate in numerous specialized teaching structures :

• Franco-Argentine School of Vascular Duplex Doppler: Director of this structure that trains practitioners in hemodynamic mapping techniques in South America.
• University Paris VII and University of Perugia: “Free Teacher” (Lecturer) involved in high-specialty modules.
• CHU Pitié-Salpêtrière: Instructor within the University Diploma (DU) of angiology and vascular duplex Doppler.

He also serves as a medical consultant for renowned institutions such as the Marie

Thérèse Center (St. Joseph Hospital Foundation in Paris) and the Casa di Cura delle Figlie di San Camillo in Cremona, Italy. Furthermore, his expertise is sought by the industry, notably as a scientific advisor for Esaote France and Esaote Biomedica, contributing to the design of imaging tools he uses daily.

Learned Societies and Peer Recognition

Dr. Franceschi is an active member of several leading professional organizations :

• Collège Français de Pathologie Vasculaire (CFPV).
• Société Française de Chirurgie Vasculaire (SFCV).
• International Foundation of Angiology (I.F.A).
• European CHIVA Society and Italian CHIVA Operator Society (SIOC).

He has been awarded honorary membership in several national phlebology societies, including those in France, Germany, and the Czech Republic. In Italy, his influence is such that he is considered the godfather of “modern phlebology,” having moved the discipline from the era of surgical excision to that of image-guided hemodynamic correction.

Scientific Production and Major Publications

Claude Franceschi’s intellectual output is prolific, totaling more than 170 publications and several reference books translated into multiple languages.

Selective List of Reference Works

Book Title	Publisher / Year	Primary Theme
Investigation Vasculaire par Ultrasonographie Doppler	Masson, 1977	Founding manual of the Doppler technique.
Précis d’Echotomographie Vasculaire	Vigot, 1986	First synthesis of vascular imaging.
La Cure CHIVA (Theory and Practice)	L’Armançon, 1988	Presentation of the saphenouspreserving concept.
Principles of Venous Hemodynamics	Nova Science, 2009	Advanced theoretical synthesis of venous physiology.
Book Title	Publisher / Year	Primary Theme
Venous Insufficiency of the Pelvis and Lower Extremities	2022 (Rev.)	Updated concepts on pelvic reflux.

 

His recent publications (2023-2025) demonstrate intact scientific vitality, with an emphasis on saphenous preservation in the face of current thermal ablation trends and the understanding of groin recurrences (cavernomas), which he explains through coherent hemodynamic models rather than technical errors.

Current Affairs and Research Perspectives (2024-2025)

At over 80 years old, Claude Franceschi continues to publish and present his work at international congresses. His current research focuses on the long-term validation (over 30 years) of the CHIVA method, demonstrating not only its clinical efficacy but also its economic superiority as an office-based procedure performed under local anesthesia.

He is also working on complex topics such as:

• Pelvic Venous Insufficiency: An often overlooked area where he applies his concepts of shunts and perineal, inguinal, and clitoral escape points.
• Deep Competitive Reflux: A new diagnostic entity identifying conditions where a dilated saphenous vein should not be treated because it participates in compensatory bypass flow.
• Overtreatment of May-Thurner Syndrome: A critique of systematic venous stenting in cases where the hemodynamic rationale does not justify it.

Conclusion on the Legacy of Claude Franceschi

Claude Franceschi’s curriculum is that of a clinician-researcher who combined the rigor of physical sciences with medical intuition to transform an entire specialty. By introducing quantification to Doppler diagnosis and proposing the first coherent and conservative alternative to venous excision surgery, he has not only improved patient comfort and safety but also initiated a crucial ethical debate on the preservation of human venous capital.

His approach, initially perceived as iconoclastic, is now supported by meta-analyses and long-term studies confirming the validity of the CHIVA model. As an expert consultant at St. Joseph Hospital and an international trainer, he continues to shape the thinking of future generations of angiologists and vascular surgeons, reminding them that the best surgery is that which respects physiology rather than suppressing it.