Claude Franceschi

Claude Franceschi
Born	(1942-10-12) October 12, 1942 Calenzana, Corsica
Occupation	Internal medicine Hemodynamics
Notable work	Doppler 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).

He further proposed a new theory regarding the hemorrhoid disease. For him, the main cause of this pathology is not due to the hemorrhoid veins but to a "fourth factor" i.e. the irritation of the anal canal. Consequently, he offered its treatment and prevention by a simple hygiene process.

Finally, he discovered through Doppler ultrasound a disease of the lymphatic system related to the intermittent obstruction of the cervical thoracic duct The recurrent cervical swelling syndrome.

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).

However, information provided by this noninvasive process remained poor and could not compete at that time with aggressive and dangerous methods such as angiography.

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]

In 1975, he worked at the Henry Dunant Hospital (Paris) with Prof. Jean Michel Cormier, pioneer of vascular surgery and then followed him at Saint Joseph Hospital (Paris). The latter decisively supported Claude Franceschi’s research and eventually would be the first to recognize and defend the diagnostic value of its results. This initial work specifically focused on the carotid arteries and then spread to all vessels.

As the Scientific Advisor of ESAOTE Company, Claude Franceschi participated in technological and ergonomic advances of Doppler ultrasound machines. In addition, he produced invention patents to improve the diagnosis and care of patients.

Since 1978, Claude Franceschi taught Doppler Ultrasound for the Angiology Degree (University Paris IV and Paris VII). He also taught in many other countries, including Algeria, Argentina, Chile, Italy, Spain, Tunisia and United States. He was invited in many international congresses and courses and published many books and articles in France and abroad.

He is currently a consultant to the Fondation Hopital Saint Joseph Centre Marie Therese Paris (France) and Casa di Cura di San Camillo delle Figlie Cremona (Italy), and teaches the Diplome d’Angiologie and Doppler Vasculaire (University of CHU Pité-Salpétrière Paris).

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]} A retrospective study CHIVA vs Laser shows similar results.^[23] Another retrospective study shows the need for specific training for phlebologists and surgeons to successfully perform CHIVA ^[24] 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.^[25]

• 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.^[26] Its effectiveness was validated by an hospital randomized study ^[27][28][29]
• In 1994, he provides an hemodynamic classification of vascular malformations.^[30] The same year he designed a prosthetic venous valve introduced via a catheter.^[31]
• In 1997, he describes the dynamic index of venous reflux (DRI), the Paranà Maneuver ^[32] and the diagnosis of the plantar vein thrombosis by Duplex Ultrasound.^[33]
• 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.^[34] The same year he also designed a surgical instrument for fast and easy control of bleeding vascular wounds: the Franceschi’s Hemostator.^[35]
• 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.^[36]

Lymphatics

• In 2004 he identified a new disease: The intermittent obstruction of the thoracic duct end. He diagnosed it by Duplex Ultrasound Scan in patients with neck swelling and chyle leak in the chest and abdomen (ascites),^[37][38]

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) ^[39]
• 1982: Mobile Ultrasound Cup for breast exploration ^[40]
• 1983: Device for Doppler guided puncture of vessels ^[41]
• 1983: Filter placed in the inferior vena cava, to prevent pulmonary embolism ^[42]
• 1990: Chair-bed stretcher convertible by only shifting the center of gravity of the patient without motorization ^[43]
• 1990: Remote water injection process into the anal canal (without body contact) ^[44]
• 1994: Prosthetic Valve for blood vessels ^[45]
• 2005: Device to stop and control the venous and arterial hemorrhage ^[46]

Movie

Education film award: Entretiens de Bichat 1977 « Le Doppler Vasculaire en pratique courante » (Vascular Doppler in common practice).^[47]

References