Surgical treatment of varicose veins with the CHIVA method

Abstract

In 1988, just after the upcoming of duplex ultrasound, the French vascular surgeon and angiologist Claude Franceschi developed a hemodynamic strategy to treat venous insufficiency on ambulatory patients. He gave the treatment the name of the French acronym. CHIVA.

The strategy is based on the preservation of draining pathways, specially the saphenous veins. The first step consists in an analysis of the recirculation pathway, which was classified by Franceschi into veno-venous shunts, depending on the reflux source and the drainage. Each shunt type requires a special way of treatment to achieve the best result and to avoid superficial thrombosis. The method has found its place in the treatment options in Spain and Italy, actually it is becoming popular in CHINA and the European Eastern Countries, especially in countries, where duplex is common in phlebology diagnostics and financial resources are small.

The method can be applied in each degree of venous illness and chronic venous insufficiency, excepting post-thrombotic saphenous trunks, which might not need to be preserved. A meta-analysis in a Cochrane review certifies that CHIVA produces less side effects and long term recidives with the same immediate results as stripping.

New techniques, like endoluminal (heat) procedures and ultrasound guided foam sklerotherapy help to make the procedure even less invasive in the future.

Key words

chronic venous insufficiency - reflux in saphenous vein - vein preservation - CHIVA

• Literatur / References

• 1 Hach W, Hach-Wunderle V. Die Wandlung der theoretischen Konzepte in der Chirurgie der Stammvarikose vom 19. Jahrhundert bis in die Gegenwart. Gefäßchirurgie 2001; 6: 111-118
• 2 Franceschi C. Théorie et Pratique de la Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire, Précy-sous-Thil 1988 (Armançon).
• 3 Zamboni P, Mendoza E, Gianesini S. Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer; 2018
• 4 Caggiati A, Bergan JJ, Gloviczki P. et al. Nomenclature of the veins of the lower limbs: An international interdisciplinary consensus statement. J Vasc Surg 2002; 36: 416-422
• 5 Mendoza E. CHIVA, ein Handbuch. Arrien Verlag; 2002
• 6 Zamboni P, Gianesini S, Menegatti E. et al. Great saphenous varicose vein surgery without saphenofemoral junction disconnection. British Journal of Surgery 2010; 97: 820-825
• 7 Delfrate R, Bricchi M, Franceschi C. et al. Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins. Veins and Lymphatics 2014; 3: 19-22
• 8 Mendoza E, Amsler F. CHIVA with endoluminal procedures: LASER versus VNUS – treatment of the saphenofemoral junction. Phlebologie 2017; 46: 5-12
• 9 Franceschi C, Cappelli M, Ermini S. et al. CHIVA: hemodynamic concept, strategy and results. Int Angiol 2016; 35 (Suppl. 01) 8-30 Epub 2015; 5. Review
• 10 Gianesini S, Delfrate R, Cappelli M. et al. CHIVA Surgical Tips and Tricks. in: Zamboni P, Mendoza E, Gianesini S. (Eds) Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer; 2018
• 11 Carandina S, Mari C, De Palma M. et al. Varicose vein stripping vs. haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg 2008; 35: 230-237
• 12 Parés JO, Juan J, Tellez R. et al. Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial. Ann Surg 2010; 251: 624-631
• 13 Mendoza E. Diameter reduction of the great saphenous vein and the common femoral vein after CHIVA Long-term results. Phlebologie 2013; 42: 65-69
• 14 Mendoza E, Cappelli M. Sclerotherapy technique in CHIVA Strategy. Phlebology 2017; 46: 5-12
• 15 Mendoza E. Duplexsonographie der oberflächlichen Beinvenen. Springer; 2013
• 16 Delfrate R, Mendoza E. Minimally Invasive Surgical Treatment of Pelvic Leak Points. in: Zamboni P, Mendoza E, Gianesini S. (Eds) Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer; 2018
• 17 Iborra-Ortega E, Barjau-Urrea E, Vila-Coll R. et al. 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 (Suppl. 06) 459-468
• 18 Bellmunt-Montoya S, Escribano JM, Dilme J. et al. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2013; 3: CD009648 doi: 10.1002/14651858.CD009648.pub2. Review. Update in: Cochrane Database Syst Rev. 2015:CD009648
• 19 Mendoza E, Berger V, Zollmann C. et al. (Calibre reduction of great saphenous vein and common femoral vein after CHIVA) Kaliberreduktion der V. saphena magna und der V. femoralis communis nach CHIVA. Phlebologie 2011; 40 (Suppl. 02) 73-78
• 20 Mendoza E, Menegatti E. CHIVA Results from literature in. in: Zamboni P, Mendoza E, Gianesini S. (Eds) Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer; 2018
• 21 Zollmann P, Zollmann C, Zollmann P. et al. Determining the origin of superficial venous reflux in the groin with duplex ultrasound and implications for varicose vein surgery. JVS V & L 2017; 5 (Suppl. 01) 82-86
• 22 Mendoza E. Provokationsmanöver zur duplexsonographischen Diagnostik der Varikose. Phlebologie 2013; 42 (Suppl. 06) 357-362
• 23 Mendoza E. Duplex-Untersuchung von Perforansvenen. Phlebologie 2014; 43: 206-209