Abstract
In this article, the CHIVA and ASVAL methods are assessed from the hemodynamic point
of view. The CHIVA method comprises complicated, unusual terminology and new perceptions,
such as closed and open shunts, fractionation of the hydrostatic pressure, subdivision
of the venous network. The principal part of the CHIVA theory is the drainage of venous
blood from the thigh saphenous system into the deep lower leg veins through the preserved
saphenous trunk after high ligation at the saphenofemoral junction, which is considered
as a beneficial, physiological phenomenon. In reality, this is recurrent reflux producing
ambulatory venous hypertension. The main impact of the CHIVA procedure is the elimination
of the saphenous reflux by high ligation at the saphenofemoral junction; thus it can
be presumed that the CHIVA procedure yields similar results like the crossectomy.
The ASVAL procedure is de facto the modification of the old Madelung method that was
the prevalent surgical procedure before the Trendelenburg era in the 19th century.
The results after ASVAL were not checked by plethysmography; there is a good case
to suppose that the results after the ASVAL method would comply with those after sclerotherapy.
Keywords
reflux - varicose veins - CHIVA - ASVAL - hemodynamics - venous hemodynamics
