Several techniques have been performed for over a century, from the more invasive named "saphenous stripping" up to mini invasives like superficial phlectomies and CHIVA cure.
Stripping consists of the removal of the saphena vein main trunk from the groin down to the ankle. The complications include deep vein thrombosis (5.3%), pulmonary embolism (0.06%), and wound complications including infection (2.2%). For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5-60%. In addition, since stripping removes the saphenous main trunks, they are no longer available for venous by-pass in the future (coronary and/or leg artery vital disease).
CHIVA is the acronym for Conservative and Haemodynamic cure of Incompetent<unk>  veins in Ambulatory patients translated from the French cure "Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire" published in France in 1988.
CHIVA relies on an hemodynamic impairment assessed by data and evidences depicted through ultrasound dynamic venous investigations. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. For example, a<unk>  vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thrombosis) or arterio-venous fistulae...and so the treatment has to be tailored according the hemodynamic feature.
It generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the<unk>  veins from the abnormal flow due to valvular incompetence which dilates them. The patient is dismissed the same day. This method leads to an improvement of the venous function in order to:
Cure the symptoms of venous insufficiency as<unk>  veins, legs swelling, ulcers.
Prevent<unk>  recurrence due to progressive enlargement of collateral veins which replace and overtake the destroyed veins: CHIVA vs Stripping:<unk>  recurrence divided by 2 to 5 at 10 years.
Preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery vital by-pass which increases with ageing.
To be achieved properly, CHIVA method needs a comprehensive knowledge of both hemodynamics and ultrasound venous investigation.
Ambulatory phlebectomy
Laser vein removal
Vein ligation
Varicose veins surgery
Varicose veins medical therapy
Buerger's disease surgery
Diabetic foot surgery
Deep vein thrombosis surgery
Suppurative thrombophlebitis surgery
Peripheral arterial disease surgery
Portal vein thrombosis surgery