The CHIVA method is a procedure for the treatment of varicose veins. Varicose veins are a widespread problem and are now considered a common disease. They often restrict the quality of life of those affected. In severe cases, surgical intervention may be necessary to treat them. Various options are available for this purpose, including the CHIVA procedure.
Below you will find further information on this procedure and selected CHIVA specialists.
The abbreviation CHIVA stands for the French term "Cure Conservatrice et Hemodynamique de I'Insuffisance Veineuse en Ambulatoire". Translated into German, this means "blood flow-correcting outpatient therapy for varicose veins".
The procedure was developed in France in the 1980s by the physician Claude Franceschi. In France, the CHIVA method is one of the most common treatment methods for varicose veins. In Germany, however, it is used less frequently.
The CHIVAmethod is a gentle treatment for varicose veins @ Yashkin Ilya /AdobeStock
CHIVA is not only a surgical method, but also a treatment approach that is carried out in several steps. Components of the method are
The CHIVA procedure is a method of specifically preventing the return flow of venous blood in pathologically dilated varicose veins without having to remove the entire vein. This procedure is considered useful if the vein is to be preserved as part of varicose vein therapy. In contrast to stripping, which is one of the classic surgical methods of varicose vein treatment, the trunk vein is left in the patient's leg. In this way, the blood outflow remains intact and can also serve as a bypass if required. According to studies, varicose veins are less likely to recur with the CHIVA method than after truncal vein removal.
In addition, CHIVA can also be performed after a previous Babcock operation (Babcock vein stripping), thrombosis in the deep veins of the leg and sclerotherapy, whereby the procedure achieves significant relief.
The CHIVA method is used when typical varicose vein symptoms such as discoloration of the skin, leg swelling or even open legs are present. The surgical procedure eliminates these symptoms by precisely identifying the vein flow and interrupting the pathological circulation at specific points.
Before the procedure can take place, a precise ultrasound examination is carried out. This creates a kind of map of the superficial leg vein system. The venous flows of the veins, which are often interconnected, are also recorded. This makes it possible to determine where the interruption of the venous flow can take place. The affected areas are marked on the skin with a waterproof pen.
The patient is usually given a local anaesthetic before the operation. If greater effort is required or if the patient expressly requests it, a general anesthetic can also be administered. Normally, the skin incisions on the lateral branches of the leg are so small that they are more noticeable as stitches. The varicose veins can then be gently pulled out with small venous hooks and tied off with a surgical thread. The varicose veins are then released and sunk under the skin. As the diseased vein remains in the leg, it can regenerate and continue to participate in the blood circulation. Ideally, however, there is only a targeted blood flow from bottom to top, the pathological backflow is prevented.
Varicose vein treatment with CHIVA includes a precise ultrasound examination before the procedure@ DK_2020 /AdobeStock
The CHIVA method is usually performed on an outpatient basis. This means that the patient can return home after the procedure. If desired, inpatient care can also be provided, which takes one to two days. In most cases, however, this procedure is not necessary.
The patient should be able to walk again shortly after the procedure. Due to the small stitches used to access the vein, the pain is significantly less than after the open procedure by stripping the vein; the latter requires 2 to 3 cm long skin incisions in the groin.
As the vein is not removed but remains in the body, there is also little or significantly less bruising. This also leads to significantly less pain and enables early mobilization (movement). This is very important in order to avoid the risk of complications, such as inflammation of the remaining varicose vein or thrombosis of the deep vein system.
Similar to other procedures for the treatment of varicose veins, the patient wears special compression stockings for a certain period of time. The remaining varicose veins can then recede significantly. In addition, the risk of thrombosis of the remaining veins and the deep veins is significantly lower.
Woman with compression stockings after treatment of varicose veins @ New Africa /AdobeStock
Whether the CHIVA method was a success or not only becomes apparent 3 to 6 weeks after the procedure. It is considered a success when the varicose veins return to their original diameter. In around 20 percent of all patients, an additional operation may be necessary, during which other veins in other areas are cut off.
A follow-up examinationis therefore carried out after approx. 6 to 8 weeks. A decision is made as to whether additional surgery or further sclerotherapy of the lateral branches is required.
Side effects and complications are considered to be lower with the CHIVA method than with the removal of varicose veins. Nevertheless, there is a risk of minor injuries to the soft tissue, nerves and lymph nodes. One in ten patients is also at risk of phlebitis. This can be treated with ointments containing heparin, cooling and, if necessary, pain-relieving medication.
CHIVA surgery is not advisable if the varicose veins are very pronounced. In this case, the treatment is rarely successful and other procedures should be carried out from the outset which involve removing or eliminating the varicose vein. These include surgical stripping as well as sclerotherapy of the vein from the inside using heat or foam.
The CHIVA method has a number of advantages. These include
Bed rest is also unnecessary after CHIVA surgery.
One of the disadvantages is that the method is very time-consuming. It places high demands on the doctors. In addition, the vein flow conditions must be thoroughly checked before treatment. Each operation takes between two and four hours, making it significantly more time-consuming than stripping (approx. 30-60 minutes).
