CHIVA Method | Doctors & Treatment Information

The abbreviation CHIVA stands for the French term “Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire.” Translated into English, this means “outpatient therapy for varicose veins that corrects blood flow.”

The physician Claude Franceschi developed the procedure in France in the 1980s. In France, the CHIVA method is one of the most common treatments for varicose veins. In Germany, however, it is used less frequently.

The CHIVA method is a minimally invasive treatment for varicose veins @ Yashkin Ilya /AdobeStock

CHIVA is not only a surgical method but is also considered a treatment approach that involves several steps. 

Components of the method include:

• A special ultrasound examination before the procedure (duplex sonography)
• The procedure itself
• Postoperative care

The CHIVA procedure is a method that specifically prevents the reflux of venous blood in pathologically dilated varicose veins. It does not require removal of the entire vein.

This procedure is appropriate when the vein is to be preserved as part of varicose vein treatment.

In this procedure, doctors leave the trunk vein in the patient’s leg. This is not the case with stripping (one of the traditional surgical methods for treating varicose veins).

In this way, blood flow is maintained and the vein can also serve as a bypass if necessary. According to studies, the CHIVA method results in a lower incidence of varicose veins recurring.

CHIVA can also be performed following a Babcock procedure (Babcock vein stripping), deep vein thrombosis in the legs, or sclerotherapy. The procedure provides significant relief.

The CHIVA method is used when typical varicose vein symptoms occur, such as:

• Skin discoloration
• Leg swelling, or
• Ulcers

The surgical procedure eliminates these symptoms by precisely mapping the venous flow and interrupting the pathological circulation at specific points.

Before the procedure takes place, a precise ultrasound examination is performed. During this process, the experts create a sort of map of the superficial venous system in the leg.

In addition, they map the venous flow of the veins, which are often interconnected. During this process, doctors identify the points where venous flow can be interrupted. Doctors mark these points on the skin with a waterproof pen.

Before the procedure, the patient receives a local anesthetic. General anesthesia can also be administered at the patient’s request.

The incisions made on the lateral branches of the leg are usually small. They are noticeable as small puncture marks.

Using small vein hooks, the doctor gently pulls the varicose veins out at these points and ties them off with surgical thread.

The doctor then releases the varicose veins and tucks them back under the skin. Because the affected vein remains in the leg, it can regenerate and resume its role in blood circulation.

Ideally, this results in targeted blood flow from the bottom up, which prevents pathological reflux.

Varicose vein treatment with CHIVA includes a detailed ultrasound examination prior to the procedure @ DK_2020 /AdobeStock

The CHIVA method is typically performed on an outpatient basis. This means that the patient can go home after the procedure. In-patient care is also available upon request and lasts one to two days. In most cases, however, this is not necessary.

The patient should be able to walk again shortly after the procedure. Because the small punctures are used to access the vein, pain is significantly less than after the open procedure (stripping). Stripping requires 2- to 3-cm-long skin incisions in the groin.

Since the vein remains in the body, there is little to no bruising—or significantly less than with open surgery. This also results in significantly less pain and allows for early mobilization (movement).

Movement is very important to reduce the risk of complications.

Complications may include:

• Inflammation of the remaining varicose vein or
• thrombosis of the deep venous system

Is it necessary to wear compression stockings?

Similar to other procedures for treating varicose veins, the patient wears compression stockings for a certain period of time.

The remaining varicose veins can then significantly shrink. In addition, the risk of thrombosis in the remaining veins and the deep veins is significantly lower.

Woman wearing compression stockings after varicose vein treatment @ New Africa /AdobeStock

How can you tell if the CHIVA treatment was successful?

It takes 3 to 6 weeks to determine whether the CHIVA method was successful. Doctors consider the treatment a success if the varicose veins return to their original diameter.

In about 20 percent of all patients, additional surgery is necessary to ligate other veins in different locations.

Therefore, a follow-up examination is scheduled after approximately 6 to 8 weeks. During this examination, the doctor assesses whether a supplementary procedure or further sclerotherapy of the lateral branches is necessary.

Side effects and complications are less common with the CHIVA method than with the removal of varicose veins.

Nevertheless, there is a risk of minor injuries to soft tissues, nerves, and lymph vessels.

One in ten patients develops phlebitis. This can be treated with heparin-containing ointments, cooling, and, if necessary, pain-relieving medications.

CHIVA surgery is not recommended if the varicose veins are severely pronounced. In such cases, the procedure rarely leads to success. Other procedures should be used from the outset, in which doctors remove or disable the varicose veins.

These include:

• Surgical stripping
• Endovenous ablation using heat or foam

The CHIVA method has several advantages.

These include:

• A safe preliminary examination consisting of a duplex ultrasound
• No need to visualize the veins using contrast dye
• Complete preservation of the blood outflow pathway from the leg
• Procedure is usually performed on an outpatient basis
• Rare instances of associated injuries
• Gentle treatment of soft tissues, as the veins are not surgically removed
• No or only a short period of incapacity for work
• Achievement of a positive cosmetic result
• In addition, bed rest is not necessary after CHIVA surgery.

Among the disadvantages is that the method is very time-consuming. It also places high demands on the surgeon.

An assessment of venous flow conditions is required before treatment. Each surgery lasts between two and four hours, making it significantly more time-consuming than stripping (approx. 30–60 minutes).