Introduction: The Shift Toward Hemodynamic Conservation
Chronic venous insufficiency (CVI) and its clinical manifestation as varicose veins represent a significant global health burden, affecting millions of individuals and placing considerable strain on healthcare resources. For decades, the surgical gold standard was high ligation and stripping (HL/S), an approach rooted in the anatomical destruction of the insufficient vein. However, the emergence of the CHIVA method (Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) has challenged this ‘ablate and destroy’ paradigm. CHIVA is a minimally invasive, hemodynamic-based strategy that aims to correct venous hypertension while preserving the superficial venous system.
Unlike thermal ablation or stripping, CHIVA focuses on redirecting blood flow from the superficial to the deep venous system by strategically disconnecting specific leak points. This approach preserves the saphenous vein, which may be crucial for future use in arterial bypass grafting. Recent high-level evidence, including Cochrane systematic reviews and large-scale network meta-analyses, provides a compelling case for the efficacy and safety of this hemodynamic strategy compared to conventional and endovenous thermal techniques.
