Introduction
Lower limb varicose veins are a common chronic venous insufficiency (CVI) disease that affects the quality of life for a large global population. Traditional treatment methods mainly include sclerotherapy and vein stripping, while in the past 20 years, technologies such as laser, radiofrequency ablation, and adhesive closure of the saphenous vein trunk have also been applied. However, in recent years, CHIVA (Conservative Hemodynamic Correction of Venous Insufficiency), an outpatient local anesthesia treatment based on hemodynamic analysis and vein preservation, has attracted significant attention for its advantages in reducing recurrence rates and improving patients’ quality of life.
Research Methods
Extensive literature searches were conducted in globally renowned databases including MEDLINE, Embase, and Cochrane. A total of over 39 RCT studies were identified, involving more than 6000 limbs, which were finally used for quantitative analysis.
Research Objectives
The study focuses on the long-term efficacy of different varicose vein treatment methods. Two objective indicators were selected for the final data synthesis analysis: successful treatment rate (STR) and recurrence rate (RR). STR is defined as anatomical and functional integrity, confirmed by ultrasound as complete ablation, closure, or stripping. RR is defined as the reappearance of any visible varicose veins or pathological reflux after the initial treatment.
Treatment Methods Analysis
The study explored ablation, CHIVA, sclerotherapy, ligation, and stripping, as well as four additional combined treatments (ablation + stripping, ablation + ligation, sclerotherapy + ligation, ligation + stripping). The results showed the success treatment rates as follows: CHIVA > sclerotherapy + ligation > ablation + stripping. Long-term recurrence rates (RR) were: CHIVA < ablation + stripping < stripping.
Discussion
Traditional Surgery
High ligation and stripping (HLS) of the saphenous vein was once considered the “gold standard” for varicose vein surgery. While it can improve quality of life and show efficacy in the short term post-operation, traditional surgery is more traumatic and carries risks of high complication and recurrence rates, potentially failing to maintain long-term clinical benefits. Studies have shown that the recurrence rate of traditional stripping surgery ranges from 20-50%, depending on the experience of the surgeon.
Minimally Invasive Techniques
Compared to traditional surgery, some minimally invasive techniques may cause less trauma and are considered safer. These techniques mainly include ablation (laser or radiofrequency) combined with surgical stripping and sclerotherapy, which have been proven to be safe and effective and are currently widely performed in many hospitals. However, despite the reduced trauma, ablation and sclerotherapy still involve vein elimination, which can lead to the destruction of the venous network and associated complications. For long-term follow-up, minimally invasive techniques cannot fundamentally prevent the recurrence of varicose veins. Studies have shown that the recurrence rate for ablation ranges from 10-20%, also depending on the surgeon’s experience.
CHIVA
The revolutionary aspect of CHIVA lies in its ability to treat varicose veins effectively while preserving healthy vein networks through precise hemodynamic assessment. In practice, CHIVA reduces venous pressure by blocking abnormal reflux, segmenting pressure columns, and preserving reflux points, causing varicose veins to gradually shrink while continuing to drain blood into deep veins. This revolutionary method overturns the traditional treatment concept centered on removing or destroying varicose veins, thereby addressing venous hypertension at its root and minimizing surgical trauma-related problems.
Although venous valve function damage is irreversible, CHIVA treatment allows the vein pathway to continue transporting blood and draining subcutaneous venous network blood, reducing interference with normal veins. This new balance further reduces the recurrence of varicose veins. These characteristics may be key factors in revealing why CHIVA treatment has better long-term clinical efficacy and lower recurrence rates.
Studies have shown that the recurrence rate of CHIVA treatment is between 5-10%, largely determined by the doctor’s experience. It is worth noting that almost all cases of recurrence after treatment can be corrected through hemodynamic methods (CHIVA).
The Importance of Standardizing CHIVA Data for Evidence-Based Results
High-quality and consistent data are crucial for evidence-based research on CHIVA. However, due to the complexity of the CHIVA technique and practice differences across regions, achieving data consistency is challenging. This may lead to reduced comparability of different study results, affecting the credibility of evidence-based medicine. Therefore, standardized data collection and reporting standards, along with the establishment of international data sharing platforms, will facilitate global data exchange and comparison, ensuring the accuracy and comparability of research results.
The global CHIVA training and certification project initiated by Dr. Smile Medical Group and Inteleos in the United States is an important step in enhancing doctors’ technical skills and promoting data standardization. Through systematic training and certification, doctors can master standardized CHIVA procedures, improving clinical outcomes and reducing the impact of technical differences. This project also promotes unified research standards and methods, ensuring more scientific and rigorous comparisons between CHIVA and traditional surgical methods.
The Significance of the Global CHIVA Project
The global CHIVA training and certification project not only helps enhance doctors’ technical skills and experience but also promotes the standardization and normalization of CHIVA techniques worldwide. This project can establish unified research standards and operational protocols, ensuring the comparability of data from different countries’ research institutions, thus providing more reliable evidence-based medicine. Additionally, the project promotes international data sharing and academic exchange, contributing to the global dissemination and application of CHIVA techniques.
Conclusion
CHIVA, as a minimally invasive treatment method that emphasizes hemodynamics, has demonstrated excellent long-term efficacy and safety in the treatment of varicose veins. Compared to traditional stripping and techniques such as laser and radiofrequency ablation, CHIVA offers lower recurrence rates and less trauma. However, CHIVA also has drawbacks, such as the high level of experience required for surgeons, who need to possess extensive hemodynamic knowledge and practical skills. Proper training and standardized procedures are essential to achieving optimal results.
Despite these limitations, the conclusion remains that CHIVA has superior long-term efficacy compared to other surgical methods. This revolutionary approach should be widely applied in clinical settings, becoming a preferred option for both patients and doctors.
The global CHIVA training and certification project initiated by Dr. Smile Medical Group and Inteleos is pivotal in promoting the standardization of the technique and enhancing evidence-based medicine. Through rigorous scientific research and high-standard clinical practice, CHIVA will continue to provide efficient, low-trauma treatment options for varicose vein patients and make significant contributions to global venous health.