Application of the CHIVA Strategy to Large-Diameter Saphenous Veins


The CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified two-stage strategy is employed for patients with a great saphenous vein (GSV) diameter ≥9 mm, aiming to decrease the risk of symptomatic superficial vein thrombosis (SVT). The risk of complications is higher when both stages are performed simultaneously.


This retrospective observational study involved 111 patients with CVD and a GVS diameter ≥9 mm treated with the two-stage CHIVA strategy between January 2010 and December 2019. The first stage targeted the interruption of the main reflux escape point (incompetent saphenofemoral junction), thereby reducing venous pressure and achieving a sufficient reduction in GSV diameter. The second stage, if required, involves the disconnection of secondary reflux exit points (incompetent saphenous tributaries), posing a lower risk of symptomatic SVT when patients do not exhibit significant clinical improvement. Reductions in GSV diameter, postoperative complications, and clinical improvements were analyzed.


The study comprised 60 men (54.1%) and 51 women (45.9%) with an average age of 57±11.9 years. All patients underwent the first surgical stage, with 77.5% (86 patients) having the interruption of the saphenofemoral junction as the sole procedure. The second stage was performed on 25 patients (22.5%). The average preoperative GSV diameter was 10.2±1.1 mm, which reduced to 7.1±1.5 mm post the first surgery. Six patients (5.4%) experienced recurrence due to recanalization of the reflux point, and 16 patients (14.4%) developed SVT, of which 12 cases (10.8%) were symptomatic.


Interrupting the main reflux escape point as a singular procedure in patients with a GSV diameter ≥9 mm resulted in a notable reduction in diameter and significant clinical improvement in nearly 80% of the cases.

Key Words: Varicose veins; Saphenous vein; Blood circulation

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