Abstract
Recent advancements in the management of varicose veins have shifted focus toward hemodynamic preservation and minimally invasive techniques. Saphenous sparing treatments, including the CHIVA method, present a significant evolution in phlebology by preserving the great saphenous vein (GSV) and reducing complications associated with ablative procedures. This review synthesizes key insights from recent studies to evaluate the efficacy and long-term benefits of these approaches.
Introduction
Varicose vein treatment has historically involved destructive methods such as stripping and sclerotherapy, which compromise venous integrity and may exacerbate venous insufficiency. Modern understanding of venous hemodynamics has catalyzed the development of conservative treatments emphasizing pressure modulation and vein preservation.
Hemodynamic Basis for Saphenous Sparing
Venous insufficiency results from excess transmural pressure (TMP) and impaired drainage, often linked to gravitational hydrostatic forces. Conservative methods, such as CHIVA, target TMP reduction through postural adjustments, compression therapy, and shunt disconnection. This approach restores venous balance without sacrificing the GSV’s structural and functional properties.
CHIVA Technique and Clinical Outcomes
Introduced in 1988, the CHIVA method preserves venous anatomy while mitigating venous hypertension through targeted shunt ligation. Clinical studies highlight its advantages in long-term outcomes, including reduced recurrence rates and suitability of treated veins for future grafting. Notably, Cappelli et al. demonstrated that reflux, often viewed as pathogenic, is less critical than TMP in determining varicose progression.
Advantages Over Ablative Procedures
Traditional techniques such as laser ablation and radiofrequency treatment prioritize symptom relief but may contribute to compensatory varicosities. By contrast, CHIVA maintains venous integrity, thereby preventing complications such as tissue ischemia and ulceration. Additionally, preserved GSVs offer viable grafting options for patients with atherosclerosis risks.
Challenges and Training Requirements
Effective implementation of CHIVA demands expertise in hemodynamic mapping and echodoppler technology. Despite its demonstrated superiority, widespread adoption is hindered by the need for specialized training and resistance to deviation from conventional practices.
Conclusion
Saphenous sparing approaches represent a paradigm shift in varicose vein management, emphasizing anatomical preservation and hemodynamic restoration. Future research and training initiatives are critical to integrating these innovations into standard clinical practice, ensuring improved patient outcomes.
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