Originally contributed by Dr. Qiang Zhang on the Veisights . Original Link: https://veinsights.blogspot.com/2024/11/www.drsmilehealth.co.html
In the field of venous disease treatment, CHIVA (Conservative Hemodynamic Treatment for Venous Insufficiency), as an important component of the global CHIVA program, is a non-destructive, minimally invasive treatment method based on hemodynamic analysis that is gaining increasing recognition. However, for vascular surgeons accustomed to traditional surgical approaches, learning and mastering CHIVA is not without obstacles. This blog will explore the main challenges faced by surgeons in learning CHIVA and outline practical measures to overcome them.
1. Shifting Paradigms and How to Overcome Them
For many years, traditional treatment for varicose veins has relied on high ligation and stripping (such as the great saphenous vein stripping) and destructive procedures like endovenous ablation. CHIVA, by preserving venous function and regulating hemodynamics to achieve natural recovery, fundamentally differs from traditional treatment philosophies. Accepting and understanding this new approach requires surgeons to rethink their understanding of venous pathology. For experienced surgeons, this paradigm shift is a significant obstacle. To overcome this, surgeons can attend workshops and seminars focused on CHIVA, read extensively on hemodynamic treatment principles, and engage with peers who have successfully adopted CHIVA. Understanding the long-term benefits of preserving venous function can help shift the perspective.
2. Technical Training Challenges and Solutions
CHIVA requires a deep understanding of the hemodynamics of the venous system and a precise evaluation of patient-specific differences. Coordinating the use of ultrasound probes and inducing blood flow is one of the critical steps for CHIVA’s success. Surgeons need to accurately position the ultrasound probe over the target vein to obtain a clear hemodynamic image, and then use compression and relaxation maneuvers to induce changes in blood flow. These operations demand a high level of hand-eye coordination and acute interpretation of ultrasound images. For those accustomed to making decisions based on direct surgical vision and tactile feedback, mastering hemodynamic ultrasound skills presents a significant obstacle. To overcome this, surgeons should seek specialized training in ultrasound imaging, participate in hands-on workshops, and practice under the supervision of experienced CHIVA practitioners to gain confidence in using ultrasound for hemodynamic assessment.
3. Limited Systematic Training Opportunities and Possible Solutions
Despite the growing recognition of CHIVA, systematic training resources are still limited. Many surgeons lack formal training or mentorship. Learning CHIVA often involves participating in intensive courses and workshops, which can be a significant time-management challenge. To address this, surgeons can use online courses and self-study materials that offer flexibility, as well as collaborate in peer support groups to facilitate efficient learning. for busy vascular surgeons. Surgeons can make effective use of training opportunities through online courses, self-study materials, and flexible short-term workshops. Establishing peer support groups can also facilitate knowledge sharing and improve learning efficiency.
4. Uncertainty of Outcomes and Strategies for Effective Patient Communication
The effectiveness of CHIVA is based on hemodynamic adjustments that reduce venous pressure through improved circulation, rather than the direct removal of affected veins. Recent clinical data indicate that CHIVA significantly reduces recurrence rates and shortens patient recovery times. Studies conducted in France, Italy, and Germany have provided valuable data and practical insights into these techniques. Nonetheless, the concept of preserving veins can make it difficult for some surgeons and patients to trust in the long-term effectiveness. Surgeons need to spend additional time explaining the long-term benefits of CHIVA and how preserving venous structures can yield sustainable outcomes. This complexity in communication adds to the challenges faced by surgeons in managing patient expectations. To overcome this, surgeons can present clinical data and case studies that support CHIVA’s efficacy, use visual aids to explain the treatment process, and build trust through transparent discussions with patients.
5. Psychological and External Resistance Challenges and How to Address Them
Years of established surgical practices make it difficult for many surgeons to embrace new treatment methods, especially when traditional approaches have proven effective. Additionally, some senior vascular experts may be concerned that adopting new techniques could undermine their academic standing. In some countries, economic interests tied to the use of surgical equipment also contribute to skepticism and resistance toward CHIVA. Adopting CHIVA means learning new skills and changing well-established habits, which is undoubtedly a considerable challenge for many practitioners. Surgeons can overcome this by participating in mentorship programs, building support networks with colleagues who are also transitioning to CHIVA, and staying informed about the latest research demonstrating CHIVA’s benefits.
