Should a Ranking System Be Adopted for CHIVA Training? Discussing the Impact of Physician Expertise on Treatment Outcomes

With the advancement of medical technology, methods for treating varicose veins have also evolved. CHIVA (Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) has gained widespread attention as an innovative minimally invasive treatment method, distinguished by its unique hemodynamic principles and superior clinical outcomes. However, the successful implementation of CHIVA relies heavily on the physician’s skills and deep understanding. This raises an important question: should a ranking system similar to martial arts be used to assess and certify a physician’s level of expertise? This article explores the significant impact of physician expertise on CHIVA outcomes and whether a ranking system is necessary.

Complexity of CHIVA

The core of CHIVA lies in correcting pathological reflux points through detailed hemodynamic assessments using ultrasound, thereby preserving all venous return pathways and avoiding the trauma associated with traditional destructive surgeries​​. This approach requires not only superb surgical skills but also an in-depth understanding of venous hemodynamics.

Firstly, preoperative hemodynamic assessment is crucial in CHIVA. Physicians must use ultrasound to conduct a detailed analysis of blood flow, identify the sources of reflux, and design individualized surgical plans​​. This process typically takes at least 20 minutes and demands significant experience and concentration from the physician​​.

Secondly, performing CHIVA requires precision in minimally invasive operations under local anesthesia. This demands steady hands, careful attention, and a comprehensive understanding of the patient’s venous anatomy and flow characteristics. Even minor errors can affect the outcome and cause complications​​.

Impact of Physician Expertise on CHIVA Outcomes

The level of physician expertise has a direct and substantial impact on the effectiveness of CHIVA. Skilled physicians can conduct more accurate hemodynamic assessments and perform precise surgeries, significantly reducing recurrence and complications​​​​.

Importance of Clinical Experience

The experience of Dr. Smile Medical Group demonstrates that extensive clinical experience is key to successful CHIVA surgeries. Since introducing CHIVA in 2011, the group has accumulated over 20,000 cases, making them the most experienced team in China and Asia​​. In these cases, the recurrence rate was significantly lower than traditional surgeries, and patient satisfaction was as high as 96.6%​​. This data clearly shows that experienced physicians can better master CHIVA techniques, improving treatment outcomes.

Necessity of Systematic Training and Certification

Despite the significant advantages of CHIVA, its complex theoretical framework and demanding operational techniques necessitate systematic training and certification. The global CHIVA certification program ensures that physicians master the standard techniques of hemodynamic assessment and surgical procedures, guaranteeing treatment safety and efficacy​​.

Currently, many physicians have not undergone systematic CHIVA training, and some even use non-standard techniques under the guise of CHIVA, harming patient interests​​. Therefore, systematic training and certification can not only enhance physician expertise but also regulate the market and protect patient rights.

Should a Ranking System Be Introduced?

Given the complexity of CHIVA and the significant impact of physician expertise on outcomes, should a ranking system similar to martial arts be introduced to assess and certify physician expertise?

Advantages of a Ranking System

Introducing a ranking system could provide a clear framework for physician training and certification. Through graded certification, physicians can progressively improve their skills, from basic hemodynamic assessments to complex CHIVA operations, receiving systematic training and evaluation at each stage. This not only helps physicians understand their progress but also provides patients with a clear reference when choosing a physician.

Feasibility of Implementation

However, implementing a ranking system also faces challenges. Firstly, it requires detailed evaluation standards and training content, along with authoritative bodies for certification. This entails substantial human and material resource investment and the establishment of a scientific, objective, and fair evaluation system.

Secondly, the ranking system might impact the career development of physicians. Some may face career limitations if they cannot achieve higher-level certification, potentially leading to disputes and dissatisfaction. Thus, balancing the relationship between physician training, certification, and career development while ensuring fairness is a complex issue that requires thorough exploration.


In summary, the successful implementation of CHIVA heavily relies on the physician’s expertise and clinical experience. Introducing a ranking system similar to Karate could provide a clear framework for training and certification, enhancing overall medical standards. However, this system requires overcoming numerous challenges, including setting detailed evaluation standards, training content, and establishing a fair certification process. Only by effectively addressing these issues can the ranking system truly fulfill its role and benefit more patients with varicose veins.

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