Originally contributed by Dr. Qiang Zhang on the Veinsights . Original Link: https://phlebologyglobaladvances.com/chiva-treatment-for-varicose-veins-without-stopping-anticoagulants/
CHIVA (Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) is an established minimally invasive treatment method for varicose veins that focuses on conserving venous structures and optimizing hemodynamics. Unlike more aggressive interventions, CHIVA therapy does not require anticoagulation post-treatment, which raises questions among patients and practitioners alike about the safety and prevention of potential complications such as Deep Vein Thrombosis (DVT). In this article, we will explore why anticoagulation is not required after CHIVA and the effective measures used to prevent DVT.
Why Anticoagulation is Not Mandatory After CHIVA
One of the critical advantages of CHIVA therapy is that it does not damage the venous endothelium. Unlike other treatments that may involve vein ablation or stripping, CHIVA preserves the integrity of the vein walls and endothelium, reducing the risk of clot formation and thereby minimizing the need for anticoagulation.
Anticoagulation is commonly used after certain venous procedures to prevent thrombotic complications. However, after CHIVA treatment, anticoagulation is not routinely required or considered mandatory for several reasons:
1. Minimally Invasive Nature of CHIVA
CHIVA is designed to minimize trauma to the venous system. Unlike endovenous treatments, CHIVA does not involve catheter-based thermal or chemical ablation, meaning that the venous endothelium remains intact. This preservation of the endothelial lining significantly reduces the risk of thrombus formation, as it maintains the natural antithrombotic properties of the vessel walls. Unlike traditional varicose vein treatments such as vein stripping or endovenous laser ablation, CHIVA does not involve extensive removal or obliteration of veins. Instead, it optimizes the hemodynamic function of the existing venous system through selective ligation and diversion of venous flow. The lack of extensive damage to the venous network significantly reduces the risk of thrombosis, thus reducing the necessity for routine anticoagulation therapy.
2. Preservation of Venous Flow
CHIVA aims to restore normal venous hemodynamics by redirecting blood flow away from the incompetent veins to more functional ones. The preservation of venous flow is key to reducing the risk of thrombus formation, as stagnant or turbulent flow is often a contributing factor to clot development. By maintaining proper circulation in the treated limbs, the risk of DVT is greatly reduced.
3. Low Incidence of DVT
Based on the multi-center data from Dr. Smile Medical Group over the past ten years, involving more than 20,000 CHIVA procedures, only one case of DVT has been reported, and it occurred three months post-treatment, without any direct link to CHIVA itself. This low incidence underscores the inherent safety of CHIVA and its effectiveness in minimizing thrombotic risk compared to more invasive procedures. The preservation of venous integrity and the lack of excessive manipulation both contribute to this favorable outcome.
DVT Risk Assessment Table
To effectively assess the risk of DVT after CHIVA treatment, the following table can be used to categorize patients based on different risk factors:
| Risk Factor | Description | Risk Level |
|---|---|---|
| History of DVT | Previous deep vein thrombosis episodes increase the likelihood of recurrence. | High |
| Genetic Clotting Disorders | Presence of genetic factors like Factor V Leiden mutation. | High |
| Tumor | Presence of malignancy, which can increase the risk of hypercoagulability. | High |
| Obesity | BMI > 30, which can contribute to poor venous return and increase DVT risk. | Moderate |
| Age > 60 | Older age is associated with a higher risk of clotting disorders. | Moderate |
| Prolonged Immobility | Limited mobility, especially after surgery, increases risk of venous stasis. | Moderate |
| Pregnancy | Pregnancy increases venous pressure and hormonal changes that contribute to clot risk. | Moderate |
| Smoking | Smoking contributes to poor vascular health and increases clotting risk. | Moderate |
| Recent Major Surgery | Any major surgery within the last three months that may impair mobility. | Moderate |
| Hormone Replacement Therapy | Estrogen-based therapies can increase risk of thrombosis. | Low |
| Dehydration | Dehydration can increase blood viscosity, contributing to clot formation. | Low |
Preventive Measures for DVT Post-CHIVA
Although anticoagulation is not required post-CHIVA, preventive measures are still important to ensure optimal outcomes and to further mitigate any potential risks of DVT. Here are the key methods used to prevent DVT after CHIVA treatment:
1. Early Mobilization
One of the most effective ways to prevent DVT is to encourage early mobilization after the procedure. Since CHIVA is a minimally invasive procedure with no large incisions or extensive recovery requirements, patients are encouraged to resume walking shortly after treatment. Early ambulation promotes healthy blood flow in the legs, reducing the risk of thrombus formation.
2. Compression Therapy
The use of compression stockings after CHIVA is generally recommended but not always necessary. In cases where venous pressure has already been restored, and there are no signs of edema or hematoma, the use of compression stockings may be considered redundant. For patients with excellent venous function post-treatment, compression therapy may be optional and can be discussed on a case-by-case basis with the treating physician.
3. Hydration and Avoiding Prolonged Immobility
Maintaining proper hydration is an important factor in reducing the risk of DVT, as dehydration can increase blood viscosity and contribute to clot formation. Patients are also advised to avoid prolonged immobility, especially during the early recovery period. Activities such as walking and light stretching can help maintain healthy blood flow and prevent venous stasis.
4. Individual Risk Assessment
Although the need for anticoagulation is rare, each patient is assessed individually for their risk of thrombotic events. Patients with a history of DVT, genetic clotting disorders, or other risk factors may require additional monitoring or preventive measures tailored to their unique needs. The CHIVA approach emphasizes individualized care, ensuring that every patient receives the most appropriate follow-up based on their risk profile.
Conclusion
CHIVA treatment for varicose veins stands out as a minimally invasive and effective procedure where anticoagulation is not mandatory or routinely applied post-treatment. The unique approach of preserving venous structures and optimizing blood flow minimizes trauma to the veins and reduces the risk of thrombotic complications. With over 20,000 procedures performed and only one reported case of DVT—occurring months after treatment and with no direct connection to the procedure—CHIVA has demonstrated an excellent safety profile in terms of thrombotic risk.
Preventive measures, such as early mobilization, compression therapy, proper hydration, and individualized patient risk assessment, are crucial in maintaining this low incidence of complications. By focusing on these strategies, CHIVA ensures a safe and effective recovery for patients without the need for anticoagulation therapy, enabling them to return to their normal activities with confidence.