CHIVA Method for the Treatment of Chronic Venous Insufficiency

Key finding

Treatment of chronic venous insufficiency with CHIVA (Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire [ambulatory conservative hemodynamic treatment venous insufficiency]) is less invasive but has similar complications and no difference in recurrent varicose veins compared with other more well-studied therapies.

Study summary

This Cochrane analysis was an update that included six randomized controlled trials with 1160 participants. CHIVA was compared to vein stripping in three, compression in patients with venous ulcers in one, vein stripping and radiofrequency ablation in one, and vein stripping and laser in one study. The follow-up periods varied from months to 10 years. No advantage was found for CHIVA in any analysis of outcome measures. All evidence was at a “low-certainty” level.

Commentary

CHIVA is one of the least reported and least studied treatment options for chronic venous hypertension. Honestly, I really do not understand the method, which is “the ambulatory conservative hemodynamic correction of venous insufficiency” (the acronym CHIVA coming from the French phrase). Even surgeons who perform this method have stated that it is difficult to learn, with a long learning curve and that extensive education is needed. I personally do not know anyone who performs this complex time-consuming procedure, which also involves superior ultrasound skills and detailed examinations. Kudos if you are one of the few. If you are in the United States, is it reimbursable within our insurance model?

Article InfoPublication HistoryCochrane Database Syst Rev 2021;9:CD009648.Identification

DOI: https://doi.org/10.1016/j.jvsv.2022.04.004

Copyright

© 2022 Published by Elsevier Inc.

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