Can varicose veins be treated without resorting to saphenous ablation?

The most diffused, but not more efficient, varicose vein treatments include saphenous ablation or stripping. Contrarily, the CHIVA treatment preserves the saphenous vein and its function. Moreover, the advantages of the CHIVA treatment include:
  1. Superior cosmetic results compared to other methods.
  2. If necessary, the saphenous vein can be used in a life-saving procedure such as a heart by-pass even if it is diseased.
  3. Minore ricomparsa di vene varicose a distanza di 10 anni dall’intervento CHIVA
  4. A minor recurrence of varicose veins 10 years after surgery with the CHIVA treatment.
  5. Surgery is performed with local anesthetic, there is no post-operative pain or trauma to the surrounding tissues. Surgery lasts about 30 minutes, the patient is able to walk right after surgery, and can return home within hours of surgery.
  6. The saphenous vein is vitally important if a deep vein becomes obstructed, like in case of thrombosis or trauma.

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     Stripping completely removes the saphenous vein by ripping it out; the use of lasers or radio frequency burns the saphenous vein at temperatures ranging from 85 to 120 C°; Clarivein fills it with foam; Superglue glues the vein with a cyanoacrylate (Crazy Glue)     

What is CHIVA?

The CHIVA treatment was first elaborated by Doctor Claude Franceschi in Paris in 1988. CHIVA is a French acronym that means Conservative Hemodynamic Venous Insufficiency Ambulatory (outpatient) Treatment.
  • Conservative: because it does not remove or ablate the saphenous vein.
  • Hemodynamic: because it re-establishes a correct blood flow in the saphenous vein.
  • Venous Insufficiency: because CHIVA treats varicose veins as well as other venous disorders where other treatments are useless or harmful.
  • Ambulatory (outpatient): because it is performed with local anesthetic, is brief, and allows the patient to return home walking, shortly after surgery.

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     CHIVA redistributes the blood flow from diseased to healthy veins, while preserving the saphenous vein. This result is achieved by deviating the blood flow in strategic points. These points are chosen through an accurate ultrasound study of the varicose vein network known as a venous hemodynamic map.     

The CHIVA treatment and a phlebologist's experience

The CHIVA treatment only gives exceptional results if performed by an experienced phlebologist. CHIVA is a treatment strategy that must be adapted to the patient’s varicose veins and requires an accurate venous ultrasound mapping. The CHIVA outcome depends on the phlebologist's sensibility when choosing the best strategy for each individual clinical case. Contrarily, ablation methods whose only purpose is to eliminate the saphenous vein apply a standard protocol that is repeated for each patient.

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     In expert hands, CHIVA can resolve apparently complicated clinical cases with a simple and mini-invasive surgery. After years of experience my motto is, "Obtain the best result possible with minimal treatment". CHIVA only has excellent results if an expert phlebologist performs it.     

The saphenous vein as a life-saving measure in by-pass surgery

The saphenous vein can be used as an arterial by-pass in place of synthetic materials. This gives better results in both heart by-pass and in lower leg by-pass surgery. What ablation method supporters say is not true. Even if the saphenous vein is diseased, it can still be used in by-pass surgery. The absence of valves is an advantage, because there are no valves in the arteries as is confirmed by scientific literature.

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     There is company in France that buys the saphenous veins removed by stripping and sells them to heart surgery units to be used as bio-prosthetic material (     

Varicose Veins: Treatment Comparison

Pros and cons of different varicose vein treatments
No nerve's damages YES NO NO NO YES YES
No Linphatic's damages YES NO YES YES YES YES
Quick healing YES NO NO NO NO NO
No pain after YES NONO NO NO NO
Local anestesia YES NO NO NO YES YES
Immediate deambulation YES NO YES YES YES YES

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     The patient must be shown an informed consent form illustrating all possible treatments, clearly stating that the saphenous vein can be saved and can be used in the future for life-saving surgery and that the CHIVA treatment has better results after 10 years.     

Three reasons for not removing the saphenous vein

  1. It ensures tissue drainage: the saphenous vein's function of collecting blood from superficial veins and sending it towards the deep veins is suppressed when it is removed or closed with a laser or other methods. VIDEO This will lead to blood drainage difficulty that is responsible for the formation of spider veins, blue reticular veins and small varicose veins where there were none prior to surgery.
  2. Even if the saphenous vein is incompetent, its preservation simplifies the management of new varicose veins that can reappear after surgery. Here are 2 examples:
    1. A woman becomes pregnant after varicose vein surgery. A tributary that brings blood towards her lower leg originates in her pelvis. If she no longer has her saphenous vein, this situation will create new varicose veins and a new treatment will be necessary. Therefore, if the saphenous vein is not removed it will act as a pole of attraction for the pelvic tributary, the blood flow will be sent towards the deep vein without forming new varicose veins, and no further treatment will be necessary.
    2. After surgery, a new perforator that did not exist before develops in the thigh. This forms a connection that brings the blood from the deep veins towards the surface. If there is no saphenous vein, this situation will form new varicose veins that will need to be re-treated. If the saphenous vein is in place, it will collect the blood from the perforator and send towards the deep veins without surgical recurrences.
  3. It is an important alternative in case of deep vein obstruction: If a thrombosis obstructs the deep veins, the blood can use the saphenous vein to reach the heart. This saphenous centripetal flow is moved by a pressure gradient and is independent of the valve's competence.

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Scientific Evidence in support of the CHIVA treatment

The CHIVA treatment is the conservative hemodynamic surgery that I have been performing since 1990 and has been validated by a Cochrane Review and four Evidence-A Trials that indicate 50% less recurrences compared to stripping after 10 years. Today, stripping is considered the Gold Standard of demolishing methods because its results are superior to laser treatment. CHIVA is directly compared to Laser ablation in a work. The conclusions are that the CHIVA treatment is superior to that with Laser in terms of post-operative pain and cosmetic results.

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     Evidence Based Medicine (EBM) bases its therapeutic choices on proof of effectiveness, that is, on clinical scientific double blind studies and not on expert opinions. The most quoted proof of efficiency are the ones in the Cochrane Library Review and the Randomized Controlled Evidence-A Trials.     

How the CHIVA treatment is performed.

A complete varicose vein mapping is performed during the first examination. This allows the type of conservative strategy treatment that will be performed to be defined. A new venous mapping is carried out immediately before surgery and this time, the points where the ligations will be made are marked on the skin. The surgeon who will perform surgery does the venous mapping. Once mapping is finished, the patient is accompanied into the operating room where a local anesthetic is only injected into the marked points. Once surgery is completed, the patient can walk normally, does not need to wear an elastic stocking, or be bandaged up to the thigh. Stitches are removed a week later and an ultrasound venous mapping is repeated. During this period, the patient does not need to be medicated at home.

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What the patient can and cannot do after surgery
activitySurgerySurgery evening1 day after 1 week after8 days after
Elastick stockings NO NO YESYESYES
Usual Activitys NO NO YESYESYES
Lift weights NO NO NO YESYES
Take a shower NO NO NO NO YES

Where does blood go when the saphenous vein is removed?

Without the saphenous vein, the blood must reach the deep veins directly from the tributaries. The saphenous vein is a collecting header and, together with the veins connecting it to the deep system, can ensure a good venous return in all situations. When the saphenous vein is removed, the blood must find a path that is different from its natural one. Therefore, an obstacle to blood drainage occurs without the saphenous vein. This obstacle is responsible for stagnation in the superficial tissues that, in some patients, can lead to the appearance of spider veins and blue reticular veins.

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     The obstacle to blood drainage resulting from saphenous vein ablation is responsible for 20% of varicose vein recurrences. These recurrences cannot be re-operated because once the saphenous vein is removed it cannot be replanted.     
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