CHIVA Achieves the Lowest Recurrence Rate Compared to Other Treatments for Varicose Veins

A recent systematic review and network meta-analysis on treatments for great saphenous vein insufficiency (GSVI) highlighted the CHIVA method (Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire) for its superior ability to reduce recurrence rates. 

As a vascular surgeon, I’d like to explore why CHIVA achieves such low recurrence rates, how it compares to other treatments, and the advantages it offers for re-treatment in cases where recurrences do occur.

Recurrence Rates in Varicose Vein Treatments

According to current clinical studies and literature, the 5-year recurrence rates for major varicose vein treatments are approximately as follows:

• Radiofrequency Ablation (RFA) and Endovenous Laser Ablation (EVLA): Recurrence rates generally fall between 10% and 30%.
• High Ligation and Stripping (HL/S): Recurrence rates vary widely, typically between 20% and 40%.
• CHIVA: Due to its conservative, hemodynamic approach, CHIVA has lower recurrence rates in some studies, typically around 10% to 20%.

Reasons for CHIVA’s Low Recurrence Rate

1. Unique Treatment Concept: Restoring Hemodynamic Balance

   • Unlike ablative methods such as HL/S and EVLA, which aim to eliminate the affected veins, CHIVA is based on preserving veins and redirecting blood flow to restore hemodynamic balance. By rerouting or redistributing blood flow, CHIVA alleviates venous pressure and reduces symptoms while keeping the vein structure intact. This hemodynamic approach helps to prevent recurrence, as it focuses on normalizing blood flow rather than removing veins.

2. Preservation of Vein Structure and Function

   • CHIVA does not involve direct removal of diseased veins. Instead, it utilizes selective ligation and blood flow diversion to redistribute blood through healthy channels. This method avoids the thermal damage and fibrosis seen in ablative treatments, reducing the risk of recurrence due to tissue repair and scarring. Additionally, by preserving vein integrity, CHIVA minimizes the likelihood of new vessel formation, a common cause of recurrence in ablation techniques.

3. Personalized Strategies

• Based on detailed hemodynamic assessments, CHIVA can implement multiple blood flow diversion strategies, allowing for highly personalized and precise treatment. This flexibility enables CHIVA to accommodate diverse anatomical and hemodynamic characteristics among patients, effectively reducing residual disease and the risk of recurrence.

Characteristics of Recurrence in CHIVA Cases

While CHIVA has a relatively low recurrence rate, some recurrences may still occur. These cases often exhibit distinct characteristics compared to recurrences from other treatments:

1. Recurrence Due to Hemodynamic Changes

   • In CHIVA, recurrence is typically due to the progression of venous disease, resulting in further hemodynamic changes or new Escape Point in untreated areas. Unlike ablation or stripping techniques, recurrences in CHIVA are rarely caused by neovascularization or fibrosis. Instead, they are more often associated with decreased effectiveness of initial flow diversion or new venous insufficiency.

2. Milder Recurrence Symptoms

   • Because CHIVA preserves the vein structure, even if recurrence occurs, symptoms are generally less severe. Patients tend to experience fewer subjective discomforts compared to recurrences following ablation or stripping, where neovascularization and scar tissue can obstruct blood flow and exacerbate symptoms.

Advantages of Re-Treatment for CHIVA Recurrences

For patients who experience recurrence after CHIVA, re-treatment options are particularly flexible and offer unique benefits:

1. High Feasibility of Repeat CHIVA Treatment

   • Because the vein structure is preserved during initial CHIVA treatment, re-treatment can often be conducted with the same hemodynamic approach. Physicians can re-evaluate the patient’s hemodynamics and design a new diversion strategy to redistribute blood flow effectively. This approach lowers the risks associated with repeat surgeries and avoids further tissue damage.

2. Minimally Invasive, Faster Recovery

   • Re-treatment after CHIVA is typically minimally invasive compared to procedures requiring additional stripping or extensive ablation. Patients benefit from less trauma and faster recovery, allowing them to resume daily activities sooner and minimizing functional loss due to surgery.

3. Reduced Risk of Neovascularization

   • Because CHIVA preserves vein integrity, it minimizes the risk of neovascularization in re-treatment. This contrasts with ablation techniques, where recurrences are often linked to the formation of new blood vessels. As a result, CHIVA re-treatments tend to have better long-term stability.

CHIVA demonstrates excellent performance in reducing recurrence rates for GSVI by focusing on restoring hemodynamic balance and preserving vein structure. In cases of recurrence, CHIVA offers the advantage of flexible and minimally invasive re-treatment options, which reduce trauma, promote faster recovery, and prevent new vessel formation. As research into CHIVA’s efficacy deepens, we gain a better understanding of its unique role in treating venous insufficiency, allowing us to provide a high-quality treatment experience with favorable long-term outcomes.

I hope these insights provide valuable guidance for vascular surgeons considering treatment options for GSVI. As we continue to explore and share experiences with CHIVA and its re-treatment potential, we contribute to the evolution of varicose vein treatment for the benefit of patients worldwide.