CHIVA method

CHIVA is not an ablation technique, but a strategy. Its principle is to correct the hemodynamic disorder while preserving the venous capital, rather than by removing the vein. In this it stands against the classic ablative logic.

The principle: preserving the vein

Most reflux treatments remove the incompetent venous segment, by stripping or by ablation. The CHIVA method proceeds otherwise. It seeks to reduce the pressure overload that dilates the vein, without removing it.

The reasoning is hemodynamic. Reflux creates pressure columns, heights of blood that bear on the vein wall. By interrupting these columns at precise points, the escape points, the pressure is lowered without sacrificing the trunk, which can return to a normal caliber. The preserved vein remains available, which is the central argument of the strategy.

Duplex ultrasound mapping

The method rests on a prior mapping, performed by duplex ultrasound. This examination establishes the reflux pattern specific to each patient, identifies the escape points and the drainage routes to preserve.

This mapping is not an accessory prerequisite, it is constitutive of the strategy. It is what determines where to act to interrupt the pressure columns while respecting physiological drainage. Without it, the hemodynamic approach has no action plan. The precision of the mapping governs the outcome.

Application by HIFU

The CHIVA method was first described with surgical disconnection gestures at the escape points. A study reported its application, following the same hemodynamic principles, by means of HIFU treatment, which closes the escape points from outside the body, without incision.

This study reported a primary occlusion rate of the escape points of 95.5% across 204 limbs. This result qualifies the occlusion of the targeted points, within the framework of a given study. It describes a documented practice, on a defined series, and does not constitute an individual prognosis. The pairing of a vein-preserving strategy with a modality without breach makes this approach an object of its own, distinct from purely ablative treatments.