CHIVA Strategy:
Conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire
CHIVA is not a surgical technique but rather a therapeutic strategy, that assesses each patient’s hemodynamics and tries to restore the normal pressure loads (closest to the physiological values) on the Shunt veins.
The CHIVA strategy is based on the belief, validated by clinical evidence, that the varicose veins are a reaction to the increased workload that the veins of a Shunt undergo. In order to copy the natural reaction of the veins to an increase in pressure loads, the veins must be dilated to accommodate the volumes of blood of the Shunt.
The dilatation, proportional to the compliance of the wall and the endoluminal pressure, is a consequence of the increase in transmural pressure.
This method is centred on haemodynamics, so once the haemodynamic disorder is eliminated, the varicose veins can recover proportional to the compliance of the wall and to symptoms while preserving the veins and drainage system.
This model involves an overall approach to the whole cardio-circulatory system. The goal is the recovery of the system for the drainage of the tissues.
The haemodynamic strategy has a complete different approach to the long-established system that is centered only on the varix and involves the material elimination of the varicose vein.
The vein can be surgically removed or its fibres can be transformed with sclerotherapy, radiofrequency of steam.
The system is centered on the varicose vein only focuses on vein dilation, considering the vein irrecoverable without performing a proper hemodynamic examination of the system. Therefore, it is not interested in restoring the draining capacity of the system.
The CHIVA strategy is the result of haemodynamic Doppler studies, of the consequent understanding of the basic phenomena of the physiology of the circle, and represents the obvious conclusion and application of all this knowledge.
Those who understand the reasons for venous haemodynamics won’t fail to comprehend the reason for CHIVA strategy.
The conservative hemodynamic surgery, through CHIVA strategy, aims to:
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Preserve the drainage of the tissues, with the preservation of the heart pre-load and thermoregulation capacity. It is believed that when a venous refluent system becomes outflowing, that is to say draining, it also becomes more stable and there is a lower percentage of relapses over the time;
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Preserve the saphenous veins for use in possible future bypasses.
The therapeutic result is achieved through the disconnection of the Shunt and the fractionation of the hydrostatic pressure column.
It’s a method that produces remarkable advantages, such as:
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Maintaining optimal natural blood circulation;
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The preservation of the saphenous vein;
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-invasive operation performed on outpatient with local anaesthesia;
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Fast post-operative recovery;
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Reduced numbers of relapses.
Learn more about the topic by reading the following papers:
Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins
Paper published by Roberto Delfrate, Massimo Bricchi, Claude Franceschi and Matteo Goldoni in the scientific journal “Veins and Lymphatics”. The aim of this paper is to compare and analyse different techniques of conservative ligatures or disconnections of the saphenous femoral vein. These techniques can be performed with the CHIVA conservative hemodynamic surgical technique.
Surgical treatment of inguinal escape point: I point; and map of haemodynamic evaluation
This video realized by Dr Roberto Delfrate and Dr Massimo Bricchi shows a CHIVA surgical treatment and a haemodynamic mapping of an inguinal escape point.
It was filmed live at the Figlie di San Camillo Clinic in Cremona.
Chiva an example Shunt I + Shunt II Haemodynamic correction.
Video realized by Dr. Claude Francesci, Dr. Roberto Delfrate and Dr. Massimo Bricchi.
Vascular Malformations
Presentation by Claude Franceschi, Claude Laurian, Amine Bahnini, Roberto Delfrate, Massimo Bricchi, Claudine Massoni, Annouk Bisdorff
