Treatments for varicose veins (V): CHIVA and Müller’s phlebectomy

Haz clic aquí para leer este artículo en Español

 

In this issue I’ll explain about two different surgical techniques for varicose veins, which can be both used separately or in a combined way.

C.H.I.V.A. method.

The C.H.I.V.A. strategy was defined by Dr. Franceschi (a French Psychiatrist, actually) in 1988. In a free translation from French means “Conservative and Hemodinamical Ambulatory Cure of Venous Insufficiency”.

This treatment is based on one concept: the veins are not the disease themselves but just a consequence of a circulatory disorder that overloads the vein (usually referred to one of the saphenous veins). Therefore, a minimal surgery is performed just to eliminate the hyperpressure mechanism without removing the vein itself, which will remain inside the body.

The procedure involves preoperative marking of the skin with a pen using a Duplex Ultrasound to find the spots where the surgeon needs to act, and then – usually under local anesthesia – close the veins at the places where the insufficient valves are, forcing the blood to find other pathways to return that are working properly. It would be similar to closing several of the possible ways of a maze, leaving open only one easy and fast route to the exit.

However, the dilated vein is not extracted. This makes it a less aggressive surgery and can be performed without hospital admission and with a much shorter recovery period.

There is considerable controversy among surgeons (“saphenectomy supporters” and “CHIVA Cure supporters”), being quite common that the surgeon who supports one of them is openly against the other one. The comparative scientific studies that have been performed until now are not totally conclusive because – according to the experts that analysed them – they do not provide enough methodological quality (they are not strictly well performed); sometimes this happens because those who have conducted the studies have a preference for one of the techniques over the other, and unconsciously favor its results (that is what in science we call “bias“).

Most likely, reality is that both techniques provide similar long-term results. Probably the wisest thing would be to appropriately select which patients are best candidates for every one of them, although it’s not frequent that the same surgeon is a supporter of both techniques. In any case the really important thing when selecting a technique is the surgeon having enough expertise in how to perform it: it’s far better a saphenectomy well performed by someone who knows how to do it than a CHIVA performed by someone inexperienced. And vice versa.

Finally note that much of the advantages offered by the CHIVA cure (less aggressive, faster recovery and feasible as outpatient surgery, which means no need for in-hospital admission, all of them great marketing tools indeed) seem to have been overcome in recent years by other minimally invasive techniques such as sclerotherapy or endovenous thermal ablation (laser or radiofrequency), which will be discussed later.

Müller’s phlebectomy.

Müller’s phlebectomy is a simple and minimally invasive surgical technique that allows removal of side branches or small isolated varicose veins (tributary varicose veins) through tiny incisions (2 or 3mm). For small isolated veins it can be carried out under local anesthesia and on an outpatient basis, or it can be used to complement any of the other techniques (stripping, C.H.I.V.A., laser / radiofrequency…) to remove the collateral branches.

phlebectomy

Along the vein to be treated these tiny incisions are performed at regular intervals (every 3-5 cm, approximately), and through them it is possible to “hook” and ligate (occlude) or remove it. The incisions are so small that they often do not even need stitches to close. After the procedure, as usual, compression stockings have to be worn for some time.

To illustrate this technique, below you’ll find a video showing how this easy procedure is carried out. The first part of this movie is an animation, but please be warned that the second part is actually a real surgical procedure (that could be disgusting for some sensible persons):


 

Jorge Molina
Dr. Jorge Molina is a Spanish doctor specialized in Angiology, Vascular Surgery and Cosmetic Medicine. He is currently residing in Abu Dhabi (UAE), and works as a Consultant and Head of Vascular Surgery and Wound Care Departments in Healthpoint hospital, in Zayed Sport City, Abu Dhabi. He is the author and editor of “Medicine Made Easy”, a book collection aimed to disclose medical topics of interest to the general public in an easy and friendly manner.

 

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10 Responses to Treatments for varicose veins (V): CHIVA and Müller’s phlebectomy

  1. Pingback: Tratamientos de las varices (V): CHIVA y flebectomía de Müller - La Medicina hecha fácil

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    • Jorge says:

      Thank you very much, it´s very nice from you.

      Trying to offer useful information is the purpose of this blog.

  5. RMAU says:

    Surgeries have been performed for over a century, from the more invasive saphenous stripping, to less invasive procedures like ambulatory phlebectomy and CHIVA.

  6. BrandenZCzap says:

    Hello, I would like to subscribe for this blog to obtain most recent updates, so where can i
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    • Jorge says:

      Thank you very much for your valuable comment!

      I updated the site, so now there is a field on the right side of the screen ONLY ON THE POST VIEW.

      You can enter any post, and in the right column you will find a “Subscribe to Blog via Email”.

      Thanks again for visiting!

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