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Immediate and long-term evolution assessment after surgery on the saphenous vein with the modified CHIVA technique

Marta Osorio de Moraes, Eliane Yumi Fuji, Francisco Winter dos Santos Figueiredo, Jonathan Souza Sarraf, Taynah Cascaes Puty, Wallingson Michael, Fernando Adami, Joao Antonio Correa



The preservation of the great saphenous vein (GSV) has increasingly been considered when surgery for the treatment of varicose veins is indicated when complications from degenerative diseases, such as atherosclerosis at a coronary level and peripheral venous insufficiency occur. Thus, the autologous GSV is considered the best substitute for arterial revascularization. The technique that preserves the great saphenous vein is the Conservative Ambulatory Hemodynamic Management of Varicose Veins (CHIVA), which is widely used. Considering the importance and the use of this technique, the objective of this study was to evaluate the immediate and long-term evolution after surgery on the saphenous vein with the modified CHIVA technique.

Materials and Methods

A prospective observational study with data from individuals who underwent surgery for the preservation of the GSV by the modified CHIVA technique with the removal of varicose tributaries without ligation of the saphenofemoral junction. Data collection was performed from March 2014 to January 2015 at Padre Anchieta Hospital in Sao Bernardo do Campo, São Paulo. The variables were the great saphenous vein patency assessed by means of vein diameter, as described above, and the presence or not of reflux during the preoperative assessment, on the 30th day after surgery, and at the sixth month after surgery.


The main results showed that there were no statistically significant differences in the saphenous vein diameter in any of the evaluated segments and in regard to the presence of reflux when comparing the pre-operative period to 30 days after CHIVA and to six months after CHIVA.


This study did not show change in the diameter of the veins, nor recurrence of reflux in the lower limbs, thus, it showed good results in the short, medium, and long term. There was no relationship between the diameter reductions of veins during the follow-up period.  


CHIVA technique; saphenous vein; long term

Full Text


Franceschi C. Pour une cure conservatrice et hemodynamique de l'insufficience veineuse en ambulatoire: CHIVA. Angiologie. 1988;72:99-100.

Maffei F, HA R. Trombose venosa profunda dos membros inferiores: incidência, patologia, fisiopatologia e diagnóstico. Doenças vasculares periféricas. 2002;3:1363-86.

Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004;44(11):2149-56. doi: 10.1016/j.jacc.2004.08.064

Giannini M, Rollo HA, Maffei FHdA. Role of duplex scanning in the diagnosis of asymptomatic lower-extremity deep vein thrombosis. Jornal Vascular Brasileiro. 2005;4(3):290-6. doi: 10.1590/S1677-54492005000300012.

Myers K, Wood S, Lee V, Koh P. Variations of connections to the saphenous system in limbs with primary varicose veins: a study in 1481 limbs by duplex ultrasound scanning. J Phlebol. 2002;2:11-7.

Hammarsten J, Pedersen P, Cederlund C-G, Campanello M. Long saphenous vein saving surgery for varicose veins. A long-term follow-up. European journal of vascular surgery. 1990;4(4):361-4.

Sarquis A. Avaliação pré e pós-operatória no tratamento cirúrgico conservador de varizes tronculares com o duplex scan a cores. Cir Vasc Angiol. 1996;12(4 supl):9-11.

Al-Assal F, Gomes A, Al-Assal R, Maffei F, Lastória S, Yoshida W, et al. Tratamento cirúrgico da hipertensão venosa crônica. Maffei FHA, Lastória S, Yoshida WB, Rollo HA Doenças vasculares periféricas 3ª ed São Paulo: Medsi. 2002.

Munn S, Morton J, Macbeth W, Mcleish A. To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg. 1981;68(6):426-8.

Lane R, McMahon C, Cuzzilla M. The treatment of varicose veins using the venous valve cuff. Phlebology. 1994;9(4):136-45. doi: 10.1177/026835559400900402.

Zamboni P, Gasbarro V, Marcellino MG, Murgia AP, Feo C, Liboni A, et al. External valvuloplasty of the saphenofemoral junction. Vasc Endovascular Surg. 1994;28(5):327-36. doi: 10.1177/153857449402800504.

McMullin G, Smith P, Scurr J. Objective assessment of high ligation without stripping the long saphenous vein. Br J Surg. 1991;78(9):1139-42.

Franceschi C. CHIVA effectiveness score: the correct one is below. Eur J Vasc Endovasc Surg. 2012;44(3):351. doi: 10.1016/j.ejvs.2012.06.027.

Zamboni P, Cisno C, Marchetti F, Mazza P, Fogato L, Carandina S, et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. Eur J Vasc Endovasc Surg. 2003;25(4):313-8. doi:10.1053/ejvs.2002.1871.

Carandina S, Mari C, De Palma M, Marcellino M, Cisno C, Legnaro A, et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg. 2008;35(2):230-7. doi: 10.1016/j.ejvs.2007.09.011.

Mendoza E, Berger V, Zollmann C, Bomhoff M, Amsler F. Kaliberreduktion der V. saphena magna und der V. femoralis communis nach CHIVA. Phlebologie. 2011;40(2):73-8.

Cappelli M, Lova RM, Ermini S, Turchi A, Bono G, Bahnini A, et al. Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years. Ann Vasc Surg. 2000;14(4):376-84.

Michaels JA, Campbell W, Brazier J, Macintyre J, Palfreyman S, Ratcliffe J, et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess. 2006;10(13):1-196, iii-iv.

Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2013;(7):CD009648. doi: 10.1002/14651858.CD009648.pub2.



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