https://doi.org/10.4081/vl.2023.11886
The troubled course of the CHIVA Cure through clinical studies: a critical review
Submitted: 27 September 2023
Accepted: 10 October 2023
Published: 10 October 2023
Accepted: 10 October 2023
Abstract Views: 962
PDF: 89
HTML: 12
HTML: 12
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases.
Franceschi C. La cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire. Precy-sous-Thil, France: Editions de L’Armançon. 1988.
Cappelli M, Molino Lova R, Pinelli M, Franceschi C. Are saphenous sparing treatments beneficial to the hemodynamics of the venous system? Journal of Theoretical and Applied Vascular Research 2022;7.
DOI: https://doi.org/10.24019/jtavr.149
Iborra-Ortega, Vila R, Barjau E, Cairols MA. Surgical treatment of varicose veins: comparative study between two different techniques. Phlebology 2006;21:152.
Carandina S, Mari C, De Palma M, et al. Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a Long Term Randomized Trial. Eur J Vasc Endovasc Surg 2008;35:230-7.
DOI: https://doi.org/10.1016/j.ejvs.2007.09.011
Parés O, Jordi J, Tellez R, et al. Stripping vs the CHIVA method: A Randomized Controlled Trial, Ann Surg 2010;251:624-31.
DOI: https://doi.org/10.1097/SLA.0b013e3181d0d0a3
Wang H, Chen Q, Fei Z et al. Hemodynamic classification and CHIVA treatment of varicose veins in lower extremities (VVLE). International Journal of Clinical and Experimental Medicine 2016;9:2465-71.
Gonzàlez Cañas E, Florit López S, Vives Vilagut R, et al. A randomized controlled noninferiority trial comparing radiofrequency with stripping and conservative hemodynamic cure for venous insufficiency technique for insufficiency of the great saphenous vein. Vasc Surg: Venous and Lym Dis 2021;9:101-12.
DOI: https://doi.org/10.1016/j.jvsv.2020.04.019
Bellmunt-Montoya S, Escribano JM, Dilme J, et al. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2015;6:CD009648.
DOI: https://doi.org/10.1002/14651858.CD009648.pub3
Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, et al. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2021;30;9:CD009648.
DOI: https://doi.org/10.1002/14651858.CD009648.pub4
Hobbs JT. Surgery or sclerotherapy for varicose veins: 10-year results of a random trial. Lancet 1978;27:1149.
DOI: https://doi.org/10.1016/S0140-6736(78)90321-5
Perrin M, Allaert FA. Intra- and inter-observer reproducibility of the Recurrent Varicose Veins after Surgery (REVAS) classification. Eur J Vasc Endovasc Surg 2006;32:326-32.
DOI: https://doi.org/10.1016/j.ejvs.2006.02.018
Higgins J, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
DOI: https://doi.org/10.1136/bmj.d5928
Franceschi C. Shunt classification, in: Principles of venous hemodynamics. New York, USA: Nova Biomedical Books. 2009.
Bailly MJ. Mappaggio CHIVA in: Encyclopédie Médico–Chirurgicale. Paris, France: Elsevier. 1995.
Cappelli M, Molino Lova R, Ermini S, et al. Ambulatory Conservative Hemodynamic Management of Varicose Veins: Critical Analysis of Results at 3 Years. Ann Vasc Surg 2000;14:376-384.
DOI: https://doi.org/10.1007/s100169910064
Cappelli M, Molino Lova R, Ermini S. Chirurgia conservativa emodinamica, in: Chirurgia delle vene e dei linfatici. Milano, Italy: Masson S.p.A. 2003.
De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022;63:184-267.
DOI: https://doi.org/10.1016/j.ejvs.2022.06.022
Siribumrungwong B, Noorit P, Wilasrusmee C, et al. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vasc Endovasc Surg 2012;44:214e23.
DOI: https://doi.org/10.1016/j.ejvs.2012.05.017
Rasmussen L, Lawaetz M, Serup J, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord 2013;1:349e56.
DOI: https://doi.org/10.1016/j.jvsv.2013.04.008
Hamann SAS, Giang J, De Maeseneer MGR, et al. Five-year results of great saphenous vein treatment: a meta-analysis. Eur J Vasc Endovasc Surg 2017;54:760e70.
DOI: https://doi.org/10.1016/j.ejvs.2017.08.034
Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord 2018;6:256e70.
DOI: https://doi.org/10.1016/j.jvsv.2017.10.012
Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med 2019;381:912e22.
DOI: https://doi.org/10.1056/NEJMoa1805186
Cao G, Gu HC, Wang JT, et al. Comparison of endovenous laser treatment and high ligation in treatment of limb varicosity: a meta-analysis. Int Wound J 2019;16:696e702.
DOI: https://doi.org/10.1111/iwj.13083
O’Donnell TF, Balk EM, Dermody M, et al. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 2016;4:97e105.
DOI: https://doi.org/10.1016/j.jvsv.2014.11.004
Milone M, Salvatore G, Maietta P, et al. Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience. G Chir 2011;32:460e3.
Gloviczki P, Comerota AJ, Dalsing MC, et al The care of patients with varicose veins and associated chronic venous diseases. J Vasc Surg 2011;53:2S-48S.
DOI: https://doi.org/10.1016/j.jvs.2011.01.079
Zamboni P, Cisno C, Marchetti F, et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. Eur J Vasc Endovasc Surg 2003;25:313-8.
DOI: https://doi.org/10.1053/ejvs.2002.1871
Franceschi C. CHIVA 30 years later. Scientific and ethical considerations. Veins and Lymphatics 2019;8:8229.
DOI: https://doi.org/10.4081/vl.2019.8229
Franceschi C. Ethics and rationale for sparing the saphenous vein. Veins and Lymphatics 2022;11:10809.
DOI: https://doi.org/10.4081/vl.2022.10809
Twine CP, McLain AD. Choice of bypass graft material for lower limb arterial bypasses. Cochrane Database of Systematic Reviews 2010;5:CD001487.
Klinkert P. Vein versus polytetrafluoroetylene in above knee bypass grafting: five years follow up. J Vasc Surg 2003;31:149-55.
DOI: https://doi.org/10.1067/mva.2002.86
Siracuse JJ. Results of primary bypass versus primary angioplasty/stent fort intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg 2012;55:1001-7.
DOI: https://doi.org/10.1016/j.jvs.2011.10.128
Mendoza E. Diameter reduction of the great saphenous vein and the common femoral vein after CHIVA Long–term results. Phlébologie, 2013,42:65-9.
Delfrate R. Thanks to the CHIVA strategy may the histo-architecture of great saphenous vein-sparing, make it suitable as graft for bypasses? Veins and Lymphatics 2019;8:8227.
DOI: https://doi.org/10.4081/vl.2019.8227
Zamboni P, Spath P, Tisato V, et al. Oscillatory flow suppression improves inflammation in chronic venous disease. J Surg Res. 2016;205:238-45.
DOI: https://doi.org/10.1016/j.jss.2016.06.046
Sessa C, Fayard P, Bakassa-Traore S et al. Quel devenir des greffons veineux issus d'une veine variqueuse. Phlébologie 1998;51:343-7.
Fattoum M, Kennel S, Knez P, et al. Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein, J Vasc Surg 2016;64:819-23.
DOI: https://doi.org/10.1016/j.jvs.2016.06.004
Balshem H, Helfand M, Schunamann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401-4.
DOI: https://doi.org/10.1016/j.jclinepi.2010.07.015
Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66:719-25.
DOI: https://doi.org/10.1016/j.jclinepi.2012.03.013
Guo L, Huang R, Zhao D, et al. Long-term efficacy of different procedures for the treatment of varicose veins: a network meta-analysis, Medicine 2019;98:7(e14495).
DOI: https://doi.org/10.1097/MD.0000000000014495
How to Cite
Cappelli, M., Molino Lova, R., Pinelli, M., & Franceschi, C. (2023). The troubled course of the CHIVA Cure through clinical studies: a critical review. Veins and Lymphatics, 12(1). https://doi.org/10.4081/vl.2023.11886
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
