C.H.I.V.A: NON DESTRUCTIVE TREATMENT OF VARICOSE VEINS

F.A.Q. about C.H.I.V.A.

What are varicose veins?

Varicose veins are veins that may appear purple or blue, twisted and bulging close to the surface of the skin. The most common area for varicose veins to appear are the backs of the calves or on the inside of the legs, but they can form anywhere on the legs, from the groin to the ankle.

What is chronic venous insufficiency?

Chronic venous insufficiency is an advanced stage of venous disease caused either by superficial or deep venous pathology, in which venous return is impaired, usually over a number of years, by reflux, obstruction or calf muscle pump failure. This leads to sustained venous hypertension and ultimately to clinical complications including oedema, eczema, lipodermatosclerosis and ulceration.

What causes varicose veins?

Varicose veins develop when you have faulty valves in your veins and weakened vein walls. Normally, the one-directional valves in these veins keep the blood flowing efficiently against gravity up toward the heart. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. One popular explanation for the production of incompetent venous valves is an inherent structural weakness of the veins themselves. The most striking feature of this problem is the positive family history usually obtained. The hemodynamic factors play a significant role in producing primary varicosities. The most important of these is the high hydrostatic pressure to which the veins to the lower extremities are subjected as a result of the patient standing. Other factors include heavy muscular work such as lifting, repeated straining at stool, pregnancy, and other situations which increase intra abdominal pressure.

What are the symptoms of varicose veins?

The reflux towards the feet and the high pressure are responsible for:

  • Heaviness in the legs and cramps (especially nocturnal)
  • Pain, a feeling of unrest, numbness and burning sensation in the legs.
  • Swelling of the ankles at the end of the day.
  • Itching (sometime severe itching) and varicose eczema.
  • Permanent skin hyperpigmentation around ankles: this is varicose dermatitis. It is like a tattoo on the skin which it is better to avoid because it is permanent and anti-aesthetic.
  • When tissues are distended and not normally supplied by blood a varicose ulcer appears. In the varicose vein the blood flows slowly at counter stream and there is a risk that a clot will form in the varicose vein. This is superficial phlebitis, which is a warning and demands effective treatment (anti clotting and anti-inflammatory treatment).
  • If the clot moves to deep veins, it is phlebitis, which is a serious complication.
  • If it migrates to the heart or lungs, it is a pulmonary embolia. The risk of this accident, luckily exceptional, may be increased by certain circumstances like prolonged bed rest or surgical operation. That's why it is important to prevent complications of varicose veins.

Why should varicose veins be treated?

Most patients with chronic venous disorder have subjective symptoms that may be very mild or very severe. In most cases the blood reflux causes leg pain and heaviness, which are relieved by the conservative treatment.

Varicose veins do not get better by themselves; indeed they get worse slowly and progressively. The hemodynamic perturbations serve no useful purpose.

Early treatment often prevents the symptoms developing and, of course, removes the unsightly appearance. In fact, the earlier you receive specialist treatment the better the long term clinical and cosmetic results.

What is C.H.I.V.A.? What does it mean?

Conservative (preserving) Hemodynamic treatment of Insufficiency of the Venous system in an Ambulatory setting.

Conservative because this method proposes the preservation of the native superficial venous system, not only for prosthetic use but primarily for functional purposes, while at the same time treating the varicose disease.

Hemodynamic because this method is founded on the concept that symptoms and manifestations (including varicose veins themselves) of venous insufficiency, are due to a perturbed hemodynamic.

Ambulatory or outpatient setting because the surgical procedure is performed in a day-surgery setting under local anesthesia, with a view to cost containment and reduction of the waiting period, since the disease has high social impact.

How is C.H.I.V.A. performed?

Interpretation of venous hemodynamic using duplex ultrasound signals allows a careful mapping of the patient venous system. Points where the superficial venous system is to be interrupted are selected and marked on the surface of the limb. A local anesthetic is injected around the marked points and through small incisions a series of ligations of the superficial venous system are performed with the primary aims of relieving the stress on the superficial venous system from overload created by reflux and of constructing the most stable emptying system possible for the superficial blood. The saphenous veins are preserved.

Will I need to be hospitalized or take time off from work?

Treatment is on an outpatient basis, under local anesthesia. You can resume most activities shortly after the procedure.

What is the difference between conservative treatment and vein stripping?

Stripping, sclerotherapy, VNUS closure procedure and laser treatment aim to remove or destroy varicose veins and therefore shifts the problem onto other veins that will eventually lose normal function. Conservative treatment aims to correct the blood flow using bypasses so that veins are not destroyed. C.H.I.V.A treatment needs a specifically trained angiologist for Duplex mapping.

What are C.H.I.V.A. results?

C.H.I.V.A clinical, functional and esthetic results are better than those obtained by destructive techniques according to control trials (see bibliography). Furthermore C.H.I.V.A. has much less recurrences and permits the conservation of main superficial veins for potentially need heart or limbs artery bypass.

Why is C.H.I.V.A. not equally developed all over Europe?

Because it is founded on new hemodynamic venous concepts which require a revision of previous theories and a real capacity in dealing with venous duplex. In fact while Doppler ultrasound and color Doppler flow imaging have a signal display that is well codified, standardized and widely used for arteries, their use with veins is sparse and certainly underutilized in the light of their enormous potential.