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

Chiva corrects venous insufficiency by suppressing hemodynamic overload and by preserving veins for optimal tissue drainage with the simplest and less traumatic procedures.

The strategy of the C.H.I.V.A Strategy applies hemodynamic principles of column pressure fractionation, venous shunt disconnection*, and preservation of venous drainage.

C.H.I.V.A represents a physiologic approach to the surgical treatment of varicose veins based on knowledge of the underlying venous pathophysiology gained through detailed duplex scanning. A change in venous hemodynamics is attained through fragmentation of the blood column by interruption of the refluxing saphenous trunks, closure of the origin of the refluxing varicose branches, and preservation of the communicating veins that drain the incompetent varicose veins into the deep venous system. After surgery, varicose veins regress through a reduction in hydrostatic pressure and efficient emptying of the superficial system by the musculo-venous pump.


An important concept in the understanding of C.H.I.V.A is the fact that retrograde flow through a venous segment drained into the deep system by a perforator vein may constitute an adequately drained superficial venous system.

Obvious advantages of this technique are that it is done in an ambulatory setting, minimizes the risk of surgical complications, and permits a rapid return to full activity.

A veno-venous shunt is defined as a short circuit between the deep and the superficial veins where the flow direction is inverted because of valve incompetence.

Chiva technique, varicosesC.H.I.V.A therapy consists in stopping reflux and diverting it back into competent deeper veins through a sophisticated system of precisely placed ligations. The saphenous veins are deliberately preserved, not only for by-pass but primarily for functional purposes, while at the same time treating the varicose disease.

Therefore C.H.I.V.A is far less traumatic than conventional surgery

This is how it is done:

  • Preoperative Duplex mapping is a key phase and an integral part of the intervention: points where the superficial venous system has to be interrupted are selected and marked on the surface of the limb.
  • Under local anesthesia, very small cuts are performed and the diseased vein is caught with a tiny hook. The reversed blood flow is stopped by double ligatures, and the cut closed by a steri-strip.

These ligatures are performed in sites specific to the individual, usually where the main superficial vein intersects with communicating veins. This allows the flow to bypass the superficial vein and directly enter the deep vein, in turn reducing the excessive pressure in the superficial veins and restoring normal venous blood flow.

Result: The venous pressure is normalized, and the vein diameter will normalize instantaneously or within 6 - 8 weeks.