Saphenous Sparing Strategy in the CHIVA Context

  • Erika MendozaEmail author


Since its publication in 1988 by Claude Franceschi, lots of professionals of phlebology have understood the challenge and learned about venous networks, reflux and drainage pathways, shunt types and venous function restoration. Depending on the shunt type, different treatment decisions are possible and necessary. This chapter aims to explain the single steps to decide which treatment to apply to which patient with superficial venous reflux. It starts explaining the definitions used in the international CHIVA group. Then the treatment options in case of each possible compartment jump are explained. Finally, the treatment strategy depending on the shunt type is summarised and illustrated with clinical examples. An essential basis to understand and take profit from this chapter is the comprehension of shunt types as described in Sects.  3.7–3.9, based on the knowledge acquired in Chap.  2 (functional anatomy), Chap.  3 (physiology) and Chap.  4 (duplex ultrasound investigation).



Anterior accessory saphenous vein


Great saphenous vein


Posterior accessory saphenous vein


Reflux elimination test


Sapheno-femoral junction


Sapheno-popliteal junction


Small saphenous vein


  1. 1.
    Hammersen F, Hesse G. Strukturelle Veränderungen der varikösen Venenwand nach Kompressionsbehandlung. Phlebol Proktol. 1990;19:193–9.Google Scholar
  2. 2.
    Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2012;2:CD009648. Scholar
  3. 3.
    Franceschi C, Cappelli M, Ermini S, Gianesini S, Mendoza E, Passariello F, Zamboni P. CHIVA: hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8–30; Epub 2015 Jun 5.PubMedGoogle Scholar
  4. 4.
    Franceschi C, Zamboni P. Principles of venous haemodynamics. New York: Nova Science; 2010.Google Scholar
  5. 5.
    Franceschi C. Théorie et pratique de la cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire. Precy-sous-Thil, France: Editions de l’Armançon; 1988.Google Scholar
  6. 6.
    Padberg FT Jr, Pappas PJ, Araki CT, et al. Hemodynamic and clinical improvement after superficial vein ablation in primary combined venous insufficiency with ulceration. J Vasc Surg. 1997;26:169–71.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    Mendoza E. Diameter reduction of the great saphenous vein and the common femoral vein after CHIVA long-term results. Phlebologie. 2013;42:65–9.CrossRefGoogle Scholar
  9. 9.
    Marshall M, Breu FX. Handbuch der Angiologie. 13. Erg.-Lfg ed. Landsberg: Ecomed; 2005.Google Scholar
  10. 10.
    Mendoza E. Handbuch CHIVA. Arrien GmbH; 2002.Google Scholar
  11. 11.
    Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose vein: five-year results of a randomized trial. J Vasc Surg. 1999;29:589–92.CrossRefGoogle Scholar
  12. 12.
    Carandina S, Mari C, De Palma M, Marcellino MG, Cisno C, Legnaro A, Liboni A, Zamboni P. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg. 2008;35(2):230–7.CrossRefGoogle Scholar
  13. 13.
    Zamboni GS, Menegatti E, Tacconi G, Palazzo A, Liboni A. Great saphenous varicose vein surgery without saphenofemoral junction disconnection. Br J Surg. 2010;97:820–5.CrossRefGoogle Scholar
  14. 14.
    Mendoza E, Amsler F. CHIVA with endoluminal procedures: LASER versus VNUS—treatment of the saphenofemoral junction. Phlebologie. 2017;46:5–12.CrossRefGoogle Scholar
  15. 15.
    Mendoza E. The sapheno-femoral junction in ultrasound. Phlebologie. 2014;43:42–5.CrossRefGoogle Scholar
  16. 16.
    Stücker M, Moritz R, Altmeyer P, Reich-Schupke S. New concept: different types of insufficiency of the saphenofemoral junction identified by duplex as a chance for a more differentiated therapy of the great saphenous vein. Phlebology. 2013;28:268–74.CrossRefGoogle Scholar
  17. 17.
    Zollmann P, Zollmann C, Zollmann P, Veltman J, Kerzig D, Doerler M, Stücker M. Determining the origin of superficial venous reflux in the groin with duplex ultrasound and implications for varicose vein surgery. J Vasc Surg Venous Lymphat Disord. 2017;5(1):82–6.CrossRefGoogle Scholar
  18. 18.
    Mendoza E, Stücker M. Duplex-ultrasound assessment of the saphenofemoral junction (Review). Phlebol Rev. 2015;23(3):1–8.Google Scholar
  19. 19.
    Mendoza E. Therapie der Stammvarikose der V. saphena magna—Konsens unter Einbeziehung von Stripping, Verödung, endoluminalen Verfahren und CHIVA als Therapieoptionen. Phlebologie. 2011;40:159–64.CrossRefGoogle Scholar
  20. 20.
    Reich-Schupke S, Mendoza E, Dörler M, Stücker M. Frequency of refluxive tributaries of the junction region in the groin in patients with recurrent varicose veins of the thigh. Phlebologie. 2016;45:149–53.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.VenenpraxisWunstorfGermany

Personalised recommendations