CHIVA: Surgical Tips and Tricks

  • Sergio Gianesini
  • Roberto Delfrate
  • Massimo Cappelli
  • Erika Mendoza


In the CHIVA context, the most important step is the analysis of the preoperative haemodynamics, followed by the decision which strategic, surgical steps to apply. These surgical steps have to be performed in a cautious way, to avoid lesion of vessels that should stay intact. This differentiates the surgical gesture in CHIVA from the ablative strategies. Technical errors are immediately noted with persistent or recurrent varicose veins. In this chapter, the performance of the crossotomy is explained, as well as the interruption of a CHIVA 2 point. Devalvulation is explained, as well as the application to endoluminal techniques to the CHIVA strategy.


Devalvulation Anterior Accessory Saphenous Vein (AASV) Sapheno-femoral Junction Perforating Veins Refluxing Tributaries 
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  1. 1.
    Mendoza E. Handbuch CHIVA. Arrien GmbH; 2002.Google Scholar
  2. 2.
    Mirjalili SA, Muirhead JC, Stringer MD. Redefining the surface anatomy of the sapheno-femoral junction in vivo. Clin Anat. 2014;27(6):915–9. Epub 20 Mar 2014.CrossRefPubMedGoogle Scholar
  3. 3.
    Mühlberger D, Morandini L, Brenner E. Venous valves and major superficial tributary veins near the sapheno-femoral junction. J Vasc Surg. 2009;49(6):1562–9. Scholar
  4. 4.
    Cappelli M, Molino-Lova R, Giangrandi I, Ermini S, Gianesini S. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. J Vasc Surg Venous Lymphat Disord. 2017 Dec 28. pii: S2213-333X(17)30436-5. Scholar
  5. 5.
    Delfrate R, Bricchi M, Franceschi C, Goldoni M. Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins. Veins Lymphat. 2014.
  6. 6.
    Winterborn RJ, Foy C, Heather BP, Earnshaw JJ. Randomised trial of flush sapheno-femoral ligation for primary great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2008;36(4):477–84. Epub 20 Aug 2008.CrossRefPubMedGoogle Scholar
  7. 7.
    Heim D, Negri M, Schlegel U, De Maeseneer M. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J Vasc Surg. 2008;47(5):1028–32. Epub 21 Mar 2008.CrossRefPubMedGoogle Scholar
  8. 8.
    Frings N, Nelle A, Tran P, Fischer R, Krug W. Reduction of neo-reflux after correctly performed ligation of the sapheno-femoral junction. A randomized trial. Eur J Vasc Endovasc Surg. 2004;28(3):246–52.CrossRefGoogle Scholar
  9. 9.
    Gianesini S, Menegatti E, Malagoni AM, Occhionorelli S, Zamboni P. Mini-invasive high-tie by clip apposition versus crossectomy by ligature: long-term outcomes and review of the available therapeutic options. Phlebology. 2017;32(4):249–55.CrossRefGoogle Scholar
  10. 10.
    Tessari L. Nouvelle technique d’obtention de la scléromousse. Phlébologie. 2000;53:129.Google Scholar
  11. 11.
    Monfreux A. Quelle mousse pour quelles indications? Phlebologie 2013; 66(3):11–18.Google Scholar
  12. 12.
    Mendoza E, Cappelli M. Sclerotherapy technique in CHIVA strategy. Phlebology. 2017;46:5–12.CrossRefGoogle Scholar
  13. 13.
    Gianesini S, Menegatti E, Zuolo M, et al. Short endovenous LASER Ablation of the great saphenous vein in a modified CHIVA strategy. Veins Lymphat. 2013;2:e21.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

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sergio Gianesini
    • 1
    • 2
  • Roberto Delfrate
    • 3
  • Massimo Cappelli
    • 4
  • Erika Mendoza
    • 5
  1. 1.Vascular Diseases Center, University of FerraraFerraraItaly
  2. 2.USUHS UniversityBethesdaUSA
  3. 3.Responsible Surgery at Casa di Cura Figlie di San CamilloCremonaItaly
  4. 4.Office SurgeryFlorenceItaly
  5. 5.VenenpraxisWunstorfGermany

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