Sclerotherapy technique in CHIVA strategy

Abstract

SummaryCHIVA has been developed by Claude France-schi in the 1980-es and was first published in 1988 (1). CHIVA is a strategy to treat venous insufficiency keeping the drainage through the saphenous veins and reentry perforating veins. Venous recirculations are stratified into shunt types depending on the origin of the reflux and the distal reentry to the deep veins (2). Originally the method was described with surgical interventions: Flush ligation of the saphenous veins from the deep veins (crossotomy), flush ligation of the tributaries at the saphenous trunk, disconnection of the refluxive saphenous trunk distal to a reentryperforating vein, disconnection of a refluxive perforating vein, if it is the proximal insufficiency point. Techniques in phlebology have developed: in the field of the vein ablating strategies (originally stripping) new possibilities are currently used, as foaming under ultrasound-guidance of the complete saphenous vein, and endoluminal heat techniques, as well as glue. In the same way, the CHIVA strategy has incorporated new techniques. This article highlights the application of foam sclero-therapy in combination with the CHIVA strategy. Sometimes in CHIVA it is useful to start with one step and complete the treatments months later, if a vein did not reduce its caliper or revert its flow after the first step.