AMBULATORY CONSERVATIVE HEMODYNAMIC CORRECTION OF VENOUS INSUFFICIENCY - TECHNIQUE, RESULTS

Ambulatory conservative haemodynamic correction of venous insufficienc y (CHIVA) is a surgical treatment of superficial venous insufficiency designed to correct the pathological haemodynamic effects of supeffici al venous insufficiency apparent on standing. Surgical treatment is ba sed on precise preoperative anatomical and haemodynamic mapping perfor med by duplex ultrasound, providing preoperative ultrasound-guided mar king. Surgical treatment consists of dividing the hydrostatic pressure column and disconnecting venovenous shunts by ligation-section of the superficial venous network at precise points determined by the preope rative ultrasound-guided marking. This strategy should achieve a super ficial venous circuit draining perfectly into the competent deep venou s network. The operation is performed under local anaesthesia as an ou tpatient procedure and allows immediate resumption of walking, which p romotes a good result due to activation of the calf muscle pump. The r esults of the technique are very good provided a reliable preoperative ultrasound-guided marking and a precise surgical procedure are perfor med. Failures are due to poor haemodynamic assessment or inappropriate surgical procedure.