Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial

Area of Science:

• Vascular Surgery
• Phlebology
• Medical Technology

Background:

• Varicose veins are a manifestation of chronic venous disorder, historically treated with surgical stripping.
• High recurrence rates (20-80%) after stripping present a significant clinical and economic challenge.
• Ambulatory Conservative Hemodynamic Management of Varicose Veins (CHIVA) offers a novel approach to managing chronic venous disorder.

Purpose of the Study:

• To compare the efficacy of the CHIVA method against standard stripping for varicose vein treatment.
• To evaluate clinical recurrence rates at five years post-intervention.
• To assess the impact of duplex marking on stripping outcomes.

Main Methods:

• An open-label, randomized controlled trial involving 501 adult patients with primary varicose veins.
• Patients were assigned to either the CHIVA method (n=167) or stripping with clinic marking (n=167) or duplex marking (n=167).
• Clinical recurrence was assessed by independent observers over five years, supplemented by duplex ultrasonography.

Main Results:

• The CHIVA group demonstrated superior clinical outcomes: 44.3% cure, 24.6% improvement, and 31.1% failure.
• Stripping groups showed significantly higher failure rates: 52.7% for clinic marking and 47.9% for duplex marking.
• Ordinal odds ratios indicated a significantly lower recurrence risk with CHIVA compared to both stripping methods (OR 2.64 vs. clinic marking, OR 2.01 vs. duplex marking).

Conclusions:

• The CHIVA method, utilizing specific venous hemodynamic evaluation, is more effective than stripping for treating varicose veins.
• Duplex marking does not enhance the clinical results of the stripping technique.
• CHIVA offers a more effective alternative to ablative stripping for managing varicose veins.