Hemodynamic Assessment：The Key to Effective Varicose Vein Treatment

Today I want to explore a question that may reshape the future of vascular medicine: will phlebology—once considered a subset of vascular surgery—emerge as a fully recognized, standalone specialty with international consensus?

This isn’t just speculation. It’s a trend I’ve observed while following the evolution of venous medicine around the world. The rise of phlebology is being driven by three powerful forces: the natural specialization of medicine, the shift in clinical philosophy, and the growing demand from patients.

From General Surgery → Vascular Surgery → Phlebology?

If we look back, surgery has always moved toward refinement and subdivision. Vascular surgery itself branched out of general surgery as arterial reconstruction, endovascular techniques, and hybrid procedures created a knowledge base and skill set distinct from traditional operations.

Now we see a parallel development. The disease spectrum, treatment philosophy, and practitioner profile in venous medicine are evolving in ways that point toward an independent discipline.

The “De-surgicalization” of Vein Care

Venous disease management is no longer the exclusive domain of vascular surgeons:

• In Europe and North America, dermatologists, internists, and interventional radiologists all treat varicose veins and venous insufficiency.

• Chronic venous ulcers are often managed by rehabilitation teams and nursing specialists.

• Minimally invasive procedures—laser, radiofrequency, medical adhesives, CHIVA—have moved into everyday outpatient practice.

• Dedicated phlebology societies, committees, and certification systems are already established in many countries.

These shifts send a clear signal: venous care has become a multidisciplinary clinical field, and it is increasingly likely to stand on its own as “phlebology.”

Hemodynamics: The Infrastructure of Next-Gen Vein Therapy

At the heart of this transformation is not just a new tool, but a new way of thinking—hemodynamic principles applied to venous reconstruction.

At Dr. Smile Medical Group, we champion the CHIVA philosophy: rather than destroying veins, we seek to restore physiological function by redirecting venous return and reducing pressure.

This approach requires more than technical skill. It demands advanced ultrasound analysis, pressure-based modeling, and a systemic understanding of venous anatomy and function. In short, it represents a paradigm shift in how we understand venous disease.

Building the Global CHIVA Project and the Asian Venous Academy

When a field develops its own philosophy, it also needs an education system to support it. For decades, venous disease was almost absent from medical school curricula.

To address this gap, we partnered with Inteleos to launch the Global CHIVA Program. The goal: to synchronize venous treatment concepts worldwide, from physician training to clinical practice, and to establish a shared medical language for phlebology.

In Hong Kong, we are preparing to open the Asian Venous Academy, a hub for international training and certification in hemodynamic venous treatment, with a focus on bringing this knowledge to physicians across Asia.

Our ambition is not only to prepare qualified venous specialists in China and Asia but also to serve as a bridge between East and West, strengthening phlebology’s position as a truly independent discipline.

Five Forces Driving Independence

Looking ahead, I believe five key forces will shape phlebology’s emergence as a standalone specialty in the next five years:

1. Rising patient numbers and the growing demand for chronic disease management.

2. Hemodynamic philosophy driving a treatment revolution.

3. Minimally invasive, office-based procedures that no longer fit traditional surgical boundaries.

4. Multidisciplinary involvement, leading to cross-professional collaboration and certification.

5. Global training and standards—such as the CHIVA project—creating an international framework.

Together, these factors form an ecosystem that supports true disciplinary independence.

CHIVA as a Starting Point, Not the Destination

What was once a side task for vascular surgeons is now on the path to becoming a fully fledged specialty with four critical pillars:

• A distinct philosophy

• Dedicated technologies

• An education and training system

• A community of physicians who identify with the field

CHIVA may be the catalyst, but the ultimate goal is bigger: the birth of phlebology as a recognized specialty, with its own voice in global medicine.