When you notice those winding "blue veins" on your calves, you might, like most people, think these "broken" vessels should just be "stripped" or "burned" away. For a long time, vein stripping and, later, thermal ablation (laser, radiofrequency), were indeed the mainstream treatments.
In recent years, however, vascular surgeons worldwide have increasingly begun to advocate: "Please, save this great saphenous vein!"
Why is this? Are these "bad" veins actually useful?
The answer is: Extremely useful.
1. The "Spare Tire" We're Discarding: A Vein That Can Be a Lifeline
The great saphenous vein (GSV) is the longest superficial vein in the leg. In patients with varicose veins, it's often the main "highway" where problems arise. However, it is simultaneously the body's highest-quality "spare conduit."
Imagine your body is a car, and the GSV is that pristine, high-quality "spare tire."
If you (unfortunately) encounter a severe arterial blockage in the future—whether it's coronary artery disease requiring a "bypass" graft, or lower extremity arterial disease (LEAD) needing a "bypass" to save a limb—the first material your doctor will look for to build that "bridge" is your own GSV. It is the most ideal, durable, and biocompatible "lifeline."
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| Fig: Application of the saphenous vein as a bypass graft in treating arterial disease |
For infrapopliteal (below-the-knee) arterial reconstruction, prosthetic grafts have proven inferior to autologous conduits. Current guidelines from the European Society for Vascular Surgery (ESVS) outline that the availability and quality of an autologous vein conduit are key to a successful bypass operation.
Unfortunately, we are actively discarding this spare tire.
In 2024, a Russian study published in the Journal of Clinical Medicine revealed a stunning fact: among patients with both varicose veins and LEAD, a staggering 82.6% had already lost the availability of their GSV for an arterial bypass due to previous "destructive" varicose vein treatments (like stripping or ablation).
With a globally aging population and a rising incidence of arteriosclerotic disease, the vein "destroyed" today to treat varicose veins could become the "unavailable material" that leads to a surgeon's regret—and a life- or limb-threatening situation—10 or 20 years down the line.
2. A Paradigm Shift: Not a "Broken" Vein, Just "Over-Pressurized" Traffic
Doctors dare to "treasure" this vein because of a revolution in understanding the disease.
The traditional view held that a varicose vein was simply "broken," its valves "loose"—like a stretched-out rubber band, rendered useless.
The modern hemodynamic perspective, however, argues: The vessel itself isn't necessarily broken; it's just experiencing "hypertension" or "over-pressurized traffic."
Imagine again: your leg's venous system is a complex traffic network, with deep "interstates" (deep veins) and superficial "highways" (saphenous veins). Blood is supposed to flow from the "highway" onto the "interstate" to return to the heart.
The essence of varicose veins is that an "intersection" (valve) on the "highway" (saphenous vein) breaks, causing blood to flow backward ("reflux"). This reverse flow builds up pressure on the highway, which then diverts this excess pressure onto smaller "county roads" and "rural routes" (superficial tributaries). Over time, this sustained pressure overwhelms these smaller routes, stretching them out and deforming them. This is the "worm-like" vein you see on the skin.
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| Fig: Disruption of blood flow order leading to varicose veins |
3. CHIVA: Re-routing Traffic, Not Destroying the Highway
Based on this new understanding, an innovative, minimally invasive, and function-preserving treatment emerged: CHIVA (Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire).
The CHIVA strategy was first proposed by Prof. Claude Franceschi in 1988. Its core concept is to reduce the excessive intravenous pressure, allowing the vessel to shrink back naturally, rather than destroying it "at all costs."
Faced with the "traffic hypertension" described above, CHIVA's strategy is not to "demolish the entire highway" (stripping or ablation). Instead, it acts like a traffic police officer who strategically places barricades at key "faulty intersections" to precisely "cut off" the refluxing blood.
Related hemodynamic studies show that if the blood flow can be "re-routed" to the deep venous system, many superficial veins have the chance to repair themselves.
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| Fig: The core of CHIVA treatment is hemodynamic correction |
The core of CHIVA treatment is:
Precise Mapping: Using POCUS (Point-of-Care Ultrasound) hemodynamic assessment to create a "battle map," accurately identifying all "reflux points" (escape points).
Precise Ligation: Under local anesthesia, making a few micro-incisions to precisely ligate these key points.
Restoring Flow: By breaking the "vicious cycle," the blood is forced to stop "looping" and is guided to flow in the correct direction, draining into the "interstate" (deep veins).
The greatest benefits of this approach are:
The "Spare Tire" is Saved: The GSV trunk is preserved, retaining that invaluable conduit for potential life-saving surgeries in the future.
Minimally Invasive & Safe: It requires only local anesthesia, no hospitalization, and patients can walk immediately after. This drastically reduces the risk of nerve damage, infection, and thrombosis.
Corrects the Cause: It targets the "cause" of the disease (the faulty hemodynamics), not just the "symptom" (the bulging vein).
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| Fig: Vascular elasticity naturally retracts after pathological reflux is resolved |
4. From Europe to Africa: The Global Practice and Value of CHIVA
CHIVA originated in Europe and is now widely practiced in Europe and China, with clinical adoption also growing in the United States. Notably, Chinese teams, such as the Dr. Smile Medical Group, have not only actively practiced CHIVA domestically but have also brought this technology to resource-limited regions in Africa.
In countries like Ethiopia, the prevalence of varicose veins is high. The medical resources required for traditional stripping (general anesthesia, hospital beds, blood banks) are scarce, and the risk of postoperative infection is high.
The value of the CHIVA technique is profoundly demonstrated in this setting:
High Adaptability: Its local anesthesia, outpatient nature perfectly fits the reality of scarce medical resources.
Low Risk: The minimally invasive procedure significantly lowers the risk of postoperative infection and bleeding, which is critical for these patients.
Significant Efficacy: Even severe venous ulcers show rapid healing after CHIVA improves the local hemodynamics.
"Teaching How to Fish": The Chinese medical teams bring not just scalpels but also technical training, empowering local doctors to perform CHIVA independently and achieving sustainable medical aid.
From the sophisticated clinics of Europe to the basic hospitals of Africa, CHIVA has proven its universal value as a "responsible" and "forward-thinking" medical technology.
Your Veins, Your Right to "Preserve"
The recent Russian study sounds a clear warning: when treating today's varicose veins, we must think further ahead.
With medical advancement, the treatment of varicose veins is no longer a destructive "search and destroy" mission. Hemodynamic therapies like CHIVA give us the ability to cure the disease while "treasuring" and preserving our precious great saphenous vein.
The next time you face a treatment decision for varicose veins, remember to ask your doctor: "Does this method allow me to keep my saphenous vein?"
References:
1. Franceschi C, Cappelli M, Ermini S, et al. CHIVA: hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8-30.
2. Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2021;9(9):CD009648. Published 2021 Sep 30. doi:10.1002/14651858.CD009648.pub4
3. Golovina V, Panfilov V, Seliverstov E, Erechkanova D, Zolotukhin I. Availability of the Great Saphenous Veins as Conduits for Arterial Bypass Surgery in Patients with Varicose Veins. J Clin Med. 2024;13(24):7747. Published 2024 Dec 18. doi:10.3390/jcm13247747
5. Ambler GK, Twine CP. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev. 2018;2(2):CD001487. Published 2018 Feb 11. doi:10.1002/14651858.CD001487.pub3
6. Klinkert P, Schepers A, Burger DH, van Bockel JH, Breslau PJ. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial. J Vasc Surg. 2003;37(1):149-155. doi:10.1067/mva.2002.86
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