Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 30;9(9):CD009648.
doi: 10.1002/14651858.CD009648.pub4.

CHIVA method for the treatment of chronic venous insufficiency

Sergi Bellmunt-Montoya  1 , Jose Maria Escribano  1 , Percy Efrain Pantoja Bustillos  2 , Cristina Tello-Díaz  1 , Maria José Martinez-Zapata  3
Affiliations

CHIVA method for the treatment of chronic venous insufficiency

Sergi Bellmunt-Montoya et al. Cochrane Database Syst Rev. .

Abstract

Background: Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (in French 'cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire' (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is the second update of the review first published in 2013.

Objectives: To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins.

Search methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, and the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries to 19 October 2020. We also searched PUBMED to 19 October 2020 and checked the references of relevant articles to identify additional studies.

Selection criteria: We included randomized controlled trials (RCTs) that compared CHIVA to other therapeutic techniques to treat varicose veins.

Data collection and analysis: Two review authors independently assessed and selected studies, extracted data, and performed quantitative analysis from the selected papers. A third author solved any disagreements. We assessed the risk of bias in included trials with the Cochrane risk of bias tool. We calculated the risk ratio (RR), mean difference (MD), number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI). We evaluated the certainty of the evidence using GRADE. The main outcomes of interest were the recurrence of varicose veins and side effects.

Main results: For this update, we identified two new additional studies. In total, we included six RCTs with 1160 participants (62% women) and collected from them eight comparisons. Three RCTs compared CHIVA with vein stripping. One RCT compared CHIVA with compression dressings in people with venous ulcers. The new studies included three comparisons, one compared CHIVA with vein stripping and radiofrequency ablation (RFA), and one compared CHIVA with vein stripping and endovenous laser therapy. We judged the certainty of the evidence for our outcomes as low to very low due to inconsistency, imprecision caused by the low number of events and risk of bias. The overall risk of bias across studies was high because neither participants nor personnel were blinded to the interventions. Two studies attempted to blind outcome assessors, but the characteristics of the surgery limited concealment. Five studies reported the outcome clinical recurrence of varicose veins with a follow-up of 18 months to 10 years. CHIVA may make little or no difference to the recurrence of varicose veins in the lower limb compared to stripping (RR 0.74, 95% CI 0.46 to 1.20; 5 studies, 966 participants; low-certainty evidence). We are uncertain whether CHIVA reduced recurrence compared to compression dressing (RR 0.23, 95% CI 0.06 to 0.96; 1 study, 47 participants; very low-certainty evidence). CHIVA may make little or no difference to clinical recurrence compared to RFA (RR 2.02, 95% CI 0.74 to 5.53; 1 study, 146 participants; low-certainty evidence) and endovenous laser (RR 0.20, 95% CI 0.01 to 4.06; 1 study, 100 participants; low-certainty evidence). We found no clear difference between CHIVA and stripping for the side effects of limb infection (RR 0.83, 95% CI 0.33 to 2.10; 3 studies, 746 participants; low-certainty evidence), and superficial vein thrombosis (RR 1.05, 95% CI 0.51 to 2.17; 4 studies, 846 participants; low-certainty evidence). CHIVA may reduce slightly nerve injury (RR 0.14, 95% CI 0.02 to 0.98; NNTH 9, 95% CI 5 to 100; 4 studies, 846 participants; low-certainty evidence) and hematoma compared to stripping (RR 0.59, 95% CI 0.37 to 0.97; NNTH 11, 95% CI 5 to 100; 2 studies, 245 participants; low-certainty evidence). For bruising, one study found no differences between groups while another study found reduced rates of bruising in the CHIVA group compared to the stripping group. Compared to RFA, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma, but may cause more bruising (RR 1.15, 95% CI 1.04 to 1.28; NNTH 8, CI 95% 5 to 25; 1 study, 144 participants; low-certainty evidence). Compared to endovenous laser, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma. The study comparing CHIVA versus compression did not report side effects.

Authors' conclusions: There may be little or no difference in the recurrence of varicose veins when comparing CHIVA to stripping (low-certainty evidence), but CHIVA may slightly reduce nerve injury and hematoma in the lower limb (low-certainty evidence). Very limited evidence means we are uncertain of any differences in recurrence when comparing CHIVA with compression (very low-certainty evidence). CHIVA may make little or no difference to recurrence compared to RFA (low-certainty evidence), but may result in more bruising (low-certainty evidence). CHIVA may make little or no difference to recurrence and side effects compared to endovenous laser therapy (low-certainty evidence). However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed, and the results were imprecise due to the low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.

PubMed Disclaimer

Conflict of interest statement

SB: declares that they have published opinions in medical journals on this topic.

JME: declares that they work as a health professional and have published opinions in medical journals on this topic.

PEP: none.

CTD: none.

MJM: none.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: CHIVA versus stripping, Outcome 1: Recurrence of varicose veins
1.2
1.2. Analysis
Comparison 1: CHIVA versus stripping, Outcome 2: Side effects
1.3
1.3. Analysis
Comparison 1: CHIVA versus stripping, Outcome 3: Retreatment
1.4
1.4. Analysis
Comparison 1: CHIVA versus stripping, Outcome 4: Free from reflux
1.5
1.5. Analysis
Comparison 1: CHIVA versus stripping, Outcome 5: Aesthetic improvement assessed by the participant
1.6
1.6. Analysis
Comparison 1: CHIVA versus stripping, Outcome 6: Aesthetic improvement assessed by the participant
1.7
1.7. Analysis
Comparison 1: CHIVA versus stripping, Outcome 7: Aesthetic improvement assessed by the investigator
1.8
1.8. Analysis
Comparison 1: CHIVA versus stripping, Outcome 8: Cure or no clinical symptoms
1.9
1.9. Analysis
Comparison 1: CHIVA versus stripping, Outcome 9: Clinical improvement
1.10
1.10. Analysis
Comparison 1: CHIVA versus stripping, Outcome 10: Pain
1.11
1.11. Analysis
Comparison 1: CHIVA versus stripping, Outcome 11: Quality of life at 24 months
1.12
1.12. Analysis
Comparison 1: CHIVA versus stripping, Outcome 12: Recurrence of varicose veins. Sensitivity analysis (intention to treat)
2.1
2.1. Analysis
Comparison 2: CHIVA versus compression dressing, Outcome 1: Recurrence of venous ulcer
2.2
2.2. Analysis
Comparison 2: CHIVA versus compression dressing, Outcome 2: Cure of venous ulcer
3.1
3.1. Analysis
Comparison 3: CHIVA versus radiofrequency ablation (RFA), Outcome 1: Recurrence of varicose veins
3.2
3.2. Analysis
Comparison 3: CHIVA versus radiofrequency ablation (RFA), Outcome 2: Side effects
3.3
3.3. Analysis
Comparison 3: CHIVA versus radiofrequency ablation (RFA), Outcome 3: Free from reflux
3.4
3.4. Analysis
Comparison 3: CHIVA versus radiofrequency ablation (RFA), Outcome 4: Pain
3.5
3.5. Analysis
Comparison 3: CHIVA versus radiofrequency ablation (RFA), Outcome 5: Quality of life at 24 months
4.1
4.1. Analysis
Comparison 4: CHIVA versus endovenous laser therapy, Outcome 1: Recurrence of varicose veins
4.2
4.2. Analysis
Comparison 4: CHIVA versus endovenous laser therapy, Outcome 2: Side effects
4.3
4.3. Analysis
Comparison 4: CHIVA versus endovenous laser therapy, Outcome 3: Cure
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Carandina 2008 {published data only}
    1. Carandina S, Mari C, De Palma M, Marcellino MG, Cisno C, Legnaro A, et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. European Journal of Vascular and Endovascular Surgery 2008;35(2):230-7. [DOI: 10.1016/j.ejvs.2007.09.011] [PMID: ] - DOI - PubMed
    1. Carandina S, Mari C, De Palma M, Marcellino MG, Legnaro A, Liboni A, et al. Stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Phlebology 2006;21(3):151. [DOI: 10.1258/026835506778253346] - DOI - PubMed
González‐Cañas 2021 {published data only}
    1. González-Cañas E, Florit S, Vives R, Guevara-Noriega KA, Santos M, Rios J, et al. A randomized controlled non-inferiority trial comparing radiofrequency with stripping and conservative hemodynamic cure for venous insufficiency technique for insufficiency of the great saphenous vein. Journal of Vascular Surgery 2021;9(1):101-12. [DOI: 10.1016/j.jvsv.2020.04.019] [PMID: ] - DOI - PubMed
    1. NCT02454452. Comparison of radiofrequency, vein stripping and CHIVA for venous insufficiency. clinicaltrials.gov/show/NCT02454452 (first posted 27 May 2015).
Iborra‐Ortega 2006 {published data only}
    1. Iborra E, Linares P, Hernández E, Vila R, Cairols MA. Clinical and random study comparing two surgical techniques for varicose veins treatment: immediate results [Estudio cínico y aleatorio que compara dos técnicas quirúrgicas para el tratamiento de las varices: resultados inmedatos]. Angiología 2000;52(6):253-8. [DOI: 10.1016/S0003-3170(00)76148-7] - DOI
    1. Iborra E, Vila R, Barjau E, Cairols MA. Surgical treatment of varicose veins: comparative study between two different techniques. Phlebology 2006;21(3):152. [DOI: 10.1258/026835506778253346] - DOI
    1. Iborra E. Comparative clinical study: CHIVA vs phlebectomy [Ensayo clínico comparativo: Fleboextracción versus CHIVA]. Anales de Cirugía Cardíaca y Vascular 2006;12(2):109.
    1. Iborra-Ortega E, Barjau-Urrea E, Vila-Coll R, Ballon-Carazas H, Cairols-Castellote MA. Comparative study of two surgical techniques in the treatment of varicose veins of the lower extremities: results after five years of follow up [Estudio comparativo de dos técnicas quirúrgicas en el tratamiento de las varices de las extremidades inferiores: resultados tras cinco años de seguimiento]. Angiología 2006;58(6):459-68. [DOI: 10.1016/S0003-3170(06)75009-X] - DOI
Pares 2010 {published data only}
    1. Pares JO, Juan J, Tellez R, Mata A, Moreno C, Quer FX, et al. Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial. Annals of Surgery 2010;251(4):624-31. [DOI: 10.1097/SLA.0b013e3181d0d0a3] [PMID: ] - DOI - PubMed
    1. Pares JO, Juan J, Tellez R, Mata A, Moreno C, Quer FX, et al. Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial. Vasomed 2011;23(2):98. - PubMed
    1. Pares O, Juan J, Moreno C, Tellez R, Codony I, Mata A, et al. Randomized clinical trial on surgical techniques for the treatment of varicose veins in legs: non-conservative treatment compared with a conservative one. Five years follow-up. Phlebology 2008;23(5):243. [DOI: 10.1258/phleb.2008.081003] - DOI
Wang 2016 {published data only}1940‐5901/IJCEM0016552
    1. Wang H, Chen Q, Fei Z, Zheng E, Yang Z, Huang X. Hemodynamic classification and CHIVA treatment of varicose veins in lower extremities (VVLE). International Journal of Clinical and Experimental Medicine 2016;9(2):2465-71. [ISSN: 1940-5901/IJCEM0016552]
Zamboni 2003 {published data only}
    1. Zamboni P, Cisno C, Marchetti F, Mazza P, Fogato L, Carandina S, et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. European Journal of Vascular and Endovascular Surgery 2003;25(4):313-8. [DOI: 10.1053/ejvs.2002.1871] - DOI - PubMed

References to studies excluded from this review

Maeso 2001 {published data only}
    1. Maeso J, Juan J, Escribano J, Allegue NM, Di Matteo A, Gonzalez E, et al. Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities. Annals of Vascular Surgery 2001;15(6):661-5. [DOI: 10.1007/s10016-001-0009-8] [PMID: ] - DOI - PubMed
Maldonado‐Fernández 2016 {published data only}
    1. Maldonado-Fernández N, Linares-Palomino JP, López-Espada C, Martínez-Gámeza FJ, Ros-Díe E. Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins [Resultados clínicos de una nueva estrategia quirúrgica (CHIVA modificado) en el tratamiento de las varices dependientes de la vena safena magna accesoria anterior]. Cirugía Española 2016;94(3):144-50. [DOI: 10.1016/j.ciresp.2015.10.010] [PMID: ] - DOI - PubMed
Solis 2009 {published data only}
    1. Solís JV, Ribé L, Portero JL, Rio J. Stripping saphenectomy, CHIVA and laser ablation for the treatment of the saphenous vein insufficiency. Ambulatory Surgery 2009;15(1):11-4. [WEB: www.iaas-med.com/index.php/current-and-past-content/volume-15-2009]
Zamboni 1995 {published data only}
    1. Zamboni P, Marcellino MG, Feo CV, Pisano L, Vasquez G, Bertasi M, et al. Alternative saphenous vein sparing surgery for future grafting. Panminerva Medica 1995;37(4):190-7. [PMID: ] - PubMed
Zamboni 1996 {published data only}
    1. Zamboni P, Feo CV, Marcellino MG, Vasquez G, Mari C. Haemodynamic correction of varicose veins (CHIVA): an effective treatment? Phlebology 1996;11(3):98-101. [DOI: 10.1177/026835559601100305] - DOI
Zamboni 1998 {published data only}
    1. Zamboni P, Marcellino MG, Cappelli M, Feo CV, Bresadola V, Vasquez G, et al. Saphenous vein sparing surgery: principles, techniques and results. Journal of Cardiovascular Surgery 1998;39(2):151-62. [PMID: ] - PubMed
Zmudzinsk 2017 {published data only}
    1. Zmudzinski M, Malo P, Hall C, Hayashi A. CHIVA – a prospective study of a vein sparing technique for the management of varicose vein disease. American Journal of Surgery 2017;213(5):967-9. - PubMed

Additional references

Agus 2001
    1. Agus GB, Allegra C, Arpaia G, Botta G, Cataldi A, Gasbarro V, et al. Guidelines for the diagnosis and treatment of chronic venous insufficiency. International Angiology 2001;20(1):2-37.
Allan 2000
    1. Allan PL, Bradbury AW, Evans CJ, Lee AJ, Vaughan Ruckley C, Fowkes FG. Patterns of reflux and severity of varicose veins in the general population – Edinburgh Vein Study. European Journal of Vascular and Endovascular Surgery 2000;20(5):470-7. - PubMed
Aziz 2011
    1. Aziz Z, Cullum NA, Flemming K. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No: CD002933. [DOI: 10.1002/14651858.CD002933.pub4] - DOI - PubMed
Blomgren 2004
    1. Blomgren L, Johansson G, Dahlberg-Akerman A, Norén A, Brundin C, Nordström E, et al. Recurrent varicose veins: incidence, risk factors and groin anatomy. European Journal of Vascular and Endovascular Surgery 2004;27(3):269-74. - PubMed
Cappelli 2000
    1. Cappelli M, Lova RM, Ermini S, Turchi A, Bono G, Bahnini A, et al. Ambulatory conservative hemodynamic management of varicose veins: a critical analysis of results at 3 years. Annal of Vascular Surgery 2000;14(4):376-84. - PubMed
Carpentier 2004
    1. Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. Journal of Vascular Surgery 2004;40(4):650-9. - PubMed
Cavezzi 2007
    1. Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs. UIP consensus document. Part II. Anatomy. Vasa 2007;36(1):62-71. - PubMed
Chan 2011
    1. Chan CY, Chen TC, Hsieh YK, Huang JH. Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins. World Journal of Surgery 2011;35(7):1679-86. - PubMed
Coleridge‐Smith 2006
    1. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs. UIP consensus document. Part I. Basic principles. European Journal of Vascular and Endovascular Surgery 2006;31(1):83-92. - PubMed
Cullum 2010
    1. Cullum NA, Al-Kurdi D, Bell-Syer SE. Therapeutic ultrasound for venous leg ulcers. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No: CD001180. [DOI: 10.1002/14651858.CD001180.pub3] - DOI - PubMed
Escribano 2003
    1. Escribano JM, Juan J, Bofill R, Maeso J, Rodríguez-Mori A, Matas M. Durability of reflux-elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3-year prospective case study. European Journal of Vascular and Endovascular Surgery 2003;25(2):159-63. - PubMed
Escribano 2021
    1. Escribano JM, Bellmunt S. Applying the correct CHIVA strategy in a randomized, controlled trial. Journal of Vascular Surgery 2021;9(1):286. - PubMed
Faccini 2019
    1. Faccini FP, Ermini S, Franceschi C. CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results. Jornal Vascular Brasileiro 2019;18:e20180099. - PMC - PubMed
Flemming 1999
    1. Flemming K, Cullum NA. Laser therapy for venous leg ulcers. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No: CD001182. [DOI: 10.1002/14651858.CD001182] - DOI - PubMed
Franceschi 1988
    1. Franceschi C. Theorie et Pratique de la Cure: Conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire. Precy-sous-Thil (France): Editions de l’Armançon, 1988.
Franceschi 1997
    1. Franceschi C. Measures and interpretation of venous flow in stress tests. Manual compression and Parana manoeuver. Dynamic reflux index and Psatakis index [Mesures et interprétation des flux veineux lors des manoevres de stimulation. Compressions manuelles et manoeuvre de Paranà. Indice dynamique de reflux (IDR) et indice de Psatakis]. Journal des Maladies Vasculaires 1997;22(2):96-136. - PubMed
Goren 1996
    1. Goren G, Yellin AE. Hemodynamic principles of varicose vein therapy. Dermatologic Surgery 1996;22(7):657-62. - PubMed
GRADE 2004
    1. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490-4. - PMC - PubMed
Hamdan 2012
    1. Hamdan A. Management of varicose veins and venous insufficiency. JAMA 2012;308(24):2612-21. - PubMed
Higgins 2021
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Hobbs 1974
    1. Hobbs JT. Surgery and sclerotherapy in the treatment of varicose veins. A random trial. Archives of Surgery 1974;109:793-6. - PubMed
Juan 2002
    1. Juan J, Escribano JM, Maeso J. Hemodynamic after stripping of varicose vein [Hämodynamik des Varizenrezidivs nach stripping operation]. In: 18 Jahreskongress 2002 der Deutschen Gessellschaft für GefäBchirurgie - Gesellschaft für vaskuläre und endovaskuläre Chirurgie. Würzburg (Germany). 2002.
Juan 2005
    1. Juan J, Escribano JM, Criado E, Fontcuberta J. Haemodynamic surgery for varicose veins: surgical strategy. Phlebology 2005;20(1):2-13.
Jull 2008
    1. Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD005083. [DOI: 10.1002/14651858.CD005083.pub2] - DOI - PubMed
Keller 1905
    1. Keller WL. A new method of extirpating the internal saphenous and similar veins in varicose conditions. A preliminary report. New York Medical Journal 1905;82:385-6.
Kranke 2004
    1. Kranke P, Bennett MH, Debus SE, Roeckl-Wiedmann I, Schnabel A. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No: CD004123. [DOI: 10.1002/14651858.CD004123.pub2] - DOI - PubMed
Kurz 1999
    1. Kurz X, Kahn SR, Abenhaim L, Clement D, Norgren L, Baccaglini U, et al. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. International Angiology 1999;18(2):83-102. - PubMed
Kurz 2001
    1. Kurz X, Lamping DL, Kahn SR, Baccaglini U, Zuccarelli F, Spreafico G, et al. Do varicose veins affect quality of life? Results of an international population-based study. Journal of Vascular Surgery 2001;34(4):641-8. [DOI: 10.1067/mva.2001.117333] [PMID: ] - DOI - PubMed
Labropoulos 2001
    1. Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour MA, et al. Nonsaphenous superficial vein reflux. Journal of Vascular Surgery 2001;34(5):872-7. - PubMed
Labropoulos 2005
    1. Labropoulos N, León L, Kwon S, Tassiopoulos A, González-Fajardo JA, Kang SS, et al. Study of the venous reflux progression. Journal of Vascular Surgery 2005;41(2):291-5. - PubMed
Lee 2003
    1. Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study. Journal of Clinical Epidemiology 2003;56(2):171-9. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Lofgren 1977
    1. Lofgren EP. The operative treatment of varicose veins. In: Rutherford RB, editors(s). Vascular Surgery. Philadelphia (PA): WB Saunders, 1977:1169-75.
Martinez‐Zapata 2005
    1. Martinez-Zapata MJ, Bonfill Cosp X, Moreno RM, Vargas E, Capellà D. Phlebotonics for venous insufficiency. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD003229. [DOI: 10.1002/14651858.CD003229.pub2] - DOI - PubMed
Mendoza 2008
    1. Mendoza E. CHIVA 1988–2008: review of studies on the CHIVA method and its development in different countries. Gefasschirurgie 2008;13(4):249-56.
Mendoza 2011
    1. Mendoza E, Berger V, Zollmann C, Bomhoff M, Amsler F. Diameter-reduction of the great saphenous vein and common femoral vein after CHIVA [Kaliberreduktion der V saphena magna und der V femoralis communis nach CHIVA]. Phlebologie 2011;40(2):73-8.
Mendoza 2018
    1. Mendoza E. Chapter 6: saphenous sparing strategy in the CHIVA context. In: Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Cham (Switzerland): Springer International Publishing AG, part of Springer Nature, 2018:121-80.
Milone 2011
    1. Milone M, Salvatore G, Maietta P, Sosa Fernandez LM, Milone F. Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon's experience. Il Giornale di Chirurgia 2011;32(11-12):460-3. - PubMed
Mowatt‐Larssen 2012
    1. Mowatt-Larssen E, Shortell CK. Treatment of primary varicose veins has changed with the introduction of new techniques. Seminars in Vascular Surgery 2012;25(1):18-24. - PubMed
Muller 1966
    1. Muller R. Treatment of varicose veins by ambulatory phlebectomy [Traitement des varices par phlébectomie ambulatoire]. Phlebologie 1966;19(4):277-9. - PubMed
NCT02454452
    1. NCT02454452. Comparison of radiofrequency, vein stripping and CHIVA for venous insufficiency. clinicaltrials.gov/show/NCT02454452 (first posted 27 May 2015).
Nelson 2000
    1. Nelson EA, Bell-Syer SE, Cullum NA, Webster J. Compression for preventing recurrence of venous ulcers. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No: CD002303. [DOI: 10.1002/14651858.CD002303] - DOI - PubMed
Nelson 2011
    1. Nelson EA, Mani R, Thomas K, Vowden K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No: CD001899. [DOI: 10.1002/14651858.CD001899.pub3] - DOI - PubMed
Nesbitt 2011
    1. Nesbitt C, Eifell RK, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No: CD005624. [DOI: 10.1002/14651858.CD005624.pub2] - DOI - PubMed
Nicolaides 2000
    1. Nicolaides AN, Cardiovascular Disease Educational and Research Trust, European Society of Vascular Surgery, The International Angiology Scientific Activity Congress Organization, International Union of Angiology, Union Internationale de Phlebologie at the Abbaye des Vaux de Cernay. Investigation of chronic venous insufficiency. A consensus statement. Circulation 2000;102(20):E126-63. - PubMed
O'Meara 2009
    1. O'Meara S, Cullum NA, Nelson EA. Compression for venous leg ulcers. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No: CD000265. [DOI: 10.1002/14651858.CD000265.pub2] - DOI - PubMed
O'Meara 2010
    1. O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No: CD003557. [DOI: 10.1002/14651858.CD003557.pub3] - DOI - PubMed
Palfreyman 2006
    1. Palfreyman SS, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No: CD001103. [DOI: 10.1002/14651858.CD001103.pub2] - DOI - PubMed
Perrin 2000
    1. Perrin MR, Guex JJ, Ruckley CV, Palma RG, Royle JP, Eklof B, et al. Recurrent varices after surgery (REVAS), a consensus document. REVAS Group. Cardiovascular Surgery 2000;8(4):233-45. - PubMed
Porter 1995
    1. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. Journal of Vascular Surgery 1995;21(4):635-45. - PubMed
Review Manager 2020 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.4. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2020.
Sterne 2011
    1. Sterne JA, Egger M, Moher D. Chapter 10: Addressing reporting bias. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Tisi 2006
    1. Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No: CD001732. [DOI: 10.1002/14651858.CD001732.pub2] - DOI - PubMed
Vanhoutte 1997
    1. Vanhoutte PM, Corcaud S, Montrion C. Venous disease: from pathophysiology to quality of life. Angiology 1997;48(7):559-67. - PubMed
Whing 2021
    1. Whing J, Nandhra S, Nesbitt C, Stansby G. Interventions for great saphenous vein incompetence. Cochrane Database of Systematic Reviews 2021, Issue 8. Art. No: CD005624. [DOI: 10.1002/14651858.CD005624.pub4] - DOI - PMC - PubMed
Winterborn 2004
    1. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. Journal of Vascular Surgery 2004;40(4):634-9. - PubMed
Zmudzinski 2017
    1. Zmudzinski M, Malo P, Hall C, Hayashi A. CHIVA – a prospective study of a vein sparing technique for the management of varicose vein disease. American Journal of Surgery 2017;213(5):967-9. [DOI: 10.1016/j.amjsurg.2017.03.025] [PMID: ] - DOI - PubMed

References to other published versions of this review

Bellmunt‐Montoya 2012
    1. Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of varicose veins. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No: CD009648. [DOI: 10.1002/14651858.CD009648] - DOI
Bellmunt‐Montoya 2013
    1. Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No: CD009648. [DOI: 10.1002/14651858.CD009648.pub2] - DOI - PubMed
Bellmunt‐Montoya 2015
    1. Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No: CD009648. [DOI: 10.1002/14651858.CD009648.pub3] - DOI - PMC - PubMed

Publication types