Assessment of the CHIVA and the ASVAL Method

Abstract

In this article, the CHIVA and ASVAL methods are assessed from the hemodynamic point of view. The CHIVA method comprises complicated, unusual terminology and new perceptions, such as closed and open shunts, fractionation of the hydrostatic pressure, subdivision of the venous network. The principal part of the CHIVA theory is the drainage of venous blood from the thigh saphenous system into the deep lower leg veins through the preserved saphenous trunk after high ligation at the saphenofemoral junction, which is considered as a beneficial, physiological phenomenon. In reality, this is recurrent reflux producing ambulatory venous hypertension. The main impact of the CHIVA procedure is the elimination of the saphenous reflux by high ligation at the saphenofemoral junction; thus it can be presumed that the CHIVA procedure yields similar results like the crossectomy. The ASVAL procedure is de facto the modification of the old Madelung method that was the prevalent surgical procedure before the Trendelenburg era in the 19th century. The results after ASVAL were not checked by plethysmography; there is a good case to suppose that the results after the ASVAL method would comply with those after sclerotherapy.

Keywords: ASVAL; CHIVA; hemodynamics; reflux; varicose veins; venous hemodynamics.

Fig. 1

Impact of sclerotherapy on the hemodynamic disorder in primary varicose veins evaluated by strain gauge plethysmographic parameters refill time t-90, t-50 in seconds (a), and refill volume in ml/100 ml (b). Note the significant improvement of the hemodynamic situation one week after completed sclerotherapy and the following distinct impairment up to two years after sclerotherapy. The parameters refill time t-90 and t-50 returned to the values before treatment. V = before sclerotherapy; N = one week after sclerotherapy; S = two years after sclerotherapy.