Ablation Sélective des Varices sous Anésthesie Locale
A.S.V.A.L. E C.H.I.V.A.
The CHIVA method ( Cure Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) is also contrary to the removal of the saphenous vein, but without calling into question the responsibility of the onset of varicose veins.
In fact, the principle on which it’s based is to redistribute the venous flow from the surface (saphenous vein and varicose collateral veins) to the depth (deep venous trunks), using a system of shunts, thus deviations of the flow, on saphenous and perforating veins circuit, through an intervention that segments the superficial reflux with ligatures at different levels.
The methods ASVAL and CHIVA differ fundamentally because according to ASVAL the saphenous vein can “heal” after the removal of varicose veins, while according to CHIVA the saphenous vein can be used to empty into the deep veins the sick varicose veins that are not removed.
A.S.V.A.L. AND INTRAVENOUS ablative techniques (radiofrequency and laser)
The laser and radiofrequency endovenous can eliminate the saphenous vein by photocoagulation. Therefore they can replace the surgical removal of the saphenous vein (stripping), with a less aggressive method.
The pathophysiological concept of intravenous ablation procedures is the same as traditional surgery: the saphenous vein is responsible for varicose disease and should be removed.
The treatment with laser or radiofrequency is generally used in opposition to the ASVAL method, whose principle is to preserve the saphenous as much as possible: we use these procedures only when the saphenous vein is not recoverable. Please note also that the intravenous ablative techniques do not eliminate varicose veins, which must be treated with surgical phlebectomy or sclerotherapy at the same time or later.