The quality of evidence is downgraded by study limitations (lack of blinding) and by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 6 studies with a total of 1 160 subjects (62% women). Three studies compared the CHIVA method with vein stripping, 1 study compared the CHIVA method with compression dressings in people with venous ulcers, 1 compared CHIVA with vein stripping and radiofrequency ablation (RFA), and 1 compared CHIVA with vein stripping and endovenous laser therapy. The ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) method is a minimally invasive surgical technique to treat varicose veins. The aim of the CHIVA treatment is to eliminate the venous-venous shunts by disconnecting the escape points, preserving the saphenous vein and normal venous drainage of the superficial tissues of the limb.
There was no difference in recurrence of varicose veins (with a follow-up of 18 months to 10 years) between CHIVA and stripping (RR 0.74, 95% CI 0.46 to 1.20; 5 studies, n=966). CHIVA appeared to reduce recurrence compared to compression dressing (RR 0.23, 95% CI 0.06 to 0.96; 1 study, n=47). There was no statistically significant difference in clinical recurrence between CHIVA and RFA (RR 2.02, 95% CI 0.74 to 5.53; 1 study, n=146), or CHIVA and endovenous laser (RR 0.20, 95% CI 0.01 to 4.06; 1 study, n=100).
There was 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, n=746), and superficial vein thrombosis (RR 1.05, 95% CI 0.51 to 2.17; 4 studies, n=846). CHIVA reduced nerve injury (RR 0.14, 95% CI 0.02 to 0.98; 4 studies, n=846) and hematoma compared to stripping (RR 0.59, 95% CI 0.37 to 0.97; 2 studies, n=245). 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 made little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma, but caused more bruising (RR 1.15, 95% CI 1.04 to 1.28; 1 study, n=144). Compared to endovenous laser, CHIVA made little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma.
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