Microsurgery and CHIVA
Varicose vein surgery
Today, varicose vein surgery has little to do with traditional saphenous vein stripping. It is done as an outpatient procedure, under local anaesthesia or sedation, through incisions just a few millimetres long. I choose the technique according to what the duplex ultrasound shows in each leg.
When surgery is considered
When varicose veins cause symptoms or complications (phlebitis, bleeding, skin changes, ulcers), or the patient wishes to treat them, and the duplex ultrasound shows reflux that should be corrected. The 2022 European guideline places endovenous thermal techniques as the first choice for the saphenous vein; surgery still has its place for branch varicose veins, for anatomies unsuitable for a catheter, and in saphenous-sparing strategies such as CHIVA.
Techniques I use
MicrophlebectomyRemoval of branch varicose veins through 1–2 mm micro-incisions under local anaesthesia. It leaves barely any scar, and the European guideline recommends it for tributary varicose veins.
CHIVAAmbulatory haemodynamic correction: instead of removing the saphenous vein, the reflux points are interrupted to redirect the circulation and preserve the vein.
Combination with endovenous techniquesRadiofrequency or VenaSeal for the saphenous vein and microsurgery for the branches, in the same session or in stages.
What the evidence says about CHIVA
A 2021 Cochrane review compared CHIVA with stripping, radiofrequency and endovenous laser: it found no clear differences in varicose vein recurrence, and suggested fewer nerve injuries and haematomas than with stripping, although slightly more bruising than with radiofrequency. The certainty of this evidence is low, because the studies are few and small.
Before and after the procedure
- Duplex ultrasound assessment and marking of the varicose veins before surgery.
- Outpatient procedure: the patient goes home the same day.
- Walking from the first day helps recovery.
- Bruising and discomfort may appear in the treated areas and fade within a few weeks.
- Follow-up duplex ultrasound to check the result.
Risks
They are uncommon and generally mild: bruising, inflammation of a superficial vein (phlebitis), changes in skin sensation from irritation of small nerves and, exceptionally, deep vein thrombosis. Varicose veins may return over the years, because venous disease is chronic, regardless of the technique.
Videos on this topic (in Spanish)
References
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267.
- 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:CD009648.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
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Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
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