The objective of this randomized study was to compare the efficacy of the CHIVA method for the treatment of varicose veins with respect to the standard treatment of stripping.
Varicose veins are a sign of chronic venous disorder. For over a century, varicose veins have been treated with surgical ablative techniques, with stripping being the standard treatment. Currently, postsurgical varicose veins recurrence (20%–80%) is a common, complex, and costly problem. Ambulatory Conservative Hemodynamic Management of Varicose Veins (CHIVA) is a new option for treating chronic venous disorder.
In this open-label, randomized controlled trial, 501 adult patients with primary varicose veins were treated in a single center. They were assigned to an experimental group, the CHIVA method (n = 167) and 2 control groups: stripping with clinic marking (n = 167) and stripping with duplex marking (n = 167). The outcome measure was clinical recurrence within 5 years, assessed clinically by previously trained independent observers. Duplex ultrasonography was also used to assess recurrences and causes.
In an intention-to-treat analysis, clinical outcomes in the CHIVA group were better (44.3% cure, 24.6% improvement, 31.1% failure) than in both the stripping with clinic marking (21.0% cure, 26.3% improvement, 52.7% failure) and stripping with duplex marking (29.3% cure, 22.8% improvement, 47.9% failure) groups. The ordinal odds ratio between the stripping with clinic marking and CHIVA groups, of recurrence at 5 years of follow-up, was 2.64, (95% confidence interval [CI]: 1.76–3.97, P < 0.001). The ordinal odds ratio of recurrence at 5-years of follow-up, between the stripping with duplex marking and CHIVA group, was 2.01 (95% CI: 1.34–3.00, P < 0.001). This trial is registered at ISRCTN and carries the following ID number: ISRCTN52861672, available at: http://isrctn.org.
The present results indicate that, thanks to specific venous hemodynamic evaluation, the CHIVA method is more effective than stripping with clinical marking or stripping with duplex marking to treat varicose veins. When carrying out a stripping intervention, Duplex marking does not improve the clinical results of this ablative technique.
The objective of this open-label, randomized controlled trial was to compare the efficacy of the CHIVA method for the treatment of varicose veins with respect to the standard treatment of stripping. The present results indicate that the CHIVA method is more effective than stripping with clinic marking or stripping with duplex marking to treat varicose veins.
From the *Department of Angiology and Vascular Surgery, Hospital General de Vic, Vic, Spain; †Department of Angiology, Vascular and Endovascular Surgery of the Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; ‡Epidemiology and Assessment Unit, Hospital General de Vic., Vic. Epidemiology and Assessment Unit, Fundació Parc Taulí, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain; §Department of General Surgery, Hospital General de Vic, Vic, Spain; and ¶Epidemiology and Assessment Unit, Fundació Parc Taulí, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.
Supported by the Instituto de Salud Carlos III, Ministerio de Sanidad (Spanish Ministry of Health) y Consumo, by 2 research grant FIS 94/5365 and FIS 97/0694 (Spain), and a research grant from the Non-Invasive Vascular Diagnosis Area of the Spanish Society for Angiology and Vascular and Endovascular Surgery (Sociedad Española de Angiología y Cirugía Vascular), 2003. Josep Jaumira as graphic designer.
Reprints: Josep Oriol Parés, MD, E-mail: firstname.lastname@example.org.