How We Perform CHIVA: A Standardized Pathway From Hemodynamic Duplex Mapping to Structured Follow-up

Abstract

CHIVA is a vein-sparing therapeutic strategy based on the analysis of venous hemodynamics. Its purpose is not to treat a named vein according to a fixed anatomical recipe, but to reduce pathological venous pressure by identifying the pressure source, the escape point, the abnormal shunt pathway, and an effective re-entry into the deep venous system. Veins that retain a useful drainage function are preserved whenever feasible. Although venous networks and pressure-drainage relationships vary considerably among patients, individualized treatment does not preclude standardization. This technical note describes an institutional pathway comprising patient selection, weight-bearing dynamic duplex ultrasound, construction of a hemodynamic map, treatment planning, same-day verification, limited intervention, structured follow-up, and remapping before any secondary procedure. The pathway emphasizes that treatment should not be determined by reflux duration or vein diameter alone. Likewise, outcome assessment should not be reduced to vein occlusion or disappearance. The principal endpoints are modification of the pathological pressure gradient, preservation of effective drainage, clinical improvement, and stabilization of the venous network under lower pressure. The proposed pathway is intended to improve reproducibility, training, documentation, and quality assurance while preserving the patient-specific reasoning that defines CHIVA.