Systematic Review and Meta-Analysis Comparing the Efficacy of CHIVA and Conventional Stripping and Ablation Techniques.

BACKGROUND

Chronic venous disease, particularly primary lower extremity varicose veins, is a prevalent global health issue. The Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) technique is a hemodynamic-based, vein-preserving strategy proposed as a minimally invasive alternative to traditional treatments like high ligation and stripping or endovenous thermal ablation (e.g., radiofrequency or laser). The CHIVA technique is designed to treat varicose veins while preserving the great saphenous vein, which is the first-choice conduit for potential future arterial grafting, especially at the infra-inguinal level. It offers theoretical advantages of reduced trauma, fewer complications, and lower recurrence potential. This systematic review aims to evaluate the efficacy and safety of CHIVA relative to established techniques, based on current evidence.

METHODS

This systematic review and meta-analysis searched multiple databases until August 2025. It included randomized controlled trials (RCTs) and cohort studies comparing CHIVA with stripping or ablation techniques in patients with primary varicose veins. The primary outcome is recurrence; the secondary outcomes include postoperative complications (e.g., saphenous nerve injury). Study quality was assessed using the Cochrane and Newcastle-Ottawa Scale. Statistical analysis was performed using Review Manager 5.4.1.

RESULTS

The analysis included 11 studies (3 RCTs, 8 cohorts) with a total of 13,089 patients, of whom 6,908 underwent the CHIVA strategy, 5,988 underwent stripping, 110 underwent endovenous laser ablation, and 83 underwent radiofrequency ablation. A meta-analysis revealed no significant differences between the CHIVA and control groups in recurrence rates, thrombophlebitis, or wound infections. CHIVA demonstrated statistically significant advantages over stripping procedure in reducing saphenous nerve injury (relative risk [RR]: 0.07; 95% confidence interval [CI]: 0.02, 0.22; P < 0.0001) and ecchymosis (RR: 0.62; 95% CI: 0.54, 0.71; P < 0.0001), and additionally showed superiority over ablation in reducing saphenous nerve injury (RR: 0.14; 95% CI: 0.03, 0.74; P = 0.02).

CONCLUSION

In conclusion, the CHIVA technique demonstrates advantages in minimizing postoperative saphenous nerve injury and ecchymosis; however, it shows no significant superiority over other methods in terms of recurrence rate, thrombophlebitis, or wound infection. Due to limitations including a small number of included RCTs, insufficient studies comparing CHIVA with ablation procedures, publication bias, and outcome heterogeneity, high-quality, multicenter, large-sample RCTs with long-term follow-up are needed to further clarify the clinical value and positioning of CHIVA, particularly in efficacy comparison with ablation procedures.