[Ambulatory conservative hemodynamic correction of venous insufficiency. Technique, results].

Ambulatory conservative haemodynamic correction of venous insufficiency (CHIVA) is a surgical treatment of superficial venous insufficiency designed to correct the pathological haemodynamic effects of superficial venous insufficiency apparent on standing. Surgical treatment is based on precise preoperative anatomical and haemodynamic mapping performed by duplex ultrasound, providing preoperative ultrasound-guided marking. Surgical treatment consists of dividing the hydrostatic pressure column and disconnecting venovenous shunts by ligation-section of the superficial venous network at precise points determined by the preoperative ultrasound-guided marking. This strategy should achieve a superficial venous circuit draining perfectly into the competent deep venous network. The operation is performed under local anaesthesia as an outpatient procedure and allows immediate resumption of walking, which promotes a good result due to activation of the calf muscle pump. The results of the technique are very good provided a reliable preoperative ultrasound-guided marking and a precise surgical procedure are performed. Failures are due to poor haemodynamic assessment or inappropriate surgical procedure.