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Review
. 2015 Jun 29;2015(6):CD009648.
doi: 10.1002/14651858.CD009648.pub3.

CHIVA Method for the Treatment of Chronic Venous Insufficiency

Affiliations
Free PMC article
Review

CHIVA Method for the Treatment of Chronic Venous Insufficiency

Sergi Bellmunt-Montoya et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is an update of the review first published in 2013.

Objectives: To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins.

Search methods: The Trials Search Co-ordinator of the Cochrane Peripheral Vascular Diseases Group searched the Specialised Register (April 2015), the Cochrane Register of Studies (2015, Issue 3) and clinical trials databases. The review authors searched PubMed (April 2015). There was no language restriction. We contacted study authors to obtain more information when necessary.

Selection criteria: We included randomized controlled trials (RCTs) that compared the CHIVA method versus any other treatments. Two review authors independently selected and evaluated the studies. One review author extracted data and performed the quantitative analysis.

Data collection and analysis: Two independent review authors extracted data from the selected papers. We calculated the risk ratio (RR), mean difference (MD), the number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI) using Review Manager 5.

Main results: No new studies were identified for this update. We included four RCTs with 796 participants (70.5% women). Three RCTs compared the CHIVA method with vein stripping, and one RCT compared the CHIVA method with compression dressings in people with venous ulcers. We judged the quality of the evidence of the included studies as low to moderate due to imprecision caused by the low number of events and because the studies were open. The overall risk of bias across studies was high because neither participants nor outcome assessors were blinded to the interventions. The primary endpoint, clinical recurrence, pooled between studies over a follow-up of 3 to 10 years, showed more favorable results for the CHIVA method than for vein stripping (721 people; RR 0.63; 95% CI 0.51 to 0.78; I(2) = 0%, NNTB 6; 95% CI 4 to 10) or compression dressings (47 people; RR 0.23; 95% CI 0.06 to 0.96; NNTB 3; 95% CI 2 to 17). Only one study reported data on quality of life (presented graphically) and these results significantly favored the CHIVA method.The vein stripping group had a higher risk of side effects than the CHIVA group; specifically, the RR for bruising was 0.63 (95% CI 0.53 to 0.76; NNTH 4; 95% CI 3 to 6) and the RR for nerve damage was 0.05 (95% CI 0.01 to 0.38; I(2) = 0%; NNTH 12; 95% CI 9 to 20). There were no statistically significant differences between groups regarding the incidence of limb infection and superficial vein thrombosis.

Authors' conclusions: The CHIVA method reduces recurrence of varicose veins and produces fewer side effects than vein stripping. However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed and the results were imprecise due to low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.

Conflict of interest statement

SB: reports he received payment from Sanofi‐Aventis for presenting to an Internal expert class and from Otsuka/Ferrer for consultancy at EMA. These activities were not related to this review JME: none known JD: none known MJM: reports that Associazione "Umanizazione" della Chirurgia, Italy paid money to her institution to finance this review

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 CHIVA versus stripping, outcome: 1.1 Recurrence of varicose veins.
5
5
Forest plot of comparison: 1 CHIVA versus stripping, outcome: 1.9 Side effects.
1.1
1.1. Analysis
Comparison 1 CHIVA versus stripping, Outcome 1 Recurrence of varicose veins.
1.2
1.2. Analysis
Comparison 1 CHIVA versus stripping, Outcome 2 Re‐treatment.
1.3
1.3. Analysis
Comparison 1 CHIVA versus stripping, Outcome 3 Free from reflux.
1.4
1.4. Analysis
Comparison 1 CHIVA versus stripping, Outcome 4 Esthetic improvement assessed by the participant.
1.5
1.5. Analysis
Comparison 1 CHIVA versus stripping, Outcome 5 Esthetic improvement assessed by the participant.
1.6
1.6. Analysis
Comparison 1 CHIVA versus stripping, Outcome 6 Esthetic improvement assessed by the investigator.
1.7
1.7. Analysis
Comparison 1 CHIVA versus stripping, Outcome 7 Cure or no clinical symptoms.
1.8
1.8. Analysis
Comparison 1 CHIVA versus stripping, Outcome 8 Clinical improvement.
1.9
1.9. Analysis
Comparison 1 CHIVA versus stripping, Outcome 9 Side effects.
1.10
1.10. Analysis
Comparison 1 CHIVA versus stripping, Outcome 10 Recurrence of varicose veins. Sensitivity analysis..
2.1
2.1. Analysis
Comparison 2 CHIVA versus compression dressing, Outcome 1 Recurrence of venous ulcer.
2.2
2.2. Analysis
Comparison 2 CHIVA versus compression dressing, Outcome 2 Cure of venous ulcer.

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