全球CHIVA治疗静脉曲张的循证医学之路：证据、挑战与前景

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下肢静脉曲张是一种常见的慢性静脉功能不全（CVI）疾病，影响全球大量人群的生活质量。传统治疗方法主要包括硬化剂注射、静脉剥脱术，而近十年来激光、射频消融、胶闭合隐静脉主干的技术也得到应用。但近年来，CHIVA（基于血流动力学分析的保留静脉的门诊局麻治疗）作为一种保留静脉的微创疗法，因其在降低复发率和改善患者生活质量方面的优势备受关注。

通过MEDLINE、Embase 和 Cochrane 三个全球知名的数据库中大量搜索文献，总共发现超过39 项 RCT研究，共涉及超过 6000 条肢体，最终用于定量分析。

研究重点关注不同静脉曲张治疗方法的长期疗效。选择了成功治疗率（successful treatment rate, STR）和复发率（recurrence rate, RR ）两个作为最终数据合成分析的客观指标。STR 被定义为解剖学和功能学上的完整性，即通过超声确认完全消融、闭合或剥脱。RR 被定义为初始治疗后再次出现的任何明显可见的静脉曲张或病理性返流情况。

分别探讨消融术、CHIVA、硬化剂治疗、结扎术和剥脱术，以及 4 种额外的联合治疗 (消融术 + 剥脱术、消融术 + 结扎术、硬化剂治疗 + 结扎术、结扎术 + 剥脱术)。结果显示成功治疗率：CHIVA > 硬化剂治疗 + 结扎术 > 消融术 + 剥脱术。长期复发率 (RR)：CHIVA < 消融术 + 剥脱术 < 剥脱术。 CHIVA 在 1 年以上随访中具有最高的成功治疗率 (P 值为 0.37)。对 1 年随访后的复发率进行分析，结果表明 CHIVA 具有最低的复发率 (P 值为 0.61)。

高位结扎加大隐静脉剥脱术（HLS）曾经是治疗静脉曲张的手术“金标准”。它可以改善部分生活质量，并在术后短期内显示出疗效。然而，传统手术的创伤性偏大，存在高并发症和复发率的风险，因此可能无法保持长期的临床益处，有研究显示传统抽剥手术的复发率为20-50%，与医生经验相关。

与传统手术相比，一些微创技术可能带来较小的创伤，比传统手术更安全。这些技术主要包括消融术（激光或射频消融）+外科剥脱+硬化剂治疗联合，这些方法已被证明是安全有效的，目前在三甲医院纷纷开展微创技术。然而，消融术和硬化疗法仍然属于废除静脉的治疗方法，这也可能造成静脉网络的破坏和带来相关的并发症。对于长期随访而言，微创技术也并不能从根本上防止静脉曲张复发，有研究显示消融术的复发率为10-20%，同样与医生经验相关。

CHIVA超微创治疗的革命性之处在于，通过精细的血流动力学评估，可以有效治疗静脉曲张的同时保留健康的静脉网络。在实践中，CHIVA 治疗通过阻断异常返流、分隔压力柱、保留回流点等方式来降低静脉内压力，静脉曲张会逐渐缩小，同时继续发挥其引流血液至深静脉的作用。

这种革命性的方法颠覆了传统的以去除或破坏静脉曲张为中心的治疗理念，因此，CHIVA治疗可以在根源上降低静脉高压，最大程度避免了手术创伤带来的问题。

尽管静脉瓣膜功能损伤是不可逆的，但CHIVA治疗后静脉通路仍然可以发挥运输血液的作用，同时也可以引流皮下静脉网络的血液，减少对正常静脉的干扰。这种新的平衡可以进一步降低静脉曲张的复发。这些特点可能是揭示CHIVA治疗具有更好的临床长期疗效和更低复发率的关键因素。

有研究显示，CHIVA治疗的复发率为5-10%，医生的经验也决定复发率高低，值得注意的是，几乎所有治疗后复发的案例都可以通过血流动力学的方法（CHIVA）进行修复。

规范CHIVA数据对于循证结果的重要性

高质量和一致的数据对于CHIVA的循证医学研究至关重要。然而，由于CHIVA技术的复杂性和不同地区的实践差异，获取一致性的数据是一个挑战。这可能导致不同研究结果的可比性下降，影响循证医学的可信度。因此，标准化的数据收集和报告标准，以及国际数据共享平台的建立，将有助于促进全球范围内的数据交流和比较，确保研究结果的准确性和可比性。

张强医生集团和美国Inteloes发起的全球CHIVA培训和认证项目，是提升医生技术水平和推动数据规范化的重要一步。通过系统的培训和认证，确保医生掌握标准化的CHIVA操作流程，从而提高临床效果，减少技术差异带来的影响。这一项目还推动了统一的研究标准和方法，确保CHIVA与传统手术方法的比较研究更加科学、严谨。

全球CHIVA项目的意义

全球CHIVA培训和认证项目不仅有助于提升医生的技术水平和经验积累，还推动了CHIVA技术在全球范围内的规范化和标准化。通过这一项目，可以建立统一的研究标准和操作规范，确保各国研究机构的数据可比性，从而提供更为可靠的循证医学证据。此外，该项目还促进了国际间的数据共享和学术交流，有助于推动CHIVA技术在全球范围内的推广和应用。

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Global CHIVA 全球专家委员会成员

• Dr. Maria Caminati
• Dr. Massimo Cappelli
• Dr. Roberto Cuaranta
• Dr. Michel Dadon
• Dr. Jianping Deng
• Dr. Luca De Siena
• Dr. Roberto Delfrate
• Dr. Xin Du
• Dr. Stefano Ermini
• Dr. José María Escribano
• Dr. Felipe Puricelli Faccini
• Dr. Davide Foresti
• Dr. Guglielmo Fornasari
• Dr. Claude Franceschi
• Dr. Gelfrido Galizi
• Dr. Sergyi Kryzhanovskyi
• Dr. Andres Jorge Kupelian
• Dr. Thanh-Phong Le
• Dr. Erika Mendoza
• Dr. Domenico Migaldi
• Dr. Fausto Passariello
• Dr. Mauro Pinelli
• Dr. Juha Pitkaenen
• Dr. Manuel Eugenio Senín Fernández
• Dr. Qiang Zhang
• Dr. Xiaoyin Zhu

ARTICLES FOCUSING ON THE PRESENTATION OF CHIVA THERAPY

（关于 CHIVA 的研究文献）

1. Franceschi, C. (1989). The conservative and hemodynamic treatment of ambulatory venous insufficiency. Phlebologie, 42(4), 567.
2. FRANCESCHI,, & FRANCO, G. (1989). La cure CHIVA Discussion. Phlébologie, 42(4),567-568.
3. Mandolesi,, Ballo, M., Galeandro, I., Filippo, S., Migaldi, D., Spinelli, F., … & Passariello,
4. (1990). The 1st national multicenter study of the CHIVA (Conservative Therapy and HemodynamicsinVenous Insufficiency in Outpatient Departments) method of treatment of varices. One-year follow-up. Annali italiani di chirurgia, 61(4), 425-427.
5. CONSIGLIO L., GIORGI G.: Terapia di exeresi o conservativa?Minerva Ang. 1991;16, sup.1: pp. 442–3.
6. Melliere, D., Cales, B., Martin-Jonathan, C., & Schadeck, M. (1991). Necessity of reconciling the objectives of the treatment of varices and arterial surgery. Practical consequences. Journal des maladies vasculaires, 16(2), 171-178.
7. Franceschi C. La cure conservatrice hémodynamique de l’insuffisance veineuse ambulatoire (chiva) [Conservative hemodynamic ambulatory treatment of venous insufficiency]. Soins Chir. 1992;(133):29-31.
8. Franceschi La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA) [Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure)]. J Mal Vasc. 1992;17(4):291-300.
9. Bailly M. La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA).Présentationd’un cas particulier [Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). Report of an atypical case]. J Mal Vasc. 1992;17(3):241-249.
10. Hugentobler JP, Blanchemaison P. La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA). Etude de 96 patients opérés de juin 1988 à juin 1990 [Ambulatoryand hemodynamic treatment of venous insufficiency (CHIVA cure). Study of 96 patients operated on between June 1988 and June 1990]. J Mal Vasc. 1992;17(3):218-223.
11. Bailly, (1993). Cartographie CHIVA. Encyclopédie Médico-Chirurgicale. Paris 43-161-B: 1–4.
12. Franceschi, (1993). La cure CHIVA et la critique: 14 réponses et 1 conclusion. STV. Sang thrombose vaisseaux, 5(7), 491-497.
13. ZamboniP, Murgia AP, Vasquez G, Zandi G, Mari C, Liboni La chirurgia venosa videoassistita [Video-assisted venous surgery]. Ann Ital Chir. 1995;66(3):379-386.
14. Zamboni,, Feo, C. V., Marcellino, M. G., Vasquez, G., & Mari, C. (1996). Haemodynamic correction of varicose veins (CHIVA): An effective treatment?. Phlebology, 11(3), 98-101.
15. di Chirurgia Generale, U. O. ILTRATTAMENTO DELLE VARICI DEGLI ARTI INFERIORI MEDIANTE CHIVA 2. NOSTRA ESPERIENZA.
16. A BANHINI,C Franceschi, X Mouren, P Caillard et : Superficial venous insufficiency JOURNAL DES MALADIES VASCULAIRES, 1996
17. FRANCESCHI, C.: Physiopathologie hémodynamique de l’insuffisance veineuse des membres inférieurs (1997) Actualités Vasculaires Internationales, 22, pp. 17-27
18. FRANCESCHI C. La Cure Hemodynamique de l’Insuffisance Veineuse en Ambulatoire.: Journal des Maladies Vasculaires. 1997 ; 22 (2) :91-95
19. CAPPELLI et Al.: Criteri di scelta della Strategia CHIVA Arch. Soc. Ital. Chirurgia 4, 118, 1998
20. Cappelli, M., Lova, R. M., Ermini, S., Turchi, A., Bono, G., & Franceschi, C. (1999). POSTERS-Conservative surgery of the saphenous trunks. Journal des Maladies Vasculaires, 24, 103-103.
21. Mendoza, E. (2002). Einteilung der Rezirkulationen im Bein: anatomische und physiologische Grundlagen der CHIVA-Methode. Phlebologie, 31(01), 01-08.
22. Criado, E., Luján, S., Izquierdo, L., Puras, E., Gutierrez, M., & Fontcuberta, J. (2002, March). Conservative hemodynamic surgery for varicose veins. In Seminars in Vascular Surgery (Vol. 15, No. 1, pp. 27-33). WB Saunders.
23. Mendoza, (2002). CHIVA-Alternative oder Erganzung zum Stripping. VASOMED-BONN-, 14(1), 6-17.
24. Hach, (2002). Was ist CHIVA?. Gefässchirurgie, 7(4), 244-250.
25. Mendoza, E. (2002). Einteilung der Rezirkulationen im Bein: anatomische und physiologische Grundlagen der CHIVA-Methode. Phlebologie, 31(01), 01-08.
26. JUAN-SAMSO’ J.: Venous haemodynamic surgery in the treatment of varicose syndrome (2003) Angiologia, 55 (5), pp. 460-475.
27. Cappelli, M., Molino Lova, R., Ermini, S., Franceschi, C., & PERRIN, M. (2002). Nouvelle approche de la physiopathologie de l’insuffisance veineuse superficielle: Conséquences thérapeutiques. Discussion: Indications thérapeutiques et nouvelles techniques de traitement en phlébologie. Phlébologie, 55(1), 27-31.
28. Criado,, Juan, J., Fontcuberta, J., & Escribano, J. M. (2003). Haemodynamic surgery

for varicose veins: rationale, and anatomic and haemodynamic basis. Phlebology, 18(4), 158-166.

1. Criado, E., Juan, J., Fontcuberta, J., & Escribano, J. M. (2003). Haemodynamic surgery for varicose veins: rationale, and anatomic and haemodynamic basis. Phlebology,18(4), 158-166.
2. PITTALUGA, P. (2008). MISE AU POINT CONCERNANT les COMMENTAIRES sur la CURE CHIVAdans l’ARTICLE des Drs P. PITTALUGA et S. CHASTANET:«TECHNIQUE et TRAITEMENT des VARICES: COMMENT CHOISIR?». Phlébologie, 61(4), 428-430.
3. Passariello, (2008). Suppression of the sapheno-femoral reflux by pure non-saphenous phlebectomy and anatomical structure of the reflux. Acta Phlebologica, 9(3), 105-7.
4. Franceschi, C. (2008). Hémodynamique de la maladie postphlébitique: conséquences diagnostiques et thérapeutiques. Journal des Maladies Vasculaires, 33, S5.
5. Franceschi, C. (2008). Hémodynamique de la maladie postphlébitique: conséquences diagnostiques et thérapeutiques. Journal des Maladies Vasculaires, 33, S5.
6. Mowatt-Larssen E, Shortell C. CHIVA. Semin Vasc Surg. 2010;23(2):118-122. doi:10.1053/j.semvascsurg.2010.01.008.
7. Mowatt-LarssenE, Shortell Treatment of primary varicose veins has changed with the introduction of new techniques. Semin Vasc Surg. 2012;25(1):18-24. doi:10.1053/j.semvascsurg.2012.02.002
8. Casian, D. (2012). Metode contemporane de tratament al maladiei varicoase. Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, 33(1), 319-322.
9. Onida, S., & Davies, A. H. (2015). CHIVA, ASVAL and related techniques–Concepts and evidence. Phlebology, 30(2_suppl), 42-45.
10. Gianesini, S., Occhionorelli, S., Menegatti, E., Zuolo, M., Tessari, M., Spath, P., … & Zamboni, P. (2015). CHIVAstrategy in chronic venous disease treatment: instructions for users. Phlebology, 30(3), 157-171.
11. Zamboni, P., & Gianesini, S. (2016). Surgical technique for deep venous reflux suppression in femoral vein duplication. EJVES Short Reports, 30, 10-12.
12. PUSKÁS A. et Al.:HAEMODYNAMIC MAPPING OF CHRONIC VENOUS INSUFFICIENCY:THECONCEPT OF SHUNTS VÉNÁK BETEGSÉGEI Érbetegségek,XXIII. évfolyam 4. szám, 2016/4.
13. Faccini FP, Arendt AL, Pereira RQ, de Oliveira AR. CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report. J Vasc Bras. 2019;18:e20180077. Published 2019 Jan 7. doi:10.1590/1677-5449.007718

第二部分：

ARTICLES CONCERNING SUBJECTES OF CHIVA PROCEDURE NOT IN TERMS OF RECURRENCES / CLINIC DATA BUT OF BIOCHEMICAL, HEMODYNAMIC PARAMETERS, THROMBOSES AND COMPLICATIONS

（关于 CHIVA 治疗的生物力学、血流动力学、血栓及并发症方面的临床数据）

1. CAPPELLI et Al.: Considerazioni sul ruolo fisiopatologico delle perforanti nella varicosi essenziale, quale presupposto alla concezione terapeutica dell’intervento CHIVA Ospedali d’Italia – Chirurgia nov–dic 1991, vol. XLIV n°6, pp.425–438.
2. ZamboniP, Marcellino MG, Feo CV, et Alternative saphenous vein sparing surgery for future grafting. Panminerva Med. 1995;37(4):190-197.
3. Mendoza, E. (2018). Perioperative Management in Saphenous Sparing Surgery. In SaphenousVein-Sparing Strategies in Chronic Venous Disease (pp. 239-250). Springer,
4. Zamboni P, Cisno C, Marchetti F, Quaglio D, Mazza P, Liboni A. Reflux elimination without any ablation or disconnection of the saphenous vein. Ahaemodynamic model for venous surgery. Eur J Vasc Endovasc Surg. 2001;21(4):361-369.
5. FRANCESCHI: CHIVA effectiveness score: the correct one is below.Eur J Vasc Endovasc Surg. 2012 Sep;44(3):351; author reply 352.
6. Maldonado-Fernández,, López-Espada, C., Martínez-Gámez, F. J., Mata-Campos, J. E., Galán-Zafra, M., & Sánchez-Maestre, M. (2010). Complicaciones postoperatorias de la estrategia CHIVA para el tratamiento de la insuficiencia venosa crónica. Angiología, 62(3), 91-96.
7. MENDOZA, BERGER V., ZOLLMANN C., BOMHOFF M., AMSLER F., Calibrereduction of great saphenous vein and common femoral vein after CHIVA Phlebologie, 2011, 40(2): pp. 73–78
8. MENDOZA, Diameter reduction of the great saphenous vein and the common femoralvein after CHIVA Long–term results, Phlebologie, 2013, 42: pp. 65–69
9. MENDOZA: Crossectomy of the great saphenous vein with the CHIVA method (2004) Vasomed, 16 (2), pp. 46-48.
10. DELFRATE, BRICCHI M., FRANCESCHI C., GOLDONI M., Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins, Veins and Lymphatics, 2014, 3: pp. 19–22
11. MENDOZAE, AMSLER , CHIVA with endoluminal procedures: LASER versus VNUS –treatment of the saphenofemoral junction, Phlebologie, 2017, 46: pp. 5–12.
12. PASSARIELLO F. et: The office based CHIVA Journal of Vascular Diagnostics 26 September 2013 Volume 2013:1 Pages 13—20
13. Gianesini, S., Menegatti, E., Zuolo, M.,Tessari, M., Ascanelli, S., Occhionorelli, S., & Zamboni, (2013). Short endovenous laser ablation of the great saphenous vein in a modified CHIVA strategy. Veins and Lymphatics, e21-e21.
14. Gianesini, S., Menegatti, E., Malagoni, M., Occhionorelli, S., & Zamboni, P. (2017). Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options. Phlebology, 32(4), 249-255.
15. Gianesini, S., Menegatti, E., Malagoni, M., Occhionorelli, S., & Zamboni, P. (2017). Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options. Phlebology, 32(4), 249-255.
16. Tisato, V., Zauli, G., Gianesini, S., Menegatti, E., Brunelli, L., Manfredini, R., … & Secchiero, P. (2014). Modulation of circulating cytokine-chemokine profile in patients affectedby chronic venous insufficiency undergoing surgical hemodynamic correction. Journal of immunology research, 2014.
17. Gianesini,, Menegatti, E., Zuolo, M., Tessari, M., Spath, P., Ascanelli, S., … & Zamboni,
18. (2015).Laser-assisted strategy for reflux abolition in a modified CHIVA approach. Veins and Lymphatics, 4(2).
19. Zamboni,, Spath, P., Tisato, V., Tessari, M., Dalla Caneva, P., Menegatti, E., … & Secchiero, P. (2016). Oscillatory flow suppression improves inflammation in chronic venous disease. Journal of Surgical Research, 205(1), 238-245.
20. Delfrate, R. (2019). Thanks to the CHIVAstrategy, may the histoarchitecture of great saphenous vein-sparing, make it suitable as graft for bypasses?. Veins and Lymphatics, 8(1).
21. ZAMBONI et Al.: Alternative saphenous vein sparing surgery for future grafting. Panminerva Med. 1995 Dec;37(4):190-7.
22. Mendoza, M. Cappelli : Sclerotherapy technique in CHIVA strategy Phlebologie 2017; 46(02): 66-74
23. FERRACANI: A Change of a Paradigm Under the Scope of a Cardiovascular Surgeon. Remodeling of the Great Saphenous Vein Instead of Ablation for Preservation of the Patient Anatomical Capital Cardiology December 30, 2019 ecronicon.com open access
24. MENDOZA : Does the suture material influence the outcome after high ligation of great saphenous vein? Vasa (2020), 49 (2), 153–155

第三部分：

ARTICLES CONCERNING THE RESULTS OF CHIVA PROCEDURE IN TERM OF RECURRENCES / CLINIC DATA WITHOUT COMPARISON WITH OTHER METHODS

（关于 CHIVA 治疗的复发率/临床数据的非对照临床研究）

• FICHELLEJM, Carbone P, Franceschi : Results of ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure) J Mal Vasc. 1992;17(3):224-8.
• BAILLY: Resultats de la cure Chiva In techniqueset stratégie en chirurgie vasculaire. Jubilé de J.M. Cormier. Edition A.E.R.C.Paris 1992: 255-71
• HUGENTOBLERP., BLANCHMAISON P.: CHIVA cure. Etude de 96 patients opres de juin1988 a juin 1990 J. Mal. Vasc., 1992, 17: pp. 218–23.
• QUINTANA et Al.:The CHIVA cure of varices of the lower extremities. La Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire Angiologia. 1993 Mar-Apr;45(2):64, 66-7
• ZAMBONI: When CHIVA treatment could be video guided. Dermatol Surg. 1995 Jul;21(7):621-5.
• ZAMBONI et AL.: Angiovideo-assisted hemodynamic correction of varicose veins. Int Angiol. 1995 Jun;14(2):202-8.
• BAHNINIA, Bailly M, Chiche L, Franceschi C.: Ambulatory conservative hemodynamic correction of venous insufficiency. Technique, results. Ann Chir. 1997;51(7):749-60.
• CAPPELLI et Al.: I risultati della cura CHIVA. Osp Ital Chir 1998; 4: 615-8.
• ZAMBONI, MARCELLINO M.G., CAPPELLI M., FEO C.V., BRESADOLA V.,

VASQUEZ G., LIBONI A., Saphenous vein sparing surgery: principles, techniques and results, J.. Cardiovasc. Surg., Torino 1998 Apr, 39(2): pp. 151–62.

• CAPPELLI M. et Al. “Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years” ANNALS OF VASCULAR SURGERY 2000 Vol 14 n°4 pag 376-384
• ESCRIBANOM., JUAN J., BOFILL R., MAESO J., RODRÍGUEZ–MORI A., MATAS M.,

Durability of reflux–elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3–year prospective case study, Eur. J. Vasc. Endovasc. Surg., 2003, 25: pp. 159–63.

• ZAMBONI P, ESCRIBANO JM.: Regarding ‘Reflux Elimination Without anyAblation or Disconnection of the Saphenous A Haemodynamic Model for Venous Surgery’ and ‘Durability of Reflux-elimination by a Minimal Invasive CHIVA Procedure on Patients with Varicose Veins. A 3-year Prospective Case Study’. Eur J Vasc Endovasc Surg. 2004 Nov;28(5):567.
• ESTEBAN-GRACIA et Al.: Application of the CHIVA strategy. A prospective study at one year Angiologia 2004, 56 (3), pp. 227-235.
• LINARES-RUIZ, P., Bonell-Pascual, A., Llort-Pont, C., Romera, A., Lapiedra-Mur, O. : Mid-term results of applying the CHIVA strategy to the external saphenous vein. Angiologia 2004 , 56 (5), pp. 481-490.
• ZAMBONI, GIANESINI S.,MENEGATTI E., TACCONI G., PALAZZO A., LIBONI A.,

Great saphenous varicose vein surgery without saphenofemoral junction disconnection, Br. J. Surg., 2010 Jun, 97(6): pp. 820–5.EVA et Al.: CHIVA – ECOGRAPHIC ASPECTS AND SURGICAL RESULTS

Maxilo-facial surgery volume 18 • issue 1 January / March 2014 • pp. 64-70EVA,, TIUTIUCA, R., & STANCIU, C. (2014). CHIVA-ECOGRAPHIC ASPECTS AND

SURGICAL RESULTS. International Journal of Medical Dentistry, 18(1).

• MALDONADO-FERNANDEZet : Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins. Cir Esp. 2016 Mar;94(3):144-50.
• ZMUDZINSKI M,MALO P, HALL C, HAYASHI , CHIVA – A prospective study of a vein sparing technique for the management of varicose vein disease, Am. J. Surg., 2017, 213: pp. 967–969.
• FRANCESCHIC, Bahnini A, Cappelli M, Cuaranta RL, Dadon M, Delfrate R, Ermini S, Gianesini S, Mendoza E, Passariello F, Puskas : Commentary on the article “A prospective study of a vein sparing technique for the management of varicose vein disease” by M Zmudzinski et al. Am J Surg. 2018 Nov;216(5):1035.
• Faccini, F. P., Ermini, S., & Franceschi, C. (2019). CHIVAto treat saphenous vein insufficiency in chronic venous disease: characteristics and Jornal Vascular Brasileiro, 18.

第四部分：

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATAWITH OTHER PROCEDURESEMPLOING NOT RANDOMIZED STUDIES

（比较 CHIVA 与其他术式的复发率/临床数据的非随机研究）

1. Gorny, P., Blanchemaison, P., Chahine, D., Hutinel, B., & Chanvallon, C. (1995). Chirurgie conservatrice et ambulatoire: étude comparative entre Chiva et crossectomie chez 321 patients opérés de la saphène interne. Discussion. Phlébologie, 48(2), 255-259.
2. CAPPELLI,MOLINO LOVA R., ERMINI S., TURCHI A., BONO G., BAHANINI A.,FRANCESCHI C.I., La Cure CHIVA dans le traitement de la Maladie Variqueuse: analyse critique des résultats après trois ans, Ann. Chir. Vasc., 1996.
3. MAESO, JUAN J., ESCRIBANO J., ALLEGUEN.M.,DIMATTEO A.,GONZALEZE.,MATAS M.: Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities Ann. Vasc. Surg., 2001, 15: pp. 661–5.
4. NOPPENEY, T., Noppeney, J., Kurth, I.: Results of standard varicose vein surgery (2002) Zentralblatt fur Chirurgie, 127 (9), pp. 748-751.
5. MARIA et Al. : Varicose disease of lower limbs: What kind of treatment? Personal experience Chirurgia 2008, 21 (4), pp. 195-198.
6. Solís, V., Ribé, L., Portero, J. L., & Rio, J. (2009). Stripping saphenectomy, CHIVA and laser ablation for the treatment of the saphenous vein insufficiency. Ambul Surg, 15(1), 11-4.
7. Franceschi, (2010). “Stripping versus the CHIVA Method” par Claude Franceschi. Angéiologie, 62(4).
8. MILONE, SALVATORE G.,MAIETTA P., SOSA FERNANDEZL.M.,MILONE F.,Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience, G. Chir., 2011, p. 32.
9. CHANCY et : Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins. World J Surg. 2011 Jul;35(7):1679-86.
10. DKELLEHER, T R A Lane, I J Franklin and A H Davies : Treatment options, clinical outcome (quality of life) and cost benefit (quality-adjusted life year) in varicose vein treatment Phlebology 2012;27 Suppl 1:16–22.
11. DE FRANCISCIS S. et Al. : Hemodynamic surgery versus conventional surgery in chronicvenous disease: a multicenter retrospective ACTA PHLEBOL. 2013; 14; 109-114
12. WANG, CHEN Q., FEI Z., ZHENG E., YANG Z., HUANG X., HEMODYNAMIC CLASSICATION AND CHIVA TREATMENT OF VARICOSE VEINS IN LOWER EXTREMITIES(VVLE) Int. J. Clin. Exp. Med., 2016, 9(2): pp. 2465–2471.

第五部分：

ARTICLES COMPARING CHIVA RECURRENCES / CLINICAL DATAWITH OTHER PROCEDURESEMPLOING RANDOMIZED STUDIES (RCT)

（比较 CHIVA 与其他术式的复发率/临床数据的随机研究）

• ZAMBONI,CISNO C.,MARCHETTIF.,MAZZA P.,FOGATO L.,CARANDINA S.,DE PALMA M., LIBONI A., Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial, Eur. J. Vasc. Endovasc. Surg., 2003 Apr, 25(4): pp. 313–8.CARANDINA, MARI C., DE PALMA M., MARCELLINO M.G., CISNO C., LEGNAROA., LIBONI A., ZAMBONI P., Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial, Eur. J. Vasc. Endovasc. Surg., 2008 Feb, 35(2):

1. 230–7.IBORRA–ORTEGA, BARJAU–URREA E., VILA–COLL R., BALLÓN–CARAZASH.,CAIROLS–CASTELLOTE M.A., Estudio comparativo de dos técnicas quirúrgicas en el tratamientode las varices de las extremidades inferiores: resultados tras cinco años de seguimiento, ANGIOLOGÍA, 2006, 58(6): pp. 459468.PARÉSO., JUAN J., TELLEZ R., MATA A., MORENO C., QUER F.X., SUAREZ D.,CODONY I., ROCA J., Varicose vein surgery: stripping versus the CHIVA method: a randomized controlled trial, Ann. Surg., 2010 Apr, 251(4): pp. 624–31.

第六部分：

REVISIONI COCHRANE e METANALISI

（关于 CHIVA 的系统性回顾以及 Meta 分析）

1. BELLMUNT–MONTOYA, ESCRIBANO J.M., DILME J., MARTINEZ–ZAPATA M.J.,

CHIVA method for the treatment of chronic venous insufficiency, Cochrane Database Syst. Rev., 2013 Jul 3, (7): CD009648.

1. BellmuntMontoya,, Escribano, J. M., Dilme, J., &MartinezZapata, M. J. (2015).CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database of Systematic Reviews, (6).
2. Guo et Al.: Long-term efficacy of different procedures for treatment of varicose veins A network meta-analysis Medicine (2019) 98:7

第七部分：

ARTICLES OF GENERAL REVIEW

（关于 CHIVA 的综述类文章）

1. Mendoza,: CHIVA 1988-2008: Review of studies on the CHIVA method and its development in different countries (2008) Gefasschirurgie, 13 (4), pp. 249-256
2. AGUS G.B.: Thirtyyears of new venous hemodynamic concept and teaching Acta Phlebologica 2019 mese;20(0):000–000
3. Mendoza, (2017). Primum non nocere. Veins and Lymphatics, 6(2).
4. CFRANCESCHI : CHIVA 30 years later. Scientific and ethical considerations Veins and Lymphatics, 2019 – pagepressjournals.org