由法国医生Franceschi教授提出的CHIVA，正式被纳入美国三大协会发布的最新临床指南（2023），这是静脉领域的一个重要里程碑。这三大学会包括：美国血管外科学会（SVS）、美国静脉论坛（AVF）和美国静脉与淋巴系统学会（AVLS）。CHIVA作为一种微创、保护静脉的替代治疗方法，提供了管理静脉曲张的新选择，标志着美国静脉诊疗技术进入了一个新阶段。
张强医生集团和INTELEOS 推动CHIVA进入美国
Dr. Smile Medical Group和Inteleos率先将CHIVA引入美国市场。Dr. Smile Medical Group是全球领先的静脉病诊疗机构，Inteleos则在全球医疗认证和培训领域拥有重要地位。两大机构的合作为CHIVA在美国医疗保健体系中的推广奠定了基础。目前，美国尚无专门的CHIVA治疗中心，但纽约首家CHIVA培训中心的筹备工作已经展开，这一举措有望革新全美静脉曲张的治疗方式。
临床证据支持CHIVA的有效性
尽管美国最新临床指南推荐早期静脉曲张使用CHIVA，并特别提到CHIVA必须由经验丰富、接受过训练的专业医生来实施，但Dr. Smile Medical Group的最新多中心研究表明，CHIVA在静脉曲张的各个阶段（从C2到C6，包括静脉溃疡）均显示出显著优势。研究突出表明，CHIVA不仅能降低复发率，还能通过保留大隐静脉的功能显著改善患者的治疗效果。这与传统的静脉抽剥或消融术有着重大区别，后者往往完全移除或破坏静脉，导致更高的复发率和更多的并发症。
CHIVA技术的推荐等级较低（2级，弱推荐）和证据强度中等（B级）的原因，可能与其学习曲线的陡峭以及部分不合格的CHIVA实施导致的负面影响有关。
CHIVA技术作为一种保护静脉的微创疗法，要求医生对静脉血流动力学有深刻理解，同时具备精湛的操作技术。它的复杂性在于，医生不仅要精准掌握血流动力学原理，还要熟练操作以确保在不破坏静脉的前提下纠正血流异常。由于其实施过程中技术难度较高，医生往往需要经历一段较长的学习曲线，才能达到理想的治疗效果。在这一过程中，如果操作不当，可能导致效果不佳，甚至导致治疗失败。这种技术难度较高的学习曲线是影响CHIVA推荐级别的重要因素之一。
随着CHIVA技术在全球的推广，部分未经过系统培训或经验不足的医生在实施该技术时未能达到预期效果，导致了一些负面结果。这些不合格的CHIVA操作不仅可能导致患者病情复发，还可能引发术后并发症。这些负面报道对CHIVA技术的整体声誉产生了不良影响，进一步使得指南制定者对该技术持谨慎态度，从而影响其推荐级别和证据强度的提升。
美国患者治疗将有新突破
CHIVA现已被纳入美国主流的临床指南，这为美国医生提供了一种对患者更友好的静脉曲张治疗选择。CHIVA专注于静脉的保护，符合当前对微创手术的需求，既能加快恢复，又能在长期效果上更为优越。随着纽约首家CHIVA培训中心即将开放，更多的美国医生将接受该技术的专业培训，确保全国范围内更多患者能够获得这项先进的治疗。
全球影响与未来扩展
CHIVA被纳入这些权威指南，标志着其全球扩展的关键一步。作为为数不多的非破坏性静脉曲张治疗方案之一，CHIVA不仅将在美国获得更多关注，还将迅速在其他主要医疗市场站稳脚跟。Dr. Smile Medical Group致力于将CHIVA带入美国市场，这也只是其全球战略的一部分，未来将通过建立更多静脉治疗中心，使全球患者更容易获得这种创新疗法。
随着越来越多的诊所采用CHIVA技术，全球CHIVA培训网络（尤其是在美国）的不断扩展，这项治疗预计将在未来几年成为寻求保留静脉、自然恢复疗法的患者和医生的首选方案。
原文转载：Global Advances In Phlebology
https://phlebologyglobaladvances.com/chiva-treatment-included-in-u-s-clinical-guidelines-a-major-step-forward-for-varicose-veins-management/
CHIVA Treatment Included in U.S. Clinical Guidelines: A Major Step Forward for Varicose Veins Management
In a landmark development, CHIVA (Conservative Hemodynamic Cure for Venous Insufficiency) treatment has been officially recognized in the latest clinical guidelines issued by three major U.S. medical societies: the Society for Vascular Surgery (SVS), the American Venous Forum (AVF), and the American Vein and Lymphatic Society (AVLS). This inclusion signals a pivotal moment for vein care in the United States, as CHIVA offers a minimally invasive, vein-preserving alternative for managing varicose veins.
Bringing CHIVA to the U.S.: Dr. Smile Medical Group and Inteleos Lead the Charge
The introduction of CHIVA to the U.S. market is driven byDr. Smile Medical Group, a global leader in vein care, and Inteleos, a key player in medical certification and education. Together, they have laid the groundwork for bringing CHIVA into the spotlight of U.S. healthcare. Up until now, no specialized CHIVA treatment centers exist in the U.S., but plans are already underway to establish the first CHIVA training center in New York, a move that could revolutionize how varicose veins are treated nationwide.
Clinical Evidence Backs CHIVA’s Effectiveness
Although clinical guidelines recommend the use of CHIVA for early-stage varicose veins and specifically emphasize that CHIVA must be performed by experienced, well-trained professionals, a multi-center study by Dr. Smile Medical Groupy shows that CHIVA offers clear advantages for patients across all stages of varicose vein disease, from mild cases (C2) to more severe conditions , including venous ulcers（C6）. The research highlights CHIVA’s ability to not only reduce recurrence rates but also significantly improve patient outcomes by preserving the function of the great saphenous vein. This is a major departure from traditional vein-stripping or ablation techniques, which remove or destroy the vein entirely and can lead to higher rates of recurrence and complications.
One of the reasons for CHIVA's lower recommendation level (Grade 2, weak recommendation) and moderate strength of evidence (Grade B) is related to the steep learning curve and the negative impact caused by suboptimal CHIVA procedures.
CHIVA, as a vein-preserving, minimally invasive treatment, requires physicians to have a deep understanding of venous hemodynamics and advanced technical skills. The complexity lies in the fact that physicians not only need to grasp the principles of hemodynamics but also execute the procedure skillfully to correct venous reflux without damaging the veins. Due to the high level of technical difficulty involved, physicians often need to go through a prolonged learning curve to achieve optimal results. During this period, if the procedure is not performed correctly, it can lead to suboptimal outcomes or even treatment failure. This challenging learning curve is one of the key factors affecting CHIVA's recommendation level.
As CHIVA technology has been promoted globally, some physicians who have not undergone comprehensive training or lack experience have failed to achieve the expected outcomes when performing the procedure, resulting in negative outcomes. These suboptimal CHIVA procedures can lead to disease recurrence or postoperative complications. Such negative reports have tarnished CHIVA's overall reputation and made guideline developers more cautious about the technology, further affecting its recommendation level and strength of evidence.
A Vein Treatment Breakthrough for U.S. Patients
With CHIVA now included in these leading clinical guidelines, U.S. physicians have a new, patient-friendly option for treating varicose veins. CHIVA’s focus on vein preservation aligns perfectly with the growing demand for minimally invasive procedures that offer faster recovery times and better long-term results. As the first CHIVA training center in New York prepares to open its doors, more U.S. doctors will be trained in this advanced technique, ensuring wider access for patients nationwide.
Global Impact and Future Expansion
The inclusion of CHIVA in these guidelines represents a critical step in the treatment’s global expansion. As one of the few treatments that offer a non-destructive approach to varicose vein care, CHIVA is poised to gain traction not only in the U.S. but also in other major medical markets. Dr. Smile Medical Group’s initiative to bring CHIVA to the U.S. is part of a broader strategy to establish vein treatment centers around the world, making it easier for patients everywhere to access this innovative therapy.
As more clinics adopt the CHIVA technique and the global CHIVA training network—especially in the U.S.—continues to expand, this treatment is expected to become the preferred option for patients and physicians seeking vein-preserving, natural recovery therapies in the coming years.