让更多医生学习CHIVA，让更多患者受益

Good morning, colleagues.

I'm Qiang Zhang from Dr. Smile Medical Group and the Asian Venous Academy. Over the past twelve years, CHIVA has changed how I think about varicose veins and what it takes to bring a different approach into everyday practice.

Today, I’d like to share how we can help more physicians to learn, and more patients to benefit.

For decades, we’ve developed manyways to eliminate saphenous veins. Devices are faster, more precise, easier to use.

But let’s step back and ask a more fundamental question:Do we have to eliminate the vein to treat the disease?

The answer is: not necessarily！

An observation from more than a century ago offers a useful starting point.

In the Perthes test, a tourniquet is applied to the thigh and the patient walks. When deep venous drainage is adequate, the visible varices can empty.

The veins are still there—what’s changed is the hemodynamics.

In 1988, Claude Franceschi introduced CHIVA as a systematic hemodynamic approach.

Before I had the book, I had only limited information from the internet.

I thought CHIVA was simply high ligation with a few tributaries ligated. I tried what I thought was CHIVA, but the results were disappointing.

In 2014, I finally obtained Franceschi’s book. I spent the next several months studying it—and that was when I truly began to learn CHIVA.

Before I truly understood CHIVA, I focused on the veins themselves.

Stripping removed the saphenous trunk; thermal ablation closed it.

Newer techniques, such as glue and mechanochemical ablation, also close the trunk. Sclerotherapy closes visible varicose veins; phlebectomy removes them.

In my earlier practice, we also divided dilated perforators with SEPS.

So what does CHIVA target?

The varicose veins we see in clinic are much like this leaking pipe.

We can see the problem, but we need to find out where the pressure comes from and where the blood drains.

That is what CHIVA asks us to find out.

CHIVA begins with hemodynamic duplex mapping.

We identify where the abnormal flow enters, how it travels, and where it re-enters the deep system. Then we interrupt the source of the overload while preserving useful drainage.

As venous pressure falls, the varicose veins can gradually shrink—as you see in this patient.

This 61-year-old woman developed recurrent varices one year after great saphenous vein radiofrequency ablation.

Mapping identified a type III shunt involving the anterior saphenous vein.

We treated the escape point through one small incision. The varices became smaller, and symptoms improved.

The same principle can be applied in more advanced disease.

This patient had longstanding, severely tortuous varices with skin changes. We identified and treated two escape points while preserving re-entry pathways.

Over 12 years, our centers have performed more than 20,000 CHIVA procedures. All were office-based and performed under local anesthesia.

We preserved the GSV in every patient who still had one; fewer than 10% required another procedure. We observed no DVT or permanent nerve injury.

Patients value this approach, and physicians trained in CHIVA find it rewarding.

So why hasn’t it been more widely adopted?

In our experience, six barriers help explain why.

First, physicians must learn functional anatomy and venous hemodynamics.

Second, they need practical competence in duplex ultrasound.

Third, they must develop a different clinical decision framework, including how to preserve drainage.

Fourth, variations in training, technique, and study methods complicate the interpretation of evidence. Clear standards and better studies are essential.

Fifth, individualized care requires a team that can support patients throughout assessment, recovery, and follow-up.

Finally, economic incentives matter. Detailed mapping takes time, training requires investment, and payment systems may reward an intervention more readily than the assessment and follow-up around it.

This schematic reflects my own learning experience.

The initial procedural skills of stripping or ablation can often be acquired relatively quickly.

CHIVA requires considerable learning before the clinical decisions become clear. Once ultrasound skills and hemodynamic reasoning come together, progress can accelerate.

This is the purpose of our collaboration with Inteleos on the Global CHIVA Program.

Inteleos is an international nonprofit certification organization whose programs include ARDMS, APCA, and the POCUS Certification Academy.

Together, we are developing a structured pathway linking foundational learning with clinical observation, supervised practice, and competency assessment.

Our New York base is intended to support this international educational effort through online learning and future in-person activities.

It provides a connection with colleagues in the United States as we continue developing the program.

Our work in Ethiopia made that especially clear.

Our team traveled from Shanghai to Addis Ababa to help establish a CHIVA center and introduce the treatment locally.

Former Ethiopian President Mulatu Teshome attended the opening ceremony.

Ethiopian colleagues also emphasized the importance of preserving the saphenous vein where access to vascular substitutes is limited.

These experiences also helped shape the Asian Venous Academy.

Our educational work includes publications, professional courses, and practical training. Crucially, it extends to clinical assistants as well as physicians.

These projects are supported by a foundation we have built over 12 years.

Beyond 20,000 procedures, we have held academic meetings, trained physicians and medical assistants, and built our own centers.

Clinical experience has gradually become training and operational capacity.

So how do we bring this experience beyond our own centers? Our answer is an MSO—a management services organization.

Think of it as the support platform connecting training, clinical mentorship, quality assurance, follow-up, and academic exchange across CHIVA centers. Each center remains responsible for patient care.

This helps more physicians learn CHIVA well, so more patients can benefit.

Here at Jing’an Temple, history and the future stand side by side. Each has its own beauty, and together they make this city extraordinary.

Our mainland MSO headquarters is in the tower you see here.

I hope we can bring the same spirit to venous medicine: honor the insights we have inherited, support the next generation, and work together so more patients can benefit.

Thank you, and welcome to Shanghai.

作者声明：
本文仅代表个人观点，不能替代专业医生的诊断与治疗建议。
静脉曲张的评估与处理需结合个体情况，由具备相关资质的医生进行判断。