CHIVA cure and sclerotherapy

Sclerotherapy is, by definition, a destructive treatment and, as such, it is conceptually long far away from the basic principles of the conservative hemodynamic cure for venous insufficiency (CHIVA cure). Accordingly, Phlebologists and Vascular Surgeons who practice the CHIVA cure at most acknowledge the use of sclerotherapy after the CHIVA cure for the aesthetical refinement or for the control over time of small calibre recurrences. However, intraoperative sclerotherapy can be used in association with the CHIVA cure in those cases in which the surgical gesture foreseen by the CHIVA cure would not be able to flush disconnect escape points at the level of the deep venous system and, as a consequence, it would leave non-draining stumps, which are a source of recurrences. Further, under some particular circumstances, sclerotherapy can be used instead of the CHIVA cure for the treatment of type II shunts or as the 1st step of the CHIVA 2 strategy for the treatment of type III shunts. This paper describes the use of intraoperative sclerotherapy for the treatment of escape points from the deep venous system difficult to treat by surgery, such as perforator veins, some anatomic presentations of the saphenous-popliteal junction and some pelvic shunts. This paper also describes the use of sclerotherapy alone for the treatment of type II shunts or for modelling saphenous hemodynamics in type III shunts before completing the treatment by surgery.