Are saphenous sparing treatments beneficial to the hemodynamics of the venous system?

This short review analyzes first the hemodynamic changes that follow destructive procedures, such as stripping or endovascular techniques, and conservative procedures, such as the CHIVA Cure. Then, the effects of the hemodynamic changes resulting from conservative and destructive procedures are compared with respect to the course over time of the varicose disease, mainly focusing on the occurrence of recurrences and their different hemodynamic characteristics. The results show that both conservative and destructive procedures significantly improve the plethysmographic reflux parameters till their normalization. However, destructive procedures reduce the compliance of the lower limb, which expresses an impaired drainage of the superficial tissue, as documented by the typical occurrence of recurrent varicose veins without a detectable trans-compartmental reflux point that are never found after conservative procedures. On the contrary, conservative procedures, when appropriately performed based upon the type of the venous shunt, preserve the drainage of the superficial tissues making the incompetent venous system more hemodynamically stable, which results in a significantly less frequent occurrence of recurrences.