由法國醫(yī)生Franceschi教授提出的CHIVA，正式被納入美國三大協(xié)會發(fā)布的最新臨床指南（2023），這是靜脈領(lǐng)域的一個重要里程碑。這三大學(xué)會包括：美國血管外科學(xué)會（SVS）、美國靜脈論壇（AVF）和美國靜脈與淋巴系統(tǒng)學(xué)會（AVLS）。CHIVA作為一種微創(chuàng)、保護(hù)靜脈的替代治療方法，提供了管理靜脈曲張的新選擇，標(biāo)志著美國靜脈診療技術(shù)進(jìn)入了一個新階段。

張強(qiáng)醫(yī)生集團(tuán)和INTELEOS 推動CHIVA進(jìn)入美國

Dr. Smile Medical Group和Inteleos率先將CHIVA引入美國市場。Dr. Smile Medical Group是全球領(lǐng)先的靜脈病診療機(jī)構(gòu)，Inteleos則在全球醫(yī)療認(rèn)證和培訓(xùn)領(lǐng)域擁有重要地位。兩大機(jī)構(gòu)的合作為CHIVA在美國醫(yī)療保健體系中的推廣奠定了基礎(chǔ)。目前，美國尚無專門的CHIVA治療中心，但紐約首家CHIVA培訓(xùn)中心的籌備工作已經(jīng)展開，這一舉措有望革新全美靜脈曲張的治療方式。

臨床證據(jù)支持CHIVA的有效性

盡管美國最新臨床指南推薦早期靜脈曲張使用CHIVA，并特別提到CHIVA必須由經(jīng)驗豐富、接受過訓(xùn)練的專業(yè)醫(yī)生來實施，但Dr. Smile Medical Group的最新多中心研究表明，CHIVA在靜脈曲張的各個階段（從C2到C6，包括靜脈潰瘍）均顯示出顯著優(yōu)勢。研究突出表明，CHIVA不僅能降低復(fù)發(fā)率，還能通過保留大隱靜脈的功能顯著改善患者的治療效果。這與傳統(tǒng)的靜脈抽剝或消融術(shù)有著重大區(qū)別，后者往往完全移除或破壞靜脈，導(dǎo)致更高的復(fù)發(fā)率和更多的并發(fā)癥。

CHIVA技術(shù)的推薦等級較低（2級，弱推薦）和證據(jù)強(qiáng)度中等（B級）的原因，可能與其學(xué)習(xí)曲線的陡峭以及部分不合格的CHIVA實施導(dǎo)致的負(fù)面影響有關(guān)。

CHIVA技術(shù)作為一種保護(hù)靜脈的微創(chuàng)療法，要求醫(yī)生對靜脈血流動力學(xué)有深刻理解，同時具備精湛的操作技術(shù)。它的復(fù)雜性在于，醫(yī)生不僅要精準(zhǔn)掌握血流動力學(xué)原理，還要熟練操作以確保在不破壞靜脈的前提下糾正血流異常。由于其實施過程中技術(shù)難度較高，醫(yī)生往往需要經(jīng)歷一段較長的學(xué)習(xí)曲線，才能達(dá)到理想的治療效果。在這一過程中，如果操作不當(dāng)，可能導(dǎo)致效果不佳，甚至導(dǎo)致治療失敗。這種技術(shù)難度較高的學(xué)習(xí)曲線是影響CHIVA推薦級別的重要因素之一。

隨著CHIVA技術(shù)在全球的推廣，部分未經(jīng)過系統(tǒng)培訓(xùn)或經(jīng)驗不足的醫(yī)生在實施該技術(shù)時未能達(dá)到預(yù)期效果，導(dǎo)致了一些負(fù)面結(jié)果。這些不合格的CHIVA操作不僅可能導(dǎo)致患者病情復(fù)發(fā)，還可能引發(fā)術(shù)后并發(fā)癥。這些負(fù)面報道對CHIVA技術(shù)的整體聲譽(yù)產(chǎn)生了不良影響，進(jìn)一步使得指南制定者對該技術(shù)持謹(jǐn)慎態(tài)度，從而影響其推薦級別和證據(jù)強(qiáng)度的提升。

美國患者治療將有新突破

CHIVA現(xiàn)已被納入美國主流的臨床指南，這為美國醫(yī)生提供了一種對患者更友好的靜脈曲張治療選擇。CHIVA專注于靜脈的保護(hù)，符合當(dāng)前對微創(chuàng)手術(shù)的需求，既能加快恢復(fù)，又能在長期效果上更為優(yōu)越。隨著紐約首家CHIVA培訓(xùn)中心即將開放，更多的美國醫(yī)生將接受該技術(shù)的專業(yè)培訓(xùn)，確保全國范圍內(nèi)更多患者能夠獲得這項先進(jìn)的治療。

全球影響與未來擴(kuò)展

CHIVA被納入這些權(quán)威指南，標(biāo)志著其全球擴(kuò)展的關(guān)鍵一步。作為為數(shù)不多的非破壞性靜脈曲張治療方案之一，CHIVA不僅將在美國獲得更多關(guān)注，還將迅速在其他主要醫(yī)療市場站穩(wěn)腳跟。Dr. Smile Medical Group致力于將CHIVA帶入美國市場，這也只是其全球戰(zhàn)略的一部分，未來將通過建立更多靜脈治療中心，使全球患者更容易獲得這種創(chuàng)新療法。

隨著越來越多的診所采用CHIVA技術(shù)，全球CHIVA培訓(xùn)網(wǎng)絡(luò)（尤其是在美國）的不斷擴(kuò)展，這項治療預(yù)計將在未來幾年成為尋求保留靜脈、自然恢復(fù)療法的患者和醫(yī)生的首選方案。

原文轉(zhuǎn)載：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.