title: CHIVA, ASVAL and related techniques--Concepts and evidence.
abstract: Chronic venous disease (CVD) is a highly prevalent condition with significant effects on patients' quality of life. Despite this, the underlying pathophysiology of venous disease still remains unclear. Two schools of thought exist, explaining the development and propagation of venous disease as an "ascending" and "descending" process, respectively. The descending theory, stating that CVD is secondary to proximal disease (e.g. saphenofemoral/saphenous incompetence), is the most widely accepted when planning treatment aiming to remove or destroy the junction or truncal veins. The ascending theory, describing the disease process as developing in the lower most part of the leg and propagating cranially, aims to re-route the venous circulation via minimally invasive interventions. Classically, superficial venous insufficiency has been treated with the removal of the incompetent trunk, via open surgery or, increasingly, with endovenous interventions. Minimally invasive treatment modalities aiming to preserve the saphenous trunk, such as CHIVA and ASVAL, may also play an important role in the treatment of the patient with varicose veins.
authors.affiliation: Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Onida
authors.affiliation: Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK a.h.davies@imperial.ac.uk.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D002908:Chronic Disease; D006439:Hemodynamics; D006801:Humans; D011788:Quality of Life; D012501:Saphenous Vein / Q000601:surgery; D014463:Ultrasonography; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000628:therapy*; D014652:Vascular Diseases / Q000628:therapy*; D014689:Venous Insufficiency / Q000628:therapy*
keywords: ASVAL; chronic venous disease; chronic venous insufficiency; duplex ultrasound; haemodynamic surgery