High-intensity-focused ultrasound treatment for the chronic venous disease based on the Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) strategy.

OBJECTIVE

Chronic venous disease management has significantly advanced with minimally invasive techniques like endovenous thermal ablation. High-intensity focused ultrasound (HIFU) is a noninvasive alternative thermal ablation method enabling targeted vein closure without percutaneous access. This study evaluates the efficacy of HIFU treatment, combined with the Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) strategy, in occluding leak points in patients with superficial venous reflux.

METHODS

This retrospective study included patients treated for chronic venous disease using the SONOVEIN device from March 2020 to February 2024. Inclusion criteria were symptomatic patients (CEAP ≥C2) with ultrasound-confirmed truncal reflux. Patients under 18 years, with <12 months life expectancy, or isolated venous flow obstruction were excluded. Treatments followed CHIVA principles, targeting leak points and proximal vein segments for occlusion. Primary endpoints were leak point occlusion rates and procedural safety. In this study, primary efficacy was defined as vein closure with one treatment, whereas secondary efficacy was defined as the need for more.

RESULTS

A total of 204 limbs in 183 patients (131 females, 52 males; mean age, 55.2 years) underwent HIFU treatment. Primary leak point occlusion rate at 1 week, and 1, 6, 12, and 24 months were 85.1 %, 91.8%, 93.7%, 94.3%, and 95.5%, respectively. Secondary closure rates at 1 week, and 1, 6, 12, and 24 months were 89.6 %, 95.4%, 95.0%, 95.4%, and 95.7%, respectively. Overall primary and secondary cumulative closure rates at 24 months were 88.1% (95% confidence interval, 77.7%-98.4%), and 92.1% (95% confidence interval, 83.3%-100%), respectively. No major complications were observed.

CONCLUSIONS

HIFU achieves high leak point occlusion rates when applied under CHIVA principles, supporting its role as an effective and safe noninvasive alternative for chronic venous disease treatment. The technique minimizes risks associated with thermal ablation, such as skin burns and nerve damage, while addressing limitations of conventional methods. These results highlight the potential of HIFU as a disruptive technology in venous disease management. Further studies should assess its long-term efficacy and safety.