CHIVA strategy for varicose vein surgery

Perforator vein incompetence in the leg can lead to the development of close loop shun ts in the leg and saphenous vein segment connected with that will be dialating in due course of time. If this perforator is ligated and the dialated vein segment may regress in size as the close loop venous shunt has been disconnected. This would require very good observation by the ultrasonoloigst who can mark them well for the surgeons. Ideally it would be better to do the intra operative duplex scan to demonstrate the incompetence of the perforator just before the ligation.