CHIVA is a hemodynamically based surgical treatment for varicose veins that preserves the veins.The CHIVA procedure involves rerouting blood flow by ultrasound localization to locate valves that are not closing properly, and treating the major pairs of valves accordingly. The procedure is currently self-pay and costs around $15,000 to $30,000. The exact price of the surgery cannot be generalized, but depends on the individual’s actual situation and the hospital’s fee schedule. The CHIVA procedure is saphenous vein preservation surgery, which is not yet widely available. The concept is completely different from traditional destructive surgery, requiring the operator to use vascular ultrasound scanning to understand each patient’s own hemodynamic characteristics and to develop an individualized surgical plan. This hemodynamic assessment-based ultrasound scan takes anywhere from 20 to 40 minutes, has a long learning curve, requires ultrasound equipment to be given to the vascular surgeon, and the time and effort spent by the surgeon on each patient is much higher than for destructive surgery. The CHIVA strategy for the treatment of lower extremity venous insufficiency preserves the saphenous vein trunk and has the advantages of less surgical trauma, shorter hospitalization, faster postoperative recovery, and a lower rate of complications at follow-up compared with traditional surgery.