Recently, at our Shenzhen CHIVA center, Dr. Deng Jianping’s team evaluated a 93-year-old woman. She is now the oldest patient treated there. What stayed with me, however, was not the number, but the question behind it: at what point do we stop intervening, and why.
In vascular surgery, this boundary is rarely stated explicitly, yet most of us carry an internal threshold. For some it is 80, for others 85, and around 90 the hesitation often becomes instinctive. Not because the disease becomes less relevant, but because the risks become harder to justify—anesthesia, immobility, complications. As a result, we often step back and choose what appears to be a safer path: compression, dressings, observation. For patients with significant venous reflux, especially those with recurrent ulcers, this approach often delays rather than resolves the problem. The wound improves, then returns.
Less discussed is what treatment itself demands from elderly patients. Compression therapy may be effective in theory, but in practice it is often difficult to maintain. Reduced hand strength, joint stiffness, or spinal limitations can turn a daily recommendation into a persistent burden. Repeated dressing changes and clinic visits may gradually reshape daily life, sometimes requiring ongoing support from family members. In this way, the treatment becomes part of the problem.
At the same time, the risks of intervention are real. General or regional anesthesia introduces physiological stress that some patients can no longer tolerate. Even a short period of reduced mobility may trigger a cascade of complications—thrombosis, pulmonary issues, functional decline. In this context, the key question is no longer simply whether we can intervene, but whether the way we intervene is appropriate.
Over the past ten years, we have treated 26 patients aged 90 or above. This is not a large number, but it supports a consistent observation: age itself is rarely the decisive factor. The structure of the intervention matters more—whether it aligns with the patient’s physiology or disrupts it.
The 93-year-old patient in Shenzhen presented with a typical course: severe reflux in the great saphenous vein, recurrent ankle ulceration, and a previous skin graft that failed because the underlying venous hypertension had not been corrected. Apart from her age, there was nothing unusual. The evaluation was careful, and the intervention deliberately restrained. It was performed under local anesthesia, without attempting complete removal, focusing instead on correcting key points of abnormal flow. The procedure took less than 30 minutes. When it was over, she stood up and walked out of the procedure room on her own.
This detail, simple as it is, may matter more than any technical description. In elderly patients, immediate mobilization is not a minor advantage. It is a form of protection. Avoiding bed rest reduces the risk of thrombosis and pulmonary complications, but more importantly, it helps preserve independence. Small differences in how we intervene can lead to very different outcomes.
There is also a less visible consideration. The great saphenous vein is often treated as expendable, yet preserving it reflects a broader principle—maintaining vascular options in a context where future needs are difficult to predict. This does not imply that it will necessarily be used, but that there is no need to eliminate it prematurely.
As life expectancy continues to rise in regions such as the Greater Bay Area, patients in their nineties will become increasingly common. This shift is gradual, but it changes the logic of care. The goal is no longer to eliminate every abnormal vein, but to restore function with the least possible physiological cost.
In this sense, CHIVA is not simply a technique for treating varicose veins. It represents a way of thinking—one that prioritizes minimal systemic stress, supports immediate mobilization, preserves vascular structures, and reduces dependence on postoperative measures that many elderly patients struggle to maintain. It also relies on continuity of care, including follow-up systems and accumulated clinical experience, to support patients over time.
This case does not provide a definitive answer, but it does suggest a shift in perspective. In elderly patients, the question is no longer how much we can do, but how little physiological cost we are willing to impose while still restoring function. Perhaps this is where the value of hemodynamic thinking lies—not in doing less, but in understanding what should be preserved, what should be corrected, and what can be left undisturbed. In the longevity era, that distinction may matter more than ever.
