Phlebology 2002; 17:19—28

(The official journal of the Venous Forum of the Royal Society of Medicine and Societas Phlebologica Scandinavica, Members of the Union Internationale de Phlebologie)

B. McDonagh1, D.E. Huntley1, R. Rosenfeld1, T. King1, J.L. Harry1, S. Sorenson1, R.C. Guptan2
1Illinois Phlebology Group, USA and 2Department of Clinical Research, Venous Research Foundation, USA. 

Efficacy of the Comprehensive Objective Mapping, Precise image guided injection, Anti-reflux positioning and Sequential Sclerotherapy (COMPASS) technique in the management of Greater Saphenous varicosities with Saphenofemoral Incompetence.

Summary: In this 2-6 year prospective study, 186 limbs with refluxing greater saphenous vein (5.4 — 25.4 mm in size) and incompetent saphenofemoral junction (6 .1 — 31.3 mm in size) were enrolled.  Greater saphenous vein varicosity was found to be a common disease of individuals in their forties with morbid clinical presentations. Three stages of "COMPASS technique" achieved 100% saphenofemoral junction and 98% greater saphenous vein obliteration. There was significant improvement in clinical symptoms and disability as assessed by the standard "Venous Dysfunction Score".  The results under the protocol were sustained in the mean 3.4 ±1.7 year follow-up. There was no serious adverse experience reported.

Conclusion: The COMPASS technique was found safe and highly efficacious in the management of extensive large vein varicose disease.

Correspondence and reprint requests to: Dr. R.C. Guptan, Director, Department of Clinical Research, Venous Research Foundation. PO Box 59444, Schaumburg, IL 60159-0444, USA.

Email: rguptan@venousresearchfoundation.com

References:

  1. Myers KA, Zrecewbein RW, Zeng GH, Mathews PA. Duplex Ultrasonography Scanning for chronic Venous Diseases:  Patterns of venous reflux.  J Vasc Surg 1995:21:  605-12.
  2. Quicley FG, Raptis S, Cashman M, Faris IB.  Duplex Ultrasound Mapping of Sites of Deep to Superficial incompetence in Primary Varicose Veins.  Aust NZ J Surg 1992; 62:  276-278.
  3. Neglen P, Seshadri R. A Comparison between descending phlebography and Duplex Doppler Investigation in the Evaluation of Reflux in Chronic Venous Insufficiency:  a challenge to phlebography and as the  "gold standard".  J Vasc Surg 1992; 16:  687-93.
  4. Hobbs JT. Surgery and Sclerotherapy in the Treatment of Varicose Veins:  A Random Trial.  Arch Surg 1974; 109:793-96.
  5. Alan Kanter, Paul Thibault.  Saphenofemoral Incompetence Treated by Ultrasound Guided Sclerotherapy. Dermatol Surg 1996; 22:668-652.
  6. Einarsson E, Eklof B, Neglen P.  Sclerotherapy or Surgery as Treatment of Varicose Veins:  A prospective randomized study.  Phlebology 1993; 8:22-6.
  7. Perrin RM, Guex JJ, Rukley V, dePalma R, Royle JP, et al. Recurrent Varices After Surgery (REVAS), a Consensus document. Cardiovas Surg 2000; 8:233-245.
  8. Holme K, Malzen M, Bomberg AJ, Ontzen S L, Holme JB.  Partial or Total Stripping of Great Saphenous Vein.  5 Year Recurrence Frequency and 3 year Frequency of Neural complications After Partial and Total Stripping of the Great Saphenous.  Ugeskr Laeger 1996; 158:405-8.
  9. Holme JB, Skajal K, Holme K.  Incidence of Lesions of the Saphenous Nerve After Partial or Complete Stripping of the Long Saphenous Vein. Acta Chir Scand 1990; 156:145-8.
  10. Durkin MT, Turton EPL, Wijesingue LD, Scott DJA, Berridge DC.  Long Term Saphenous Vein Stripping and Quality of Life — A Randomized Trial. Eur J Vac Endovasc Surg 2001; 21:545-549.
  11. Fegan WA.  The Treatment of Varicose Veins during Pregnancy. Pacif Med Surg 1964; 72:274-279.
  12. Drake LA, Dinehart SM, Goltz RW, Ghram GF, Hordinsky MK, et al. Guidelines of care for sclerotherapy treatment of varicose and telangiectic leg veins.  J Am Acad Dermatol 1996; 34:523-8.
  13. Martimbeau PR. Advanced Sclerotherapy Treatment of Varicose Veins with Duplex Ultrasonographic Guidance. Seminars in Dermatol 1993; 12:123-128.
  14. Schadeck M, Allancrt FA.  Long term results of sclerotherapy of the great Saphenous veins [Fr]. Phebologie 1997; 50:257-262.
  15. Green, D. Sclerotherapy for permanent eradication  of varicose veins:  theoretical and practical consideration.  J Am Acad Dermatol 1998; 38:461-75.
  16. Bresford SA, Chant ADB, Jones HO, Pichaud D, Weddell JM. Varicose veins: a comparison of surgery and injection/compression sclerotherapy. Five year follow up. Lancet 1978;iii:921-4.
  17. Neglen P, Einarsson E, Eklog B.  The functional long term value of different types of treatment for Saphenous vein incompetence.  J Cardio Vasc Surg 1993; 34:295-301.
  18. Hobbs, JJ. Surgery or Sclerotherapy for varicose veins:  10 year results of a random study. In:  Tesi M. Dormandy J Eds:  Superficial and deep venous diseases of the lower limbs.  Torino:  Minerva Medica 1984; 243-6.
  19. Baccaglini V, Spreafico G, Castoro C, Sorrentino P.  Sclerotherapy of varicose veins of the lower limbs:  Consensus paper.  Dermatol Surg 1996; 22:883-889.
  20. Martimbeau PR. Two different techniques for sclerosing the incompetent saphenofemoral junction:  A comparative study. J Dermatol Surg Oncol  1990; 16:626-631.
  21. Coultier G. Sclerosis of the junction of the internal and external Saphenous vein: A novel approach. Phlebologie  1976 ;29:227-32.
  22. Orbach EJ. Contribution to the therapy of the varicose complex.  J Int Coll Surg 1950; 13:765-71.
  23. Tessari L. Nouvelle technique d'obtention de la Scleromousse. Phlebologie 2000; 53:129-35.
  24. Frullini  A. New technique in producing sclerosing foam in a disposable syringe. Dermatol Surg 2000;26:705-6.
  25. McDonagh, B. Comment on the use of post-sclerotherapy compression.  Dermatol Surg 1999;25:519-21.
  26. Lagattolla NR, Donald A, Lockhart S, Burnand  KG. Retrograde flow in the deep veins of subjects with normal venous functions.  Br J Surg 1997; 84:36-39.
  27. Olapade — Olaopa EO, Foy DM, Dikko BV, Darke SG.  Primary lower limb varicosities arising directly from normal deep venous system: A series report.   Annals of Vascular Surgery 2000; 14:166-169.
  28. Beebe HG, Bergan JJ, Bergqvist D, Eklof B, Eriksson I, Goldman MP, et al.  Classification and grading of chronic venous disease in the lower limbs:  A consensus statement.  Phlebology 1995; 10:42-45.
  29. Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes R.  What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey.  B M J 1999; 318:353-356.
  30. Rutgers PH, Peter JE, Kitslaar HM.  Randomized trial of stripping versus high ligation with sclerotherapy in the treatment of the incompetent greater saphenous vein.  Am J Surg 1994; 168:311-315.
  31. Cabrera J, Cabrera J Jr, Olmedo GA. Treatment of varicose Long Saphenous veins with Sclerosant in micro foam:  Long term Outcomes.  Phlebology 2000; 15:19-23.
  32. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ.  Neovascularization is the principal cause of varicose vein recurrence: Results of a randomized trial of stripping the long saphenous vein. Eur  J  Vasc Endovasc Surg  1996:12:442-45.
  33. Belcaro  G, Nicolaudes  AN, Ricci  A, Dugall M,  Enrichi  BM  etal.  Endovascular sclerotherapy, Surgery and Surgery plus Sclerotherapy in superficial venous incompetence:  A Randomized 10 year follow up trial — Final  results. Angiology  2000; 51:529-534.
  34. Jacobsen BH. The value of different forms of treatment for varicose veins. Br. J. Surg 1979; 66:182-4.
  35. Munn SR, Morton JB, Macbeth WA, Mcleish AR. To Strip or not to strip the long term saphenous vein? A varicose vein trial. Br. J . Surg 1981; 68:426-428.
  36. Hammarsten J , Pedersen P, Cederlund CG, Campanello M.  Long saphenous vein saving surgery for varicose veins: a long term follow up. Eur J Vasc Surg  1990; 4:361-4.
  37. Sarin S, Scurr JH, Coldridgesmith PD.  Stripping of the long saphenous vein in the treatment of primary varicose veins. B J  Surg  1994; 81:1455-1458.
  38. Dwerryhouse S, Davies B, Harradine K, Jonathan J, Earshaw J. Stripping the long Saphenous vein reduces the rate of reoperation for recurrent varicose veins: Five-year results of a randomized trial. J  Vas Surg 1999; 29:589-92.
  39. Jiang P, Van Rij AM, Christie R, Hill G, Solomon C, Thomson I. Recurrent varicose veins: patterns of reflux and clinical severity. Card Vas Surg  1999; 7:332-339.
  40. Rutherford E, Kianiford  B, Cook  SJ, Holdstock JM,  Whiteley MS.  Incompetent perforating veins are associated with recurrent varicose veins. Eur  J Vac  Endovasc Surg   2001;21:458-460.
  41. Thibault PK, Lewis WA. Recurrent varicose veins: Injection of incompetent perforating veins using ultrasound guidance.  J Dermatol Surg Oncol 1992; 18:895-900.
  42. Isaacs  M,  Forrestal M, Harp  J, Gardener M. ECHO guided  sclerotherapy of the saphenous trunks[Fr] Phlebologie 1997; 2:247-49.
  43. Valencia IC, Falabella A, Kirsner R, Baglstein WH. Chronic venous insufficiency and leg ulceration. J Am Acad Dermatol  2001;44:401-21.
  44. Fegan WG. Continuous compression technique of injecting varicose veins. Lancet 1963; ii:109-12.
  45. Batch AJ, Wickremesinghe SS, Gannon ME, Dormandy JA. Randomized trial of  bandaging for varicose veins. BMJ 1980; 281:423.
  46. Fraser IA, Perry EP, Hatton M, Watkin DFL. Prolonged bandaging is not required following sclerotherapy of varicose veins. Br.  J. Surg.  1985; 72:488-90.
  47. Raj TB, Goddard M, Makin  GS. How long do compression bandages maintain their pressure during ambulatory treatment of varicose veins? Br. J. Surg  1980; 67:122-124.
  48. Ramlet AA. Compression Therapy. Dermatol Surg 2002; 28:6-10.
  49. Tazelaar DJ, Neumann HAM,  De Roos  KP. Long  cotton wool rods as compression enhancers in macro-sclerotherapy for varicose veins. Dermatol Surg 1999;25:38-40.
  50. Sarin  S, Scurr JH,Coleridge Smith  PD. Mechanism  of action of external compression on venous function.  Br. J. Surg  1992; 79:499-502.
  51. Yang D, Vandengen YK, Stacy MC. The influence of minimal stretch and elasticated bandages on calf muscle pumps function in patients with chronic venous diseases. Phlebology 1999; 14:3-8.
  52. Coleridge Smith PD. Compression treatment — Still incompletely Understood.  Phlebology 1999; 14:1-2.
  53. Phillips TJ, Dorer JS. Leg ulcers .  J Am Acad Dermatol 1991; 25:965-87.
  54. Clark RL, Orandl A, Clifton EE. Tourniquet induction of  fibrinolysis. Angiology 1960;11:367-70.
  55. Nilsson  IM, Robertson  B. Effects  of Venous occlusion on coagulation and fibrinolytic components in normal subjects. Thronmb Diath Haemorrh  1968; 20:397-408. 
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