B. McDonagh*, S. Sorenson*, C. Gray*, D.E. Huntley*, P. Putterman*, T. King*, T. Eaton*, C. Martin*, J.L. Harry*, A. Cohen* and R.C. Guptan†
*Illinois Phlebology Group, Schaumburg, Illinois, USA; †Department of Clinical Research, Venous Research Foundation, Chicago, Illinois, USA.

Objectives: To study the efficacy of ultrasound-guided sclerotherapy using the COMPASS (comprehensive objective mapping, precise image-guided injection, anti-reflux positioning, and sequential sclerotherapy) technique in the management of recurrent varices after surgery (REVAS) and determine its impact on the venous dysfunction scoring of the treated patients.

Methods: A prospective open study involving 168 consecutively treated patients (253 limbs) with REVAS who had originally been treated with surgery for their varicose disease. Follow up was 1.5-5.7 years (mean: 3.1+/-1.7 years).

Results: REVAS presented most commonly in women in their fifties who had symptoms related to their chronic venous disease and complications due to chronic venous insufficiency (CVI). The COMPASS technique attained sustained obliteration in 97% of varices in the groin. There was 100% obliteration of isolated refluxing veins in the thigh and around the popliteal fossa. The cumulative obliteration rate, including obliteration of perforator reflux, was greater than 90%. Decrease in venous dysfunction scoring (anatomical, clinical, and disability) was significant. No serious adverse sequelae were observed.

Conclusions: REVAS is a symptomatic chronic venous disease that requires skilled medical care. It is a major complication of varicose vein surgery, especially vein stripping. Repeat surgery fails in 50-80% of cases. The etiology of REVAS is poorly understood and minimally invasive therapeutic options have not been well studied. The COMPASS technique achieved sustained obliteration in 97-100% of recurrent varices. A lasting reduction in patients’ venous dysfunction scores suggests that the COMPASS technique appears to be more effective than currently available surgical approaches in the long-term management of REVAS.

Correspondence: Dr. R.C. Guptan MD, Director, Department of Clinical Research, Venous Research Foundation. PO Box 59444, Schaumburg, IL 60159-0444, USA.
Tel: +1 847 619 1748 or +1 847 363 4910. Fax: +1 847 619 3125.

Email: rguptan@venousresearchfoundation.com

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