The Impact of Different Concentrations of Sodium Tetradecyl Sulphate and Initial Balloon Denudation on Endothelial Cell Loss and Tunica Media Injury in a Model of Foam Sclerotherapy

• Published in: European journal of vascular and endovascular surgery 2010-03, Vol.39 (3), p.366-371
• Main Authors: Ikponmwosa, A, Abbott, C, Graham, A, Homer-Vanniasinkam, S, Gough, M.J
• Format: Article
• Language: English
• Subjects: Balloon denudation; Case-Control Studies; Catheterization; Collagen; Endothelial Cells - drug effects; Endothelial Cells - pathology; Foam sclerosant; Human saphenous vein endothelial cell; Humans; Ligation; Reproducibility of Results; Saphenous Vein - drug effects; Saphenous Vein - pathology; Saphenous Vein - surgery; Sclerosing Solutions - administration & dosage; Sclerotherapy; Sodium Tetradecyl Sulfate - administration & dosage; Surgery; Transmission electron microscopy; Tunica Media - drug effects; Tunica Media - injuries; Tunica Media - pathology; Tunica media injury; Varicose Veins - surgery; Vascular Surgical Procedures
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2009.12.025

Abstract Introduction Recanalisation rates (20–32%) 1–3 years after truncal vein foam sclerotherapy (FS) suggest thrombotic occlusion rather than irreversible vein wall injury. This study examines the injury inflicted by sodium tetradecyl sulphate (STD) foam before and after balloon endothelial denudation (BD). Methods In 20 patients undergoing great saphenous vein (GSV) stripping 1.5 cm proximal GSV were harvested (controls). The next 1.5 cm were harvested after in situ BD (n = 10) or no denudation (n = 10). These test segments were filled with 1% or 3% STD foam (5 min), flushed and fixed in formalin. Percentage endothelial cell loss (ECL) and tunica media injury were determined (H&E staining) and collagen structure assessed (transmission electron microscopy, TEM). Results Controls showed no injury. 1% and 3% STD foam caused 86.3% and 92.2% ECL ( p < 0.001 versus controls; 1% versus 3%, p = 0.55). Endothelial cells persisted in all sections. BD increased ECL (1%: 96.9%, 3%: 98.1%, p = 0.01) Tunica media injury (smooth muscle vacuolation) was minimal (8.9% (1% STD) and 12% (3% STD) of its depth) and not enhanced by BD (1%: 8.7%, p = 0.93; 3%: 11.3%; p = 0.86). No collagen disruption occurred (TEM). Conclusions Balloon denudation increased ECL but did not facilitate tunica media injury. Equivalent injury was inflicted by 1% and 3% STD.