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.
BACKGROUND
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.
Ikponmwosa
A
A
Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
Abbott
C
C
Graham
A
A
Homer-Vanniasinkam
S
S
Gough
M J
MJ
D016022:Case-Control Studies; D002404:Catheterization; D042783:Endothelial Cells / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D008026:Ligation; D015203:Reproducibility of Results; D012501:Saphenous Vein / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage*; D017540:Tunica Media / Q000187:drug effects* / Q000293:injuries / Q000473:pathology; D014648:Varicose Veins / Q000601:surgery; D014656:Vascular Surgical Procedures
D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate