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Title: Development of a model for foam sclerotherapy in the treatment of varicose veins
Author: Ikponmwosa, Anna
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2012
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Introduction The development of minimally invasive techniques for the treatment of varicose veins is driven by the aim of achieving results equivalent or superior to surgery whilst minimising complications. Foam sclerotherapy is associated with inferior short-term occlusion rates in comparison to other treatments, suggesting irreversible vein wall injury has not occurred. Further knowledge of the mechanism of action of foam sclerotherapy may facilitate its modification in order to improve clinical efficacy. Methods This study assessed the cellular response to the application of sodium tetradecyl sulphate (STD) foam by analysis of intracellular protein release from cultured human saphenous vein endothelial cells. An ex vivo model using proximal great saphenous vein was developed to quantify the tissue response to the application of foam STD with, and without, initial balloon denudation of vein wall endothelium. Percentage endothelial cell loss (ECL), tunica media injury and collagen structure were assessed. Stability of foam STD was established and modified by surfactant additives. The tissue effects of the modified foam were evaluated. Results All concentrations of foam STD produced equivalent cellular injury. Intra-luminal application of STD foam to great saphenous vein segments was associated with incomplete endothelial destruction and superficial tunica media injury. There was little evidence of collagen disruption. Viscosity enhancing agents were the most effective foam stabilisers. Initial mechanical balloon denudation of endothelium and prolongation of foam stability with surfactants, increased ECL but did not enhance tunica media injury. Conclusions The superficial injury and lack of collagen disruption sustained by veins following exposure to foam STD is likely to explain the capacity for recanalisation following treatment. The increased ECL observed following balloon endothelial denudation and application of modified STD foam may be beneficial in the clinical setting. Further in vivo evaluation of these adjuncts to foam sclerotherapy is required
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available