不同浓度十四烷基硫酸钠和初始球囊剥脱对泡沫硬化疗法模型中内皮细胞丢失和中膜损伤的影响。
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.
机构信息
Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
出版信息
Eur J Vasc Endovasc Surg. 2010 Mar;39(3):366-71. doi: 10.1016/j.ejvs.2009.12.025. Epub 2010 Jan 18.
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.
简介
主干静脉泡沫硬化疗法（FS）后 1-3 年的再通率（20-32%）表明存在血栓闭塞，而不是不可逆转的静脉壁损伤。本研究检查了球囊内皮剥脱（BD）前后十四烷基硫酸钠（STD）泡沫造成的损伤。
方法
在 20 例行大隐静脉（GSV）剥脱术的患者中，在 GSV 近端 1.5cm 处采集（对照组）。接下来，在原位 BD（n=10）或不剥脱（n=10）后，采集下 1.5cm 的静脉段。这些测试段用 1%或 3%的 STD 泡沫（5 分钟）填充，冲洗并固定在福尔马林中。确定内皮细胞丢失率（ECL）和中膜损伤程度（H&E 染色），并评估胶原结构（透射电子显微镜，TEM）。
结果
对照组无损伤。1%和 3%的 STD 泡沫分别导致 86.3%和 92.2%的 ECL（p<0.001 与对照组相比；1%与 3%相比，p=0.55）。所有切片中都存在内皮细胞。BD 增加了 ECL（1%：96.9%，3%：98.1%，p=0.01）中膜损伤（平滑肌空泡化）最小（1% STD 为其深度的 8.9%，3% STD 为 12%），BD 并未加重损伤（1%：8.7%，p=0.93；3%：11.3%，p=0.86）。未发生胶原破坏（TEM）。
结论
球囊剥脱增加了 ECL，但并未促进中膜损伤。1%和 3%的 STD 造成了同等程度的损伤。
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