The Whiteley Clinic, Guildford, Surrey, United Kingdom; Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
The Whiteley Clinic, Guildford, Surrey, United Kingdom; Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2017 May;5(3):370-377. doi: 10.1016/j.jvsv.2016.12.009. Epub 2017 Mar 6.
Nonthermal, tumescentless devices are the next generation of minimally invasive devices to treat varicose veins. We aimed to investigate the effects of mechanochemical ablation (MOCA) using ClariVein (Vascular Insights, Quincy, Mass) on ex vivo great saphenous vein with histology and immunofluorescent staining.
Extrafascial great saphenous veins were harvested during surgery for varicose veins and were treated ex vivo for 10 to 11 minutes with either liquid sclerotherapy or the use of ClariVein, with and without 3% sodium tetradecyl sulfate. Veins were sectioned and subjected to hematoxylin and eosin staining and immunofluorescent staining for endothelial and smooth muscle cell markers (CD31 and α-actin) to assess overall damage and cell death in the vein wall compared with control sections.
Histologic observations confirmed intimal damage from ClariVein, as has been previously shown; however, medial damage was also evident, which was not observed in control or liquid sclerotherapy sections. Immunofluorescent staining in the three sections studied showed a 42% decrease in CD31 staining and 27% mean reduction in α-actin staining up to a depth of 300 μm with liquid sclerotherapy. This cytotoxic effect was significantly enhanced by MOCA with a reduction in CD31 staining just above 60% and a 46% mean decrease in α-actin staining noted up to a depth of 300 μm. Far greater reductions in staining compared with sclerotherapy were observed up to a depth of 600 μm.
MOCA using 3% sodium tetradecyl sulfate increases the penetration of the sclerosant and its effect into the vein wall and shows superior rates of tissue destruction compared with liquid sclerotherapy alone. In this model, it appears not solely to damage the endothelium but also to shear the medial layer, creating small lesions into which sclerosant can flow and exert its cytotoxic effect.
非热、非肿胀设备是治疗静脉曲张的下一代微创设备。我们旨在通过组织化学消融（MOCA）使用 ClariVein（Vascular Insights，马萨诸塞州昆西）研究离体大隐静脉的效果，并用组织学和免疫荧光染色进行分析。
在静脉曲张手术过程中采集筋膜外大隐静脉，并使用液体硬化疗法或 ClariVein 进行离体处理 10-11 分钟，同时使用和不使用 3%十四烷基硫酸钠。将静脉切片进行苏木精和伊红染色以及内皮和平滑肌细胞标志物（CD31 和α-肌动蛋白）的免疫荧光染色，以评估静脉壁的整体损伤和细胞死亡与对照切片相比。
组织学观察证实了 ClariVein 引起的内膜损伤，如前所述；然而，也观察到中膜损伤，而在对照或液体硬化疗法切片中未观察到。在研究的三个切片中，免疫荧光染色显示 CD31 染色减少了 42%，α-肌动蛋白染色减少了 27%，平均减少了 300μm 的深度，而液体硬化疗法则减少了 27%。MOCA 显著增强了这种细胞毒性作用，CD31 染色减少了 60%以上，α-肌动蛋白染色减少了 46%，平均减少了 300μm 的深度。与硬化疗法相比，在 600μm 的深度范围内观察到更大的染色减少。
使用 3%十四烷基硫酸钠的 MOCA 增加了硬化剂的渗透及其对静脉壁的作用，并显示出与单独使用液体硬化疗法相比更高的组织破坏率。在这种模型中，它似乎不仅损伤内皮，而且还剪切中膜层，形成小的损伤，硬化剂可以流入其中并发挥其细胞毒性作用。
