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تعداد صفحات این فایل: ۲۶ صفحه

بخشی از مقاله انگلیسیعنوان انگلیسی:Infusion of foam sclerosants results in a distance-dependent procoagulant activity, haemoconcentration and elevation of D-dimer levels~~en~~

Abstract

Objective To investigate the biological effects of foam sclerotherapy in vivo.

Materials and methods Ultrasound-guided sclerotherapy was performed using a 3% sodium tetradecyl sulphate or polidocanol. A total of 15mL of foam was injected. Samples were collected from antecubital veins, target saphenous veins and the adjoining deep veins before, immediately after and 1 hour after the procedure. Saphenous vein samples were also taken sequentially at set 15cm intervals. Clotting times, D-dimer, cell counts and biochemical parameters were measured. D-dimer levels were repeated one week later.

Results Forty procedures were performed. Systemic clotting times were not affected by the procedure. Injection of 0.5mL of foam 5cm away from the relevant junctions resulted in procoagulant activity in the adjoining deep veins (sodium tetradecyl sulphate) and the target saphenous veins (sodium tetradecyl sulphate and polidocanol). The procoagulant effect in the target veins reached a peak at 15cm but normalised at 45cm. D-dimer levels were significantly increased 1 hour after treatment with either agent and remained elevated one week later. Sodium tetradecyl sulphate and to a lesser degree polidocanol induced biochemical changes consistent with haemoconcentration.

Conclusion Infusion of foam sclerosants results in a distance-dependent procoagulant activity in the exposed vessels. Foam sclerotherapy results in haemoconcentration and elevation of D-dimer.

۱ Introduction

Detergent sclerosants sodium tetradecyl sulphate (STS) and polidocanol (POL) are commonly administered in the foam format during ultrasound-guided sclerotherapy (UGS) to treat varicose veins and vascular malformations. These agents act by inducing endothelial cell lysis, exposure of basement membrane proteins with the ultimate aim of achieving endovascular fibrosis. The procedure may be complicated by rare thromboembolic events such as deep vein thrombosis (DVT),1,2 pulmonary embolism,1 transient ischaemic attacks and stroke.3

We have previously demonstrated that the in vitro administration of high concentration sclerosants to plasma samples significantly prolongs the activated partial thromboplastin time (APTT), prothrombin time (PT) and Factor Xa clotting time (XACT) assays.4 The in vitro incubation of circulating blood cells, as well as cultured endothelial cells with high concentrations of detergent sclerosants, results in cellular lysis, whilst at low concentrations, stimulates the activation of platelets and release of procoagulant platelet-derived microparticles (PMP) that correspond to shortened XACT times.4,5 We have also shown that blood components and in particular plasma proteins deactivate the sclerosants resulting in a gradual fall in the concentration and a corresponding change from an anticoagulant to a procoagulant profile. Due to the in vitro nature of these investigations, only liquid agents were investigated as foam sclerosants could not be incubated with blood samples without affecting the foam structure.

Only a handful of in vivo studies have investigated the biological effects of foam sclerotherapy and those published have produced conflicting results.6–۸ One study6 reported a prolongation of PT at both 30 minutes and 24 hours following liquid sclerotherapy using STS, while another publication7 reported no change in the systemic clotting times with STS foam. None of these studies investigated the biological effects of foam sclerosants on target vessels or the adjoining deep veins where a deep vein thrombus may actually form.

In the current study, we investigated the in vivo effects of foam sclerotherapy on circulating blood cell counts and coagulation assays. Samples were taken from the systemic circulation, target vessels and the adjoining deep veins at set time and distance intervals. In the systemic circulation, we also assessed the effects of sclerotherapy on D-dimer levels and biochemical markers including renal and liver function tests and cardiac enzymes.

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