Evaluation Of The Minimum Effective Concentration Of Foam Sclerosant In An Ex-Vivo Study

Abstract

Background: Foam sclerosants are widely used in sclerotherapy and have been accepted as more effective than the liquid form; however, there is no consensus about the most applicable and effective concentration. Objective: The aim of this study was to investigate the histopathological changes caused by various widely used concentrations of foam sclerosant Methods: Fifty-six varicose vein segments of 5-10 mm diameter were gently resected and exposed to various concentrations of foam sclerosant (0.5%, 1%, 2%, 3%) for 5 min, and were then prepared for routine histopathological examination. A total damage scoring system, including the presence of endothelial swelling, intimal thickening, cellular vacuolization in the muscle layer, edema in the tunica media and extent of necrosis, was established. Results: The total damage score of the foam sclerosant groups was significantly higher than that of the control group (median 2.75 vs 1, p = 0.007). The highest damage score was achieved by 1% and 2% foam sclerosants (3.5 and 2.5). No significant difference was found among the different concentrations of sclerosant, although the 1% group caused more severe damage at a near significant level (p = 0.074). Conclusion: Significant pathological damage can be caused by even the lowest doses of foam sclerosant The most injurious concentrations were found to be 1% and 2%, morphologically. A working concentration of 1% could thus be preferable to 0.5%, especially in larger veins. Further in-vivo studies are needed in order to validate these findings. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.