Significant endothelin release in patients treated with foam sclerotherapy

Background: Foam sclerotherapy has been proven to be a safe and effective treatment for superficial venous insufficiency, but transient visual and neurological disturbances continue to be reported. These side effects have been postulated to be related to the presence of air or gases in the sclerosing foam. We present a differing hypothesis where significant Endothelin release from the treated varices is capable of generating such complications. Material and methods: we have tested the release of Endothelin 1 in 12 rats where a sclerotherapy was performed with liquid or foamed sodium tetradecylsulphate. Moreover we have measured Endothelin 1 in the systemic circulation and in a draining vein from the treated area in a group of 11 patients treated with foam sclerotherapy with Lauromacrogol 400 Results: Rats treated with STS showed significant increase in ET 1 levels at 1 and five minutes after foam sclerotherapy. Patients treated with foam sclerotherapy showed significant increase in ET 1 levels and this significantly correlated with local ET 1 levels. Conclusions: Evidence of Endothelin 1 release after sclerotherapy represents a plausible relationship explaining neurological and visual disturbances.