We are delighted to announce that one of our trainees, Amy Cross, has won an international prize. Amy presented her research comparing two different sorts of sclerotherapy treatments for varicose veins. This was presented at the American Vein and Lymphatic Society (AVLS) on Saturday, 9 October 2021.
Having presented her research, and answered questions, Amy was announced as winning the best presentation by a trainee in conference.
Sclerotherapy is one way that is used to treat certain varicose veins. Although research shows that sclerotherapy is not optimal for large varicose veins, it is very effective in smaller varicose veins and some complex patterns. Larger varicose veins need either heat-based techniques such as endovenous laser ablation (EVLA), radiofrequency (RFA), microwave (EMWA), steam or the new non-invasive Sonovein (Echotherapy), or other non-heat techniques like mechanochemical ablation (MOCA) or cyanoacrylate glue.
When used in less concentrated forms, it is also the optimal treatment for leg thread veins (spider veins or telangiectasia).
In the northern hemisphere, most doctors use what is called a “detergent sclerosant” for sclerotherapy. The detergent drug damages the inner surface of the veins by destroying the lining cell membrane. Many doctors and nurses tell patients that this “sticks the vein together”. However, research from The Whiteley Clinic has shown this is not correct.
What actually happens is that the damage to the inner vein wall causes a reaction that kills the whole vein wall, provided the vein wall is thin. This is why sclerotherapy works in small veins with thin walls but not large veins with thick walls.
In the southern hemisphere, many doctors use a very strong sugar solution called 70% dextrose. This pulls water out of the cells in the vein wall, damaging them by dehydration. This is a process called osmosis. Doctors who use this substance feel that it has advantages over the detergent sclerosants.
However, until this research was done, there is very little research comparing the two different sort of sclerotherapy.
Following our research principles at The Whiteley Clinic, we always like to understand treatments in the laboratory before subjecting patients to studies. There seems little point in doing a clinical study comparing the sclerotherapy solutions, until we understand how they work.
Therefore, Amy performed this experiment by studying the effect of the different sclerotherapy solutions in varicose veins removed from volunteers at surgery. As with all of our research, this was done under ethics committee review and approval.
Veins that normally have been thrown away at the end of surgery from consenting patients, were put through a model that we have previously developed and published. We are able to treat veins using different techniques, and then see the effect that they have, once the technique has had chance to work on the vein.
Amy performed this research as part of her BSc dissertation at the University of Surrey.
Now it has been presented internationally and has won a prize, it will be submitted for peer-review publication in an international medical journal.
American Vein and Lymphatic Society (AVLS) – October 2021
Amy C Cross, Katherine Walker, Emma A. Borkowski, Laura Setyo, Roberto M La Ragione, Mark S Whiteley. Comparison of the effects of detergent and osmotic sclerosants in an ex-vivo human vein study using histology and immunohistochemistry.