Summary
The mechanism of thrombosis following intravariceal injection of sodium tetradecyl sulphate (S.T.D.) was investigated with respect to effects on the vascular endothelium, the coagulation cascade, and platelet function. Using an umbilical cord model designed to simulate blood flow over the endothelium, it was found that S.T.D. is a potent toxin for endothelial cells in that brief exposure to even low concentrations of the agent were effective in stripping endothelium over a considerable distance, exposing highly thrombogenic endothelium in the process. Effects on coagulation and platelet function were found to be dependent on concentration. Diluted S.T.D. induced a hypercoagulable state, possibly in consequence of a selective inhibition of the physiological anticoagulant, protein C, and promoted platelet aggregation. Higher concentrations inactivated the coagulation cascade and lysed platelets completely. These results suggest that intravariceal infusion of S.T.D. at considerable dilution may be at least as effective in inducing thrombosis as standard dosage, and possibly more so.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Broekmans AW, Veltkamp JJ, Bertina RM (1983) Congenital protein C deficiency and venous thromboembolism. N Engl J Med 309: 340
Caprini JA, Zuckerman L, Cohen E (1976) The identification of accelerated coagulability. Thromb Res 9: 167–180
Craffoord C, Frenkner P (1939) New surgical treatment of varicose veins of the oesophagus. Acta Otolaryngol 27: 422–429
Evans DMD, Jones DB, Cleary BK, Smith PM (1982) Oesophageal varices treated by sclerotherapy: a histopathological study. Gut 23: 615–620
Jaffe EA, Nachman RL, Becker CG, Minick CR (1973) Cutlure of human endothelial cells derived from umbilical veins: Identification by morphologic and immunologic criteria. J Clin Invest 5: 2745
Jacobson BF, Laage NJ, Cilliers K, Lopes RMC, Franz RC (1984) Effect of sclerosing agents on blood coagulation. SA J Surg 22: 182–183
Kang JH, Kambayashi J, Sakon M, Shiozaki H, Ogawa Y, Oshiro T, Mori T (1987) Mechanism of the haemostatic effect of ethonalamine oleate in the injection sclerotherapy for oesophageal varices. Br J Surg 74: 50–53
Keppel G, Saufley WH (1980) Introduction to design and analysis: a student's handbook. WH Freeman and Lampry, San Francisco, p. 174
Little D, Said JW, Siegel RJ, Fealy M, Fishbein MC (1986) Endothelial cell markers in vascular neoplasms: an immunochemical study comparing factor VIII-related antigen, blood group specific antigens, 6-keto-PGFI alpha andUlex europeus I lectin. J Pathol 149: 89–95
Musso R, Longo A, Triolo A, Giustolisi R, Lacciola RR, Lacciola E, Vecchio R, Russo A, Magnano A (1987) Polidocanol may directly activate the contact phase of blood coagulation during sclerotherapy. Gastrointest Endosc 33: 400–401
Rice S, Lee KP, Johnson MB, Korula J, Ralls P (1991) Portal venous system after portosystemic shunts or endoscopic sclerotherapy evaluation with doppler sonography. Am J Rad 156: 85–89
Russo A, Giannone C, Magnana A (1989) Prophylactic sclerotherapy in non-alcoholic liver cirrhosis: preliminary results of a prospective controlled randomized trial. World J Surg 13: 149–153
Stroncek DF, Hutton SW, Silvis SE, Vercellotti GM, Garob HS, Hammerschmidt DE (1985) Sodium morrhuate stimulates granulocytes and damages erythrocytes and endothelial cells: probable mechanism of an adverse reaction during sclerotherapy. J Lab Clin Med 106: 498–504
Terblanche J, Burrough AK, Hobbs KE (1989) Controversies in the management of bleeding esophageal varices (2 parts). N Engl J Med 320: 1393–1398, 1469–1475
Zucker HD (1949) Platelet thrombosis in human hemostasis: a histologic study of skin wounds in normal and purpuric individuals. Blood 4: 631
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jacobson, B.F., Franz, R.C., Hurly, E.M. et al. Mechanism of thrombosis caused by sclerotherapy of esophageal varices using sodium tetradecyl sulphate. Surg Endosc 6, 4–9 (1992). https://doi.org/10.1007/BF00591179
Issue Date:
DOI: https://doi.org/10.1007/BF00591179