Timing and modality of the sclerosing agents binding to the human proteins: laboratory analysis and clinical evidences

Sclerosing agents (SA) are blood inactivated. Nevertheless, investigations concerning the interaction among SA and blood components have never been deeply investigated. Aim of the study is to precisely identify SA blood ligands, to determine their binding time and to highlight the clinical consequences. Thirty-one blood samples were collected from chronic venous disease patients and tested by capillary and agarose gel (AGE) electrophoresis before and after adding polidocanol (POL) and sodiumtetradecylsulphate (STS). The two different types of electrophoresis allowed an evaluation of the blood proteins binding with the sclerosing agents, with a reaction time lower than 8 seconds for the AGE. Subsequently six patients underwent foam sclerotherapy and then were subdivided in group A (4 patients) and B (2 patients). In group A blood sample was obtained from the ipsilateral brachial vein immediately before (T0) and repeated 1, 3, 5, and 10 minutes after injection of STS 3% injection into the GSV. In group B, the same procedure was performed with the same timing from the ipsilateral femoral vein. Free STS (fSTS) and total proteinbound STS (bSTS) were measured. POL mainly binds to β-globulins (11%), while STS to albumin and α-globulins (62.6% and 30.7%) on the protidogram, respectively. Both in the brachial and in the femoral vein, the average fSTS was always 0. STS binds to albumin (62.6%) and α-globulins (30.7%), while POL is bound mainly by the b-globulins (11%). The present paper demonstrates how the vast majority of the sclerosing agent is bound to the blood proteins, suggesting the need to look for possible sclerotherapy complications factors also in the used gas and/or in the subsequent cathabolites release.