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Serkan M, Gokay D. Low temperature offers better foam stability. J Cosmet Dermatol 2024. [PMID: 38837644 DOI: 10.1111/jocd.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The foam's structural longevity, linked to the effectiveness of sclerotherapy, depends on preparation conditions. The factors enhancing the treatment's effectiveness and efficacy are still under discussion. METHODS We conducted an in vitro preclinical research, which included 144 independent trials. A total of 8 combinations involving 18 trials were designed according to settings of +4°C and room temperature (20-22°C), liquid-to-air ratios of 1/1 and 1/4, and polidocanol concentrations of 0.5% and 1% using the modified Tessari method. Our study aimed to examine the effect of air ratio, agent temperature, and polidocanol concentration on stability by assessing the foam half-time (FHT) and defining the optimal preparation conditions. RESULTS The mean FHT was 117 ± 30.4 s. The longest FHT was in a 1:4 air-to-sclerosant ratio at +4°C, regardless of the sclerosant concentration (for %0.5 mean FHT: 146.2 ± 13.9 s, for % 1 mean FHT: 146.9 ± 18 s). There was a significant interaction among the three variables on FHT (p = 0.001). Temperature emerged as the primary factor (F(1, 136) = 124, p < 0.001, ηp2 = 0.477), with lower temperatures markedly enhancing the longevity (p < 0.001). Preparation at a temperature of 4°C resulted in an extended FHT of 32.5 s compared to 22°C (95% CI: 24.06-41.04 s). CONCLUSION The temperature, agent concentration, and gas ratio significantly influence the stability of the physician-compounded foam. The low temperature at +4°C may offer better FHT for sclerotherapy.
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Affiliation(s)
- Mola Serkan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Deniz Gokay
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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Azmoun S, Liu Y, Bian K, Chen A, Liu S. The Effect of Pushing Rate on Foam Stability in the Tessari Method. Dermatol Surg 2024; 50:542-545. [PMID: 38460194 DOI: 10.1097/dss.0000000000004155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
BACKGROUND The Tessari method is commonly used in sclerotherapy for producing foam, involving 2 syringes pushed back and forth 20 times with the use of a 3-way connector. Many factors affect the foam stability which is crucial for clinical efficacy. OBJECTIVE This study aimed to identify the optimal pushing rate which may impact the foam stability. MATERIALS AND METHODS Polidocanol (POL) solution (1% and 3%) was used to make sclerosant foam via the Tessari method, with a total of 20 pushes performed at different time durations: 10, 15, 20, 25, 30, 35, and 40 seconds. The foam stability was recorded using foam half-life time (FHT), and the pushing pressure to the syringe was recorded using a self-made electric device. Both FHT and the pressure among different groups were compared respectively. RESULTS The FHT was decreased as pushing duration exceeding 20 seconds in POL 1% and 15 seconds in POL 3%. Both the highest FHT and pressure point were located in the 10-second group. CONCLUSION It is recommended to complete 20 back-and-forth passages within 10 seconds to create stable foam.
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Affiliation(s)
- Sajjad Azmoun
- Department of Plastic and Burn Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yiran Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kai Bian
- Department of Plastic and Burn Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Anwei Chen
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shaohua Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
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FIGUEROA V, PINTO P, CIFUENTES S, MORENO O, SOLANO A, ULLOA J. The implication of altitude in foam stability of polidocanol and lapyrium chloride. ACTA PHLEBOLOGICA 2023. [DOI: 10.23736/s1593-232x.22.00553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Foam-in-Vein: Characterisation of Blood Displacement Efficacy of Liquid Sclerosing Foams. Biomolecules 2022; 12:biom12121725. [PMID: 36551153 PMCID: PMC9775758 DOI: 10.3390/biom12121725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
Sclerotherapy is among the least invasive and most commonly utilised treatment options for varicose veins. Nonetheless, it does not cure varicosities permanently and recurrence rates are of up to 64%. Although sclerosing foams have been extensively characterised with respect to their bench-top properties, such as bubble size distribution and half-life, little is known about their flow behaviour within the venous environment during treatment. Additionally, current methods of foam characterisation do not recapitulate the end-point administration conditions, hindering optimisation of therapeutic efficacy. Here, a therapeutically relevant apparatus has been used to obtain a clinically relevant rheological model of sclerosing foams. This model was then correlated with a therapeutically applicable parameter-i.e., the capability of foams to displace blood within a vein. A pipe viscometry apparatus was employed to obtain a rheological model of 1% polidocanol foams across shear rates of 6 s-1 to 400 s-1. Two different foam formulation techniques (double syringe system and Tessari) and three liquid-to-gas ratios (1:3, 1:4 and 1:5) were investigated. A power-law model was employed on the rheological data to obtain the apparent viscosity of foams. In a separate experiment, a finite volume of foam was injected into a PTFE tube to displace a blood surrogate solution (0.2% w/v carboxymethyl cellulose). The displaced blood surrogate was collected, weighed, and correlated with foam's apparent viscosity. Results showed a decreasing displacement efficacy with foam dryness and injection flowrate. Furthermore, an asymptotic model was formulated that may be used to predict the extent of blood displacement for a given foam formulation and volume. The developed model could guide clinicians in their selection of a foam formulation that exhibits the greatest blood displacement efficacy.
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Abstract
BACKGROUND Sclerotherapy is commonly performed for elimination of reticular and telangiectatic leg veins. There are several variations in practice, from the preparation to post-therapy directives. OBJECTIVE To critically examine the misconceptions of sclerotherapy for aesthetic indications. MATERIALS AND METHODS This review assesses evidence for and against each of the most common myths regarding sclerotherapy for aesthetic indications. RESULTS Sclerotherapy can be safely used to treat veins in areas other than the lower extremities, with the exception of the face. Laser therapy is not superior to sclerotherapy for the treatment of small telangiectatic veins on the lower extremities. The type of syringe used to produce foam sclerotherapy is an important procedural consideration. After sclerotherapy, graduated compression stocking usage is a vital part of the procedure. Detergent sclerotherapy agents are similar, but not equivalent. Touch-up treatments after sclerotherapy should not be performed for 2 months post-treatment. Foam sclerotherapy does not have a high risk for air emboli. It is not advisable to treat the leg veins in "sections." Finally, one cannot reliably treat the telangiectatic veins without treating the feeding reticular veins for a satisfactory result. CONCLUSION Many aspects of sclerotherapy have existing evidence to dictate best clinical practice.
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Meghdadi A, Jones SA, Patel VA, Lewis AL, Millar TM, Carugo D. Foam-in-vein: Rheological characterisation of liquid sclerosing foams using a pipe viscometer. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.128916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ulloa J, Moreno OY, Castillo-Cabrera C, Cifuentes S, Figueroa V, Solano A. Telangiectasia diameter in response to thermal stimulus: experimental data and possible clinical applications. INT ANGIOL 2021; 40:451-456. [PMID: 34515449 DOI: 10.23736/s0392-9590.21.04693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Telangiectasias are dilated blood vessels on the skin that develop progressively because of several diseases, including chronic venous disease. The skin blood flow has differences compared to the rest of the circulatory system. These vessels have a permanent vasoconstrictor tone that can respond to vasoconstriction/vasodilation stimulative substances and higher or lower temperatures. The aim of this study was to investigate any possible telangiectasias vasoconstriction or vasodilation in response to temperature changes. METHODS This study is a clinical trial with 26 outpatients of vascular surgery with telangiectasias in the lower limbs. We used direct skin digital microscopy to obtain telangiectasias images at room temperature and after the thermal stimulus with cold pads. These photographs were processed using AmScopeAmLite (United Scope LLC Euromex Optics Group b.v., Los Angeles, CA, USA) and the capillary diameter and area were measured in Adobe Illustrator (Adobe Inc., Mountain View, CA, USA). The data collected was analyzed in SPSS Statistics (SPSS Inc., Chicago, IL, USA) with a paired t-test for the telangiectasias area and a Wilcoxon matched-pairs signed-rank test for the telangiectasias diameter. RESULTS In comparison to telangiectasias measures at room temperature, we found a statistically significant decrease in the diameter (median of -0.04 mm; interquartile range: -0.10 mm to -0.01 mm; P<0.001) and area (mean of -26.54 mm2; 95% Confidence interval (-36.31, -16.76) mm2; P<0.001 in response to the cold stimulus. CONCLUSIONS Telangiectasias respond to cold patch application with a significantly statistical microscale quantifiable vasoconstriction. This intervention has the potential to improve the current state of telangiectasias sclerotherapy due to its mechanism helping to stabilize the applied foam. We speculate that topic cold used as a neoadjuvant treatment could improve the efficiency, stability, and other outcomes of sclerotherapy. Also, complementary use of topical cold stimulus application may be of interest in the therapeutic management of telangiectasias.
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Affiliation(s)
- Jorge Ulloa
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia - .,Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia -
| | - Oscar Y Moreno
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Sebastian Cifuentes
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Valentin Figueroa
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Antonio Solano
- Department of Vascular Surgery, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
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Afifi HR, Mohammadi S, Mirzaei Derazi A, Moradi S, Mahmoudi Alemi F, Hamed Mahvelati E, Fouladi Hossein Abad K. A comprehensive review on critical affecting parameters on foam stability and recent advancements for foam-based EOR scenario. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.116808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roberts TG, Cox SJ, Lewis AL, Jones SA. Characterisation and optimisation of foams for varicose vein sclerotherapy. Biorheology 2021; 57:77-85. [PMID: 33459690 DOI: 10.3233/bir-201004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Foam sclerotherapy is the process of using an aqueous foam to deliver surfactant to a varicose vein to damage vein wall endothelial cells, causing the vein to spasm, collapse and ultimately be re-absorbed into the body. Aqueous foams are complex fluids that can exhibit a significant yield stress and high effective viscosity which depend on their composition, particularly the bubble size and liquid fraction. OBJECTIVE To characterise the properties of foams used for varicose vein sclerotherapy and determine their effectiveness in the displacement of blood during sclerotherapy. METHODS Foams are modelled as yield stress fluids and their flow profiles in a model vein are predicted. Values of the yield stress are determined from experimental data for three different foams using the Sauter mean of the bubble size distribution. Along with the measured liquid fraction of the foams, this information is collected into a Bingham number which entirely characterises the process of sclerotherapy. RESULTS Polydispersity in bubble size has a strong effect on the yield stress of a foam and the Sauter mean of the size distribution better captures the effects of a few large bubbles. Reducing the polydispersity increases the yield stress, and a higher yield stress results in a larger plug region moving along the vein, which is more effective in displacing blood. The width of the plug region is proportional to the Bingham number, which also has a quadratic dependence on the liquid fraction of the foam. Assuming typical values for the rate of injection of a foam, we predict that for a vein of diameter 5 mm, the most effective foams have low liquid fraction, a narrow size distribution, and a Bingham number B ≈ 4.5. CONCLUSIONS The Sauter mean radius provides the most appropriate measure of the bubble size for sclerotherapy and the Bingham number then provides a simple measure of the efficacy of foam sclerotherapy in a vein of a given size, and explains the ability of different foams to remove varicose veins. Foams containing small bubbles, with a narrow size distribution, and a low liquid fraction are beneficial for sclerotherapy.
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Affiliation(s)
- T G Roberts
- Department of Mathematics, Aberystwyth University, UK
| | - S J Cox
- Department of Mathematics, Aberystwyth University, UK
| | - A L Lewis
- Biocompatibles UK Ltd, a Boston Scientific Company, Lakeview, Camberley, Surrey, UK
| | - S A Jones
- Biocompatibles UK Ltd, a Boston Scientific Company, Lakeview, Camberley, Surrey, UK
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Jeong S, Kim S, Choi Y, Jung HN, Lee K, Park MH. Development of Glycerol-Rose Bengal-Polidocanol (GRP) foam for enhanced sclerosis of a cyst for cystic diseases. PLoS One 2021; 16:e0244635. [PMID: 33400697 PMCID: PMC7785218 DOI: 10.1371/journal.pone.0244635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Polycystic kidney disease (PKD) is a common genetic disorder that results in a proliferating and enlarging cyst and ultimately leads to loss of kidney function. Because an enlarged cyst is a primary factor for limited kidney function, the large cyst is surgically removed by laparoscopic deroofing or sclerosant. This a relatively nascent treatment method entails complications and sometimes fail due to the cyst fluid refilling and infection. This study proposes using a more stable and effective polidocanol foam with glycerol and Rose Bengal (GRP form) to prevent cyst regeneration and irritation, which is caused by the required body movement during the treatment. Specifically, the foam retention time and viscosity were increased by adding glycerol up to 10% (w/v). The GRP form inhibited cellular proliferation and disrupted cellular junctions, e-cadherin, and cyst formation, demonstrated by the LDH, Live and Dead, and re-plating culture assays. The GRP foam was shown to be a safe and effective treatment as a commercial grade polidocanol foam form by an in vivo study in which subcutaneously injected mice injected with commercial 3% polidocanol, and the GRP foam showed no difference in inflammation. Thus, this study provides an advanced polidocanol form by adding glycerol and Rose-Bengal to help existing sclerotherapy.
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Affiliation(s)
- Soohyun Jeong
- Program in Nanoscience and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Sujin Kim
- Program in Nanoscience and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Youngjoo Choi
- Program in Nanoscience and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Han Na Jung
- Program in Nanoscience and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Kangwon Lee
- Program in Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Min Hee Park
- Center for Convergence Bioceramic Materials, Korea Institute of Ceramic Engineering and Technology, Cheo-ngju, Republic of Korea
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del Castillo-Santaella T, Yang Y, Martínez-González I, Gálvez-Ruiz MJ, Cabrerizo-Vílchez MÁ, Holgado-Terriza JA, Selles-Galiana F, Maldonado-Valderrama J. Effect of Hyaluronic Acid and Pluronic-F68 on the Surface Properties of Foam as a Delivery System for Polidocanol in Sclerotherapy. Pharmaceutics 2020; 12:pharmaceutics12111039. [PMID: 33143001 PMCID: PMC7693533 DOI: 10.3390/pharmaceutics12111039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
The use of foams to deliver bioactive agents and drugs is increasing in pharmaceutics. One example is the use of foam as a delivery system for polidocanol (POL) in sclerotherapy, with the addition of bioactive compounds to improve the delivery system being a current subject of study. This work shows the influence of two bioactive additives on the structure and stability of POL foam: hyaluronic acid (HA) and Pluronic-F68 (F68). HA is a natural non-surface-active biopolymer present in the extracellular matrix while F68 is a surface-active poloxamer that is biocompatible with plasma-derived fluids. Both additives increase the bulk viscosity of the sample, improving foam stability. However, HA doubled and F68 quadruplicated the foam half lifetime of POL. HA reduced the size and polydispersity of the bubble size distribution and increased the surface elasticity with respect to POL. Both facts have a positive impact in terms of foam stability. F68 also altered bubble structure and increased surface elasticity, again contributing to the enhancement of foam stability. The surface characterization of these systems is important, as in foam sclerotherapy it is crucial to assure the presence of POL at the surface of the bubbles in order to deliver the sclerosant agent in the target vein.
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Affiliation(s)
- Teresa del Castillo-Santaella
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
| | - Yan Yang
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
| | - Inmaculada Martínez-González
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
| | - María José Gálvez-Ruiz
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, 18071 Granada, Spain
| | - Miguel Ángel Cabrerizo-Vílchez
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
| | - Juan Antonio Holgado-Terriza
- Department of Software Engineering, University of Granada, C/Periodista Daniel Saucedo Aranda, sn, 18071 Granada, Spain;
| | | | - Julia Maldonado-Valderrama
- Department of Applied Physics, University of Granada, Campus de Fuentenueva, sn, 18071 Granada, Spain; (T.d.C.-S.); (Y.Y.); (I.M.-G.); (M.J.G.-R.); (M.Á.C.-V.)
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, 18071 Granada, Spain
- Correspondence:
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Mullagura HN, Dash S. Bubble-Induced Rupture of Droplets on Hydrophobic and Lubricant-Impregnated Surfaces. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2020; 36:8858-8864. [PMID: 32614589 DOI: 10.1021/acs.langmuir.0c01187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bursting of bubbles is ubiquitous with numerous applications ranging from spraying of pesticides, drug delivery, and inkjet printing to forming emulsions. Understanding the parameters that influence the dynamics of bubble rupture is crucial to design systems with improved performance. Here, we experimentally investigate the behavior of air-bubble-induced rupture of a sessile droplet placed on hydrophobic and lubricant-impregnated surfaces (LIS). We demonstrate that the bubble dynamics inside a sessile droplet and subsequent rupture of the thinning film is dependent on the nature of the underlying substrate and the thermodynamic state of the droplet on the substrate. The growth of the bubble is shown to be dependent on the contact angle hysteresis of water and air on the substrate and the presence of a cloaking oil film around the water droplet. On a plain and textured surface with a high contact angle hysteresis, bubble-induced rupture initiates at the apex of the droplet. In the case of LIS that offers negligible pinning forces, the bubble-induced rupture of liquid shell initiates near the triple contact line. The dynamics of rupture of droplets placed on LIS is shown to be dependent on the viscosity of the impregnating and cloaking lubricant.
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Affiliation(s)
- Haritha N Mullagura
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Susmita Dash
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore 560012, India
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Critello DC, Pullano SA, Gallo G, Matula TJ, Fiorillo AS. Low frequency ultrasound as a potentially viable foaming option for pathological veins. Colloids Surf A Physicochem Eng Asp 2020. [DOI: 10.1016/j.colsurfa.2020.124919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meghdadi A, Jones SA, Patel VA, Lewis AL, Millar TM, Carugo D. Foam-in-vein: A review of rheological properties and characterization methods for optimization of sclerosing foams. J Biomed Mater Res B Appl Biomater 2020; 109:69-91. [PMID: 32621565 DOI: 10.1002/jbm.b.34681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
Varicose veins are chronic venous defects that affect >20% of the population in developed countries. Among potential treatments, sclerotherapy is one of the most commonly used. It involves endovenous injection of a surfactant solution (or foam) in varicose veins, inducing damage to the endothelial layer and subsequent vessel sclerosis. Treatments have proven to be effective in the short-term, however recurrence is reported at rates of up to 64% 5-year post-treatment. Thus, once diagnosed with varicosities there is a high probability of a permanently reduced quality of life. Recently, foam sclerotherapy has become increasingly popular over its liquid counterpart, since foams can treat larger and longer varicosities more effectively, they can be imaged using ultrasound, and require lower amounts of sclerosing agent. In order to minimize recurrence rates however, an investigation of current treatment methods should lead to more effective and long-lasting effects. The literature is populated with studies aimed at characterizing the fundamental physics of aqueous foams; nevertheless, there is a significant need for appropriate product development platforms. Despite successfully capturing the microstructural evolution of aqueous foams, the complexity of current models renders them inadequate for pharmaceutical development. This review article will focus on the physics of foams and the attempts at optimizing them for sclerotherapy. This takes the form of a discussion of the most recent numerical and experimental models, as well as an overview of clinically relevant parameters. This holistic approach could contribute to better foam characterization methods that patients may eventually derive long term benefit from.
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Affiliation(s)
- Alireza Meghdadi
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Dario Carugo
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
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Bi M, Li D, Chen Z, Wang Y, Ren J, Zhang W. Foam sclerotherapy compared with liquid sclerotherapy for the treatment of lower extremity varicose veins: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20332. [PMID: 32481409 DOI: 10.1097/md.0000000000020332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. MATERIALS AND METHODS We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. RESULTS There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). CONCLUSIONS Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.
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Affiliation(s)
- Minglei Bi
- Department of Plastic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Connor DE, Gerbelli J, Chew AN, Cooley-Andrade O, Goonawardhana D, Cheung K, Parsi K. Sirolimus and propranolol inhibit endothelial proliferation while detergent sclerosants induce endothelial activation, microparticle release and apoptosis in vitro. Phlebology 2020; 35:566-575. [PMID: 32216526 DOI: 10.1177/0268355520913384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the effects of detergent sclerosants, sodium tetradecyl sulphate and polidocanol, on endothelial cell activation and microparticle release and the effects of detergent sclerosants, sirolimus and propranolol, on apoptosis in vitro. METHODS Cultured human umbilical vein endothelial cells and murine haemangioendothelioma (EOMA) cell lines were incubated with different concentrations of sodium tetradecyl sulphate and polidocanol, as well as sirolimus and propranolol. Endothelial activation was assessed using flow cytometry for CD62e (E-Selectin), CD54 (ICAM-1), CD105 (endoglin), CD144 (VE-Cadherin), CD146 (MCAM) and the release of endothelial microparticles. Cell proliferation was assessed using [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] and carboxyfluorescein succinimidyl ester assays. Apoptosis was assessed using flow cytometry for lactadherin/propidium iodide staining and for Caspase-3 expression. RESULTS Sublytic concentrations of sodium tetradecyl sulphate and polidocanol (0.075%-0.3%) increased the expression of the activation markers CD62e and CD54. The expression of CD105 decreased in sclerosant treated cultured human umbilical vein endothelial cells. Both sodium tetradecyl sulphate and polidocanol induced the release of endothelial microparticles. All agents inhibited cell proliferation. Sodium tetradecyl sulphate and polidocanol-induced apoptosis as evidenced by increased phosphatidylserine exposure and caspase-3 expression, whereas sirolimus and propranolol increased caspase-3 expression only. CONCLUSION Sublytic concentrations of detergent sclerosants induce endothelial activation and the release of endothelial microparticles. All agents were anti-proliferative in EOMA cell lines, with sodium tetradecyl sulphate and polidocanol inducing cellular apoptosis.
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Affiliation(s)
- David E Connor
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jessica Gerbelli
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centro Universitário Barão de Mauá, Ribeirão Preto, Brazil
| | - An-Ning Chew
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Osvaldo Cooley-Andrade
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Dulani Goonawardhana
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kelvin Cheung
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kurosh Parsi
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND Foam sclerotherapy is an effective treatment strategy for vascular malformations, and its sclerosing power depends on foam stability. Twenty quick passages have been widely used as an indicator of the most stable state of sclerosants, but the universality of their effectiveness has not been proven yet. OBJECTIVE We aimed to identify simple and objective indicators of the most stable state of commonly used sclerosants and provide practitioners with suggestions to judge when foam producing is completed in sclerotherapy. MATERIALS AND METHODS The universality of the effectiveness of 20 passages was tested by producing bleomycin foam with different passages. Further study was performed by testing modified bleomycin, polidocanol, and sodium tetradecylsulfate foam. RESULTS The bleomycin foam became denser as passages were added, and the sound of each passage became almost silent after 40 passages. The almost silent sound can be an indicator of foam stability for most sclerosants. It has a different application range compared with 20 quick passages. CONCLUSION We suggest that practitioners choose a different indicator depending on the foam used.
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18
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Critello CD, Pullano SA, Matula TJ, De Franciscis S, Serra R, Fiorillo AS. Recent developments on foaming mechanical and electronic techniques for the management of varicose veins. Expert Rev Med Devices 2019; 16:931-940. [PMID: 31622557 DOI: 10.1080/17434440.2019.1682549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Varicose veins are a common disease, causing significant impairment of quality of life to afflicted individuals. Conventional surgery has represented the traditional treatment for years, with significant post-operative complications. By the end of the 20th century, novel approaches had been developed to induce biochemical sclerosis into the treated vein in order to exclude it from blood circulation.Areas covered: Foaming techniques for treatment of varicose veins, both clinically-approved methods and those under experimental studies. A brief description of cavitation, which is the basis of microbubbles formation, and an overview of foam properties have been also provided, including a discussion on clinical efficacy and safety profile.Expert commentary: Foam sclerotherapy has rapidly gained popularity since it represents the most minimally invasive and cost-effective procedure in the short term. Several different methods of foam preparation have been described in literature. In general, the foam generation method may affect characteristics such as stability and bubble size distribution, which in turn affect the therapeutic action of foam itself. Therefore, the selection of a suitable foaming technique is of importance for treatment success. Future developments on foaming techniques are expected to make sclerotherapy, already an effective treatment, even safer and more versatile therapeutic procedure.
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Affiliation(s)
- C Davide Critello
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Salvatore A Pullano
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Thomas J Matula
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Stefano De Franciscis
- Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino S Fiorillo
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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19
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Gianesini S, Obi A, Onida S, Baccellieri D, Bissacco D, Borsuk D, Campisi C, Campisi CC, Cavezzi A, Chi YW, Chunga J, Corda D, Crippa A, Davies A, De Maeseneer M, Diaz J, Ferreira J, Gasparis A, Intriago E, Jawien A, Jindal R, Kabnick L, Latorre A, Lee BB, Liew NC, Lurie F, Meissner M, Menegatti E, Molteni M, Morrison N, Mosti G, Narayanan S, Pannier F, Parsi K, Partsch H, Rabe E, Raffetto J, Raymond-Martimbeau P, Rockson S, Rosukhovski D, Santiago FR, Schul A, Schul M, Shaydakov E, Sibilla MG, Tessari L, Tomaselli F, Urbanek T, van Rijn MJ, Wakefield T, Wittens C, Zamboni P, Bottini O. Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019. Phlebology 2019; 34:4-66. [PMID: 31495256 DOI: 10.1177/0268355519870690] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
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Affiliation(s)
| | - Andrea Obi
- 2 University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Denis Borsuk
- 6 Clinic of Phlebology and Laser Surgery, 'Vasculab' Ltd, Chelyabinsk, Russia
| | | | | | - Attilio Cavezzi
- 9 Eurocenter Venalinfa, San Benedetto del Tronto (AP), Italy
| | - Yung-Wei Chi
- 10 University of California, Davis Vascular Center, Sacramento, CA, USA
| | | | | | | | | | | | - Josè Diaz
- 15 Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julio Ferreira
- 16 Instituto Brasilerio de Flebologia, Sao Paulo, Brazil
| | | | | | - Arkadiusz Jawien
- 19 Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | | | | | | | | | - N C Liew
- 24 Putra University, Serdang, Malaysia
| | - Fedor Lurie
- 25 Jobst Vascular Institute, Toledo, OH, USA
| | | | | | | | | | | | | | | | - Kurosh Parsi
- 32 St. Vincent's Hospital, University of NSW, Sydney, Australia
| | | | | | | | | | - Stanley Rockson
- 37 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Cees Wittens
- 44 Maastricht University Medical Center, Maastricht, Netherlands.,45 Uniklinik Aachen, Aachen, Germany
| | | | - Oscar Bottini
- 46 Universidad de Buenos Aires, Buenos Aires, Argentina
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