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Nguyen HL, Holderbaum Do Amaral R, Lerouge S, De Roo AK, Zehtabi F, Vikkula M, Soulez G. Injectable chitosan hydrogel effectively controls lesion growth in a venous malformation murine model. Diagn Interv Imaging 2024:S2211-5684(24)00165-7. [PMID: 39095271 DOI: 10.1016/j.diii.2024.07.004] [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: 02/20/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of intralesional injection of chitosan hydrogel (CH) combined with sodium tetradecyl sulfate (STS) to sclerose and embolize venous malformations (VMs) by comparison with 3% STS foam and placebo in a mouse model. MATERIALS AND METHODS Subcutaneous VMs were created by injecting HUVEC_TIE2-L914F cells, mixed with matrigel, into the back of athymic mice (Day [D] 0). After VM-like lesions were established at D10, 70 lesions were randomly assigned to one of six treatment groups (untreated, saline, 3% STS-foam, CH, 1% STS-CH, 3% STS-CH). For 3% STS-foam, the standard Tessari technique was performed. VMs were regularly evaluated every 2-3 days to measure lesion size until the time of collection at D30 (primary endpoint). At D30, VM lesions including the matrigel plugs were culled and evaluated by histological analysis to assess vessel size, chitosan distribution and endothelial expression. One-way analysis of variance (ANOVA) test was performed to compare quantitative variables with normal distribution, otherwise Kruskal-Wallis test followed by pairwise comparisons by a Wilcoxon rank sum test was performed. RESULTS All VMs were successfully punctured and injected. Six VMs injected with 3% STS-CH showed early skin ulceration with an extrusion of the matrigel plug and were excluded from final analysis. In the remaining 64 VMs, skin ulceration occurred on 26 plugs, resulting in the loss of three 3% STS-foam and one 1% STS-CH plugs. Both chitosan formulations effectively controlled growth of VMs by the end of follow-up compared to untreated or 3% STS-foam groups (P < 0.05). Vessel sizes were smaller with both CH formulations compared to untreated and saline groups (P < 0.05). Additionally, there were smaller vascular channels within the 1% STS-CH group compared to the 3% STS-foam group (P < 0.05). CONCLUSION Chitosan's ability to control the growth of VMs suggests a promising therapeutic effect that outperforms the gold standard (STS-foam) on several variables.
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Affiliation(s)
- Ha-Long Nguyen
- Human Molecular Genetics, de Duve Institute, University of Louvain, B-1200 Brussels, Belgium
| | - Ricardo Holderbaum Do Amaral
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Montreal, QC, H2 × 0A9, Canada; Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montreal, Montreal, QC, H3T 1J4, Canada
| | - Sophie Lerouge
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Montreal, QC, H2 × 0A9, Canada; Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montreal, Montreal, QC, H3T 1J4, Canada; Department of Mechanical Engineering, Ecole de Technologie Supérieure (ÉTS), Montreal, QC, H3C 1K3, Canada
| | - An-Katrien De Roo
- Department of Pathology, Saint Luc University Hospital, B-1200 Brussels, Belgium; Institute of Experimental and Clinical Research, University of Louvain, B-1348 Brussels, Belgium; Center for Vascular Anomalies, Member of VASCERN (European Reference Network on Rare Multisystemic Vascular Diseases) VASCA European Reference Centre Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium
| | - Fatemeh Zehtabi
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Montreal, QC, H2 × 0A9, Canada; Department of Mechanical Engineering, Ecole de Technologie Supérieure (ÉTS), Montreal, QC, H3C 1K3, Canada
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, B-1200 Brussels, Belgium; WELBIO Department, WEL Research Institute, B-1300 Wavre, Belgium
| | - Gilles Soulez
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Montreal, QC, H2 × 0A9, Canada; Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montreal, Montreal, QC, H3T 1J4, Canada.
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Tan M, Moreno HB, Bechter-Hugl B, Gianesini S, Connor D, Parsi K, Davies AH. Sclerotherapy: Indications and safety volumes. Phlebology 2024; 39:135-138. [PMID: 37899570 PMCID: PMC10877989 DOI: 10.1177/02683555231211092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Matthew Tan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Beate Bechter-Hugl
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - David Connor
- Department of Dermatology, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Kurosh Parsi
- Department of Dermatology, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, London, UK
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Lim C, Lee S, Ghosh A, Funaki B. Embolic Agents: Sclerotherapy. Semin Intervent Radiol 2024; 41:79-83. [PMID: 38495260 PMCID: PMC10940036 DOI: 10.1055/s-0043-1778656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Christina Lim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, Creighton University School of Medicine, Baltimore, Maryland
| | - Sean Lee
- Touro College of Osteopathic Medicine, New York City, New York
| | - Abheek Ghosh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brian Funaki
- Division of Vascular and Interventional Radiology, University of Chicago Medicine, Chicago, Illinois
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Postsclerotherapy compression: A systematic review. J Vasc Surg Venous Lymphat Disord 2020; 9:264-274. [PMID: 32791308 DOI: 10.1016/j.jvsv.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compression after sclerotherapy is commonly used, although the evidence base for this practice is unclear. This study aims to summarize and assess the evidence for compression therapy after sclerotherapy to inform clinical practice. METHODS A systematic review was performed according to PRISMA guidelines via Medline and EMBASE databases (1946 to December 31, 2019) by two reviewers. Full-text, English-language studies comparing compression type and/or duration in adult chronic venous disease patients undergoing liquid or foam sclerotherapy were included. RESULTS Nine studies were identified: five using liquid sclerotherapy, three foam sclerotherapy and one using both. Studies had short follow-up periods (6-24 weeks) and reported on clinical outcomes, quality of life, side effects and complications. In C1 patients undergoing liquid sclerotherapy, any duration of stocking use significantly decreased telangiectasia and reticular vein number and size compared with no compression. No significant difference in clinical symptoms or quality of life was seen when comparing compression duration after liquid or foam sclerotherapy in tributary or truncal veins in C2 to C6 patients. Greater superficial vein resolution was seen with stockings compared with bandages in C2 patients undergoing liquid sclerotherapy to tributary veins. A comparison of stockings vs bandaging revealed differing thrombophlebitis rates but no significant difference in pigmentation. In C2 to C6 patients undergoing foam sclerotherapy, use of 35 mm Hg stockings significantly improved post-treatment symptoms compared with 23 mm Hg stockings. This review was limited by heterogeneity of outcome measurements and the variety of comparisons between compression types and durations. CONCLUSIONS Postsclerotherapy compression may have beneficial clinical outcomes at short-term follow-up; however, evidence is lacking regarding its type, class, length, and duration. Further trials are required to guide the optimal management of postsclerotherapy patients.
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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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