Size of Sclerosing Foams Prepared by Ultrasound, Mechanical Agitation, and the Handmade Tessari Method for Treatment of Varicose Veins

Critello, Costantino Davide; Fiorillo, Antonino S.; Matula, Thomas J.

doi:10.7863/ultra.16.02052

Cited by 17 publications

(21 citation statements)

References 27 publications

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“…Depending on surfactant concentration (Bai et al, 2018), liquidto-gas ratio-also referred to as foam quality in the literature (Cameron et al, 2013), method of production (Carugo et al, 2013;Critello et al, 2017), syringe type and needle size , and bubble size distribution-also referred to as size dispersity in the literature (Cameron et al, 2013;Carugo et al, 2016;Critello et al, 2017); the stability of the resulting foam can vary (Cavezzi & Tessari, 2009).…”

Section: Conventional Clinical Methodsmentioning

confidence: 99%

“…The gas canister is then replaced with a Varithena® transfer unit which allows the withdrawal of foam into a syringe (Modified and Reprinted from Carugo D. et al, Copyright [2015], distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)) produce sclerosing foams. It has been reported that foams can also be produced by mechanical agitation of a surfactant solution via acoustic cavitation, using either a tip sonicator (Critello et al, 2017) or under the effect of an ultrasound field in a non-flowing fluid system (Fiorillo, Fiorillo, Critello, & Pullano, 2015). A study demonstrated that low-frequency ultrasound can produce foams with smaller bubbles compared to PCF foams.…”

Section: Alternative Methods Of Foam Productionmentioning

confidence: 99%

“…On a general note, reported studies have investigated the effect of foam production technique Carugo et al, 2015;Critello et al, 2017), syringe size and number of pumping cycles (Bai et al, 2018;Nastasa et al, 2015), surfactant concentration (Cameron et al, 2013;Wong et al, 2015) and temperature (Bai et al, 2018), different liquid to gas ratios (Cameron et al, 2013;Carugo et al, 2015;Wong et al, 2015) and various gas types (Carugo et al, 2013(Carugo et al, , 2015Hashimoto, Uchida, Horikawa, Mimura, & Farsad, 2018) F I G U R E 1 6 Molecular dynamics simulation results of a water phase flanked by two surfactant (SDS) monolayers with hydrophilic ends of surfactant placed inside the water phase. Two gas monolayers were positioned near the hydrophobic groups of SDS.…”

Section: Optimizing Sclerotherapymentioning

confidence: 99%

“…Depending on surfactant concentration (Bai et al, 2018), liquid‐to‐gas ratio—also referred to as foam quality in the literature (Cameron et al, 2013), method of production (Carugo et al, 2013; Critello et al, 2017), syringe type and needle size (Bottaro et al, 2019), and bubble size distribution—also referred to as size dispersity in the literature (Cameron et al, 2013; Carugo et al, 2016; Critello et al, 2017); the stability of the resulting foam can vary (Cavezzi & Tessari, 2009). An ideal sclerosing foam needs to be sufficiently cohesive, viscous, and with a low bubble size dispersity in order to exhibit stable characteristics (i.e., lower drainage time and slower rate of coarsening) (Star, Connor, & Parsi, 2018).…”

Section: Foam Sclerotherapymentioning

confidence: 99%

“…Thus, it is evident that non‐invasive treatment options such as sclerotherapy need to be optimized. Some recent efforts have been made to optimize sclerosing foams in vitro (Bai et al, 2018; Critello, Fiorillo, & Matula, 2017; Wong, Chen, Connor, Behnia, & Parsi, 2015); however, they lack clinically relevant parameters that can correlate physical characteristics of foams with clinical outcomes of sclerotherapy. Other studies have instead defined new parameters that could directly reflect the performance of sclerosing foams (Bottaro et al, 2019; Carugo et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Foam‐in‐vein: A review of rheological properties and characterization methods for optimization of sclerosing foams

et al. 2020

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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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