The role of hyaluronic acid in polidocanol foam: An in vitro study

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BackgroundAlthough sclerotherapy is widely used to treat vascular malformations (VMs), it is associated with several challenges. One significant issue is the insufficient understanding of the influence of various factors on the stability of polidocanol (POL) foam used in sclerotherapy.ObjectiveThis study aimed to explore the effect of the catheter needle caliber on foam stability when using POL with or without hyaluronic acid (HA) for the treatment of VMs.Methods and materialsThe Tessari method generated sclerosant foam using POL both with and without HA. We used catheters and syringe needles of various calibers, and the resulting foam was transferred into new syringes to facilitate a comparison of foam stability. Foam half-life (FHT) was utilized as a metric to assess foam stability.ResultsThe study found that narrower needle calibers produced a more stable foam when POL was used alone; however, no significant effect was observed when HA was added. Furthermore, when the foam was expelled using catheters and syringe needles of the same size, no noticeable changes in the stability were observed.ConclusionWhen choosing needles of varying calibers, their effect on foam stability should be carefully considered, particularly when the foam contains HA.

Section: Introductionmentioning

confidence: 99%

Effect of catheter needle caliber on polidocanol foam stability in foam sclerotherapy

Azmoun,

Liu,

Tursun

et al. 2024

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Ethanol foam: a novel type of foam sclerosant for treating venous malformations

Zhang,

Liu,

Liu

2024

IntroductionSclerotherapy is a commonly utilized treatment approach for venous malformations. Absolute ethanol is renowned for its remarkable efficacy as a potent sclerosants, but it is potentially associated with severe complications. Foam sclerotherapy is considered superior to liquid sclerotherapy owing to its heightened efficacy and diminished incidence of complications. Thus, our objective was to devise an ethanol foam sclerosant that delivers exceptional efficacy while mitigating complications.MethodsIn the first set of experiments, we identified the suitable range of ethanol concentrations for sclerotherapy through human umbilical vein endothelial cell proliferation assays and blood clotting experiments. Next, the surfactants polysorbate 80, egg yolk lecithin, and hyaluronic acid were added to create stable ethanol foam, with their ratios meticulously optimized.ResultsThe optimal concentration range of ethanol was determined to be 30–60%. Eventually, a 48% ethanol foam was successfully produced with excellent stability. Other than ethanol, the formulation included 5 × 10−3 g/mL polysorbate 80, 10−2 g/mL egg yolk lecithin, and 0.04 mL/mL hyaluronic acid.DiscussionThe novel ethanol foam produced here could be a promising candidate for the treatment of venous malformations.

Efficacy and safety of hyaluronic-polidocanol foam in sclerotherapy for head and neck venous malformations

Sun,

Liu,

Chen

et al. 2024

BackgroundFoam sclerotherapy is currently the first-line treatment for venous malformations (VMs). Hyaluronic acid-polidocanol (HA-POL) foam has been used in the treatment of head and neck VMs recently; however, its clinical efficacy and safety have yet to be further evaluated, and the impact of age and other related factors on its safety is still unclear.ObjectiveTo assess the efficacy and safety of HA-POL foam in the treatment of head and neck VMs.Methods and materialsWe performed a single-center retrospective review of all patients with VMs involving the head and neck region undergoing HA-POL foam sclerotherapy from February 2015 to February 2022 in the Oral and Maxillofacial Surgery Department of Qilu Hospital Shandong University. Patients’ medical records were collected and all patients enrolled were followed up for 1–6 months (group 1), part of them were followed up for 3–9 years (group 2).ResultsA total of 223 patients with head and neck VMs were enrolled in the study, with 36 patients who were followed for 3–9 years. Total response rate in group 1 was 96.41% (n = 215), of which 30.94% (n = 69) of the patients met the criteria of “resolution,” and 65.47% (n = 146) of the patients had “significant improvement.” In group 2, the total response rate was 72.22% (n = 26), of which the rates of the patients met the criteria of “resolution” and patients had “significant improvement” were all 36.11% (n = 13)0.144 (64.57%) patients experienced complications like localized swelling, pain and fever, and no serious complications occurred. The risk of developing complications after treatment was independent of age, and was weakly associated with the dose of HA-POL foam.ConclusionThe HA-POL foam sclerotherapy is safe and effective in the treatment of head and neck VMs.