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Skuła M, Hobot J, Czaja J, Simka M. The effect of the calibre and length of needle on the stability of sclerosing foam. Phlebology 2020; 36:322-328. [PMID: 33236673 DOI: 10.1177/0268355520953317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Little is known how calibre and length of needles affect the stability of sclerosing foam. METHODS Foams were made of 0.5%, 1%, 2% and 3% polidocanol, and 0.2%, 0.5%, 1% and 3% sodium tetradecyl sulfate (STS), which were mixed with air in the proportion of 4:1. These foams were ejected through needles with the length of: 4 mm, 6 mm and 13 mm, and diameter of: 0.26 mm, 0.3 mm and 0.4 mm. RESULTS Foams made of more concentrated polidocanol were more stable. Regarding STS an opposite relationship was revealed. Foams made of polidocanol were more stable if ejected through a longer needle, while the length of needle did not significantly affect stability of STS foams. Foams ejected through 0.26 mm diameter needles were very unstable. In the case of 0.5% polidocanol, 0.3x6mm needle provided atypically stable foam. CONCLUSION In order to inject maximally stable foam, calibre and length of needle should be taken into account.
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Affiliation(s)
- Marcin Skuła
- Department of Anatomy, University of Opole, Opole, Poland
| | - Jacek Hobot
- Department of Anatomy, University of Opole, Opole, Poland
| | - Joanna Czaja
- Department of Anatomy, University of Opole, Opole, Poland
| | - Marian Simka
- Department of Anatomy, University of Opole, Opole, Poland
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Liu X, Zheng G, Ye B, Chen W, Xie H, Zhang T, Lin J. A retrospective cohort study comparing two treatments for active venous leg ulcers. Medicine (Baltimore) 2020; 99:e19317. [PMID: 32080149 PMCID: PMC7034671 DOI: 10.1097/md.0000000000019317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced traditional surgery for treatment of varicose veins (VVs) with active venous leg ulcers (VLUs), and multiple combined modes have emerged. A retrospective cohort study was performed to compare the effect of traditional surgery (high ligation and stripping followed with compression [compression plus HL-S]) to high ligation-endovenous laser ablation-foam sclerotherapy followed with compression (compression plus HL-EVLA-FS) on the treatment of active VLUs.Data of active VLUs treated in our center from 2008 to 2017 and followed up for 1 year were analyzed. The intervention measures in the first 5 years were compression plus HL-S, and in the following 5 years were compression plus HL-EVLA-FS. The primary outcome was ulcer healing time. The secondary outcomes were the VVs occlusion and clinical success as assessed by a change in venous clinical severity score (VCSS) and complications.The study included 120 patients and 200 patients treated with HL-S and HL-EVLA-FS, respectively, during 2008 to 2017. The average ulcer healing time were 2.3 ± 2.4 and 1.7 ± 1.7 months, respectively. Significant difference was found in the cumulative ulcers healing rate between the two groups (Hazard ratio [HR] and 95% confidence interval [CI] was respectively 1.458 and 1.140-1.865, P = .0002), but no difference was found in the VVs occlusion (HR and 95% CI was respectively 1.005 and 0.774-1.3071, P = .967). Significant difference occurred in 6 months and 12 months post-operatively in the VCSS change and in the procedure data and some complications between the 2 groups.In conclusion, the treatment of HL-EVLA-FS can accelerate the healing of VLUs, improve the VCSS and present superior procedure data. However, no advantage could be found in the VVs occlusion compared with control group.
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Santler B, Goerge T. Die chronische venöse Insuffizienz - Eine Zusammenfassung der Pathophysiologie, Diagnostik und Therapie. J Dtsch Dermatol Ges 2018; 15:538-557. [PMID: 28485867 DOI: 10.1111/ddg.13242_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/11/2017] [Indexed: 01/06/2023]
Abstract
Die chronische Venenerkrankung ist eine weit verbreitete Krankheit, die in späteren Stadien mit einer Vielzahl an Symptomen, aber auch Komplikationen wie dem Ulcus cruris, einhergeht. Dies wiederum hat weitreichende Auswirkungen auf die Lebensqualität der Patienten wie auch auf das Gesundheitssystem. Für die Diagnostik der chronischen Venenerkrankungen steht eine Auswahl an Verfahren zur Verfügung, wobei sich die farbkodierte Duplexsonographie als Goldstandard etabliert hat. Im Bereich der Therapie kam es in den letzten Jahrzehnten zu großen Fortschritten, sodass heute auch Alternativen zum klassischen Stripping durch die endoluminalen Verfahren zur Verfügung stehen. Die Wahl der Therapieoption ist jedoch weiterhin stark abhängig von mehreren Faktoren, unter anderem von den anatomischen Gegebenheiten und dem Krankheitsstadium. Im folgenden Artikel werden die Anatomie und Pathophysiologie, sowie die aktuellen Standards der Diagnostik und Therapie zusammengefasst.
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Affiliation(s)
- Bettina Santler
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
| | - Tobias Goerge
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
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Santler B, Goerge T. Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges 2018; 15:538-556. [PMID: 28485865 DOI: 10.1111/ddg.13242] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/11/2017] [Indexed: 01/20/2023]
Abstract
Chronic venous disease is a common disorder associated with a variety of symptoms in later disease stages but also with complications such as venous leg ulcer. This, in turn, has substantial socioeconomic effects and significantly impacts patients' quality of life. While there are a number of diagnostic procedures available, color-flow duplex ultrasound has become the gold standard. As regards therapeutic options, major advances have been made in recent decades. Today, there are alternatives to saphenofemoral ligation and stripping of the great saphenous vein, including endovenous thermal ablation techniques. However, treatment selection continues to depend on many factors such as individual anatomical circumstances and disease stage. The following article provides an overview of the anatomy and pathophysiology as well as current diagnostic and therapeutic standards.
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Affiliation(s)
- Bettina Santler
- Department of Dermatology and Venereology, University Hospital Münster, Münster, Germany
| | - Tobias Goerge
- Department of Dermatology and Venereology, University Hospital Münster, Münster, Germany
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de Franciscis S, Nobile C, Larosa E, Montemurro R, Serra R. Air contamination in the sclerosing foam for the treatment of varicose veins. Phlebology 2014; 31:96-100. [PMID: 25514923 DOI: 10.1177/0268355514565194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fluids and drugs formulated for intravenous infusion may potentially promote the growth of microorganisms that can cause infections. The aim of this study is to test the sterility of sclerosing foam. METHODS Polidocanol was used for the production of the foam. The Tessari method was used in order to generate the foam. The preparation was carried out both in the operating theater and in an outpatient room. A validation test with microorganisms was also performed. RESULTS The measurements showed no evident growth of microorganisms and in the validation tests the foam appeared to even display bacteriostatic and/or bactericide properties. CONCLUSIONS Sclerosing foam seems to be safe from a microbiological point of view.
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Affiliation(s)
- S de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Græcia of Catanzaro, Catanzaro, Italy Department of Surgical and Medical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Cga Nobile
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - E Larosa
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - R Montemurro
- Department of Surgical and Medical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - R Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Græcia of Catanzaro, Catanzaro, Italy Department of Surgical and Medical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
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Itou C, Koizumi J, Hashimoto T, Myojin K, Kagawa T, Mine T, Imai Y. Foam sclerotherapy for a symptomatic hepatic cyst: a preliminary report. Cardiovasc Intervent Radiol 2013; 37:800-4. [PMID: 24170168 PMCID: PMC4024151 DOI: 10.1007/s00270-013-0761-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 09/21/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE We evaluated our initial experience of performing sclerotherapy for symptomatic hepatic cysts using polidocanol foam instead of a liquid sclerosant. METHODS Three consecutively registered patients with symptomatic hepatic cysts (one with polycystic liver disease) underwent polidocanol foam sclerotherapy. A pigtail catheter was inserted into the targeted cyst following percutaneous cyst puncture under ultrasound guidance, and the cyst fluid was aspirated. To confirm the absence of communications between the cyst and surrounding hepatic vessels, 3 % polidocanol foam sclerosant was injected at a 1:4 ratio of polidocanol to air following digital subtraction cystography with carbon dioxide. C-arm computed tomography (CT) guidance also was used to monitor foam filling of the targeted cyst. The maximum dose of sclerosant injected per treatment session did not exceed 10 ml. The catheter was kept unclamped overnight for open drainage, and additional sclerotherapy sessions were performed on subsequent days, if needed. RESULTS Efficient sclerotherapy was achieved with an average of two sessions. The initial mean cyst volume was 1,052 ml, and gradual resolution was observed without recurrence. The mean reduction rate was 97.9 % (97.7-98.3 %), and all cyst-associated symptoms disappeared. The median follow-up period was 17 (range 6-21) months. Although one patient experienced moderate-grade fever and another moderate pain at the puncture site, no major complications were observed. CONCLUSION Polidocanol foam sclerotherapy is a safe and effective treatment for symptomatic hepatic cysts.
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Affiliation(s)
- Chihiro Itou
- Department of Diagnostic Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan,
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Kendler M, Simon JC, Wetzig T. Local anesthesia with lidocaine and prilocaine, using the tumescent technique, for the radiofrequency ablation of lower extremity varicose veins. Int J Dermatol 2013; 52:739-44. [DOI: 10.1111/ijd.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Kendler
- Department of Dermatology, Venerology and Allergology; University of Leipzig; Leipzig; Germany
| | - Jan C. Simon
- Department of Dermatology, Venerology and Allergology; University of Leipzig; Leipzig; Germany
| | - Tino Wetzig
- Department of Dermatology, Venerology and Allergology; University of Leipzig; Leipzig; Germany
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Simka M. Principles and Technique of Foam Sclerotherapy and Its Specific Use in the Treatment of Venous Leg Ulcers. INT J LOW EXTR WOUND 2011; 10:138-45. [DOI: 10.1177/1534734611418154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Invention of foam sclerotherapy has significantly changed the current phlebological practice. Compared with liquid sclerosants, obliterating foam is more efficient, especially for the closure of larger veins. This review discusses clinical aspects of foam sclerotherapy with a focus on its use for the treatment of venous leg ulceration, including the rationale for its use in the treatment of these chronic wounds, physicochemical mechanisms responsible for stability and disintegration of sclerosant foam, pathomechanism of neurologic adverse events seen after foam sclerotherapy, and techniques that can increase efficacy of this procedure and lower frequency of adverse events.
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Affiliation(s)
- Marian Simka
- Private Healthcare Institution SANA, Department of Angiology, Pszczyna, Poland
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Peterson JD, Goldman MP. An investigation on the influence of glycerin on sclerosant foam stability. Phlebology 2011; 26:232-4. [PMID: 21415429 DOI: 10.1258/phleb.2010.010028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Foam stability varies according to foam composition, volume and injection technique. MATERIALS AND METHODS A disposable plastic connector was used to create foam from 0.50% sodium tetradecyl sulphate (STS) mixed with varying volumes of glycerin. As a measure of foam stability, the half liquid time was defined as the time required for half of the original volume of sclerosing solution to settle. Three recordings were determined for each of the three mixtures of sclerosant foam. RESULTS The time for sclerosing solution to settle to half of its initial volume was found to be 89 seconds for 0.50% STS alone, 117.7 seconds with the addition of 0.1 mL of 72% glycerin, and 114.7 seconds with the addition of 0.2 mL of 72% glycerin. CONCLUSION The small volumes of glycerin added to STS prolonged the half liquid time of STS foam up to 35%. As glycerin alone is unable to be foamed with the double-syringe system technique there may be a point at which further addition of glycerin has a negative effect on the half-life of foam.
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Affiliation(s)
- J D Peterson
- Dermatology and Laser Surgery Centre, 6400 Fannin Ste, Ste 2290, Houston, TX 77030, USA
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PETERSON JENNIFERD, GOLDMAN MITCHELP. An Investigation into the Influence of Various Gases and Concentrations of Sclerosants on Foam Stability. Dermatol Surg 2011; 37:12-7. [DOI: 10.1111/j.1524-4725.2010.01832.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Safety and effectiveness of transcatheter foam sclerotherapy for testicular varicocele with a fluoroscopic tracing technique. J Vasc Interv Radiol 2010; 21:824-8. [PMID: 20434363 DOI: 10.1016/j.jvir.2010.02.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 02/10/2010] [Accepted: 02/18/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous sodium morrhuate foam sclerotherapy of varicoceles with the use of fluoroscopic tracing technique. MATERIALS AND METHODS At baseline and at 6-month follow-up, 58 patients with grade II/III left varicocele (mean age, 21.1 years; range, 19-25 y) with abnormal semen parameters underwent clinical assessment, Doppler ultrasonography, and semen analysis between September 2002 and January 2007. In all 58 cases, selective catheterization of the spermatic vein was performed with a right transfemoral approach. The standardized sclerosing foam was prepared with the Tessari method. Foam sclerotherapy was performed by the "filling-defects technique" under fluoroscopic guidance, with the sclerosing foam visualized as translucent filling defects in the internal spermatic vein filled with contrast medium during injection of the foam. RESULTS Technical success was achieved in all patients. Sodium morrhuate foam dose ranged from 2 mL to 8 mL (0.4-1.6 mL of solution) per patient, with an average dose of 5.3 mL (approximately 1.1 mL of solution). There were no major side effects or complications of the procedure. At 6-month follow-up, 53 of 58 patients (91.4%) reported disappearance of previous varicoceles and five had slight, asymptomatic residual varicoceles. Seminal parameters showed significant increases after treatment. No major complications occurred, and no recurrent/persistent varicoceles were found. CONCLUSIONS Fluoroscopy-guided transcatheter foam sclerotherapy is a safe and effective approach for varicoceles, and the filling-defects technique under fluoroscopy is a feasible method for tracing the sclerosing foam.
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Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations. AJR Am J Roentgenol 2010; 194:W439-44. [PMID: 20410391 DOI: 10.2214/ajr.09.3416] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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