SIR 2024
Embolization
Felipe M. Berg (he/him/his)
MD/PhD Student
Case Western Reserve University
Financial relationships: Full list of relationships is listed on the CME information page.
Henry T. Ruhl (he/him/his)
Student
Case Western Reserve University
Financial relationships: Full list of relationships is listed on the CME information page.
Agata Exner, PhD (she/her/hers)
Henry Willson Payne Professor and Vice Chair for Basic Research
Case Western Reserve University
Disclosure information not submitted.
Sclerotherapy is a cornerstone treatment for various venous diseases. When made with room air, as per standard protocol, the lifetime of the sclerosis foam is typically less than 10 minutes. In some circumstances, a longer lasting foam may be required. The goal of this study was to evaluate the impact of air to foam material ratio and to examine the inclusion of alternative high molecular weight, hydrophobic perfluorocarbon gasses on the stability of clinically utilized sclerosing foam (Sotradecol ®). We also studied the impact of total foam volume on the decay rate.
Materials and Methods:
Foams were generated using two 10 mL syringes connected by a 3-way stopcock. One syringe was filled with gas (either room air, C3F8, or C4F10 high MW perfluorocarbons (PFC)), the other contained 2 mL of sodium tetradecyl-sulfate (STS). The components were mixed through the stopcock 30 times (Tessari’s method). Consistent temperature and pressure were assured throughout all experiments. Each trial set encompassed ratios of 1:1.5, 2, 3, and 4 mL of STS to gas. Foam decay (% change from the initial foam volume) was monitored using a 4K camera over 1 hour, followed by hourly snapshots for 3 hours. Supplementary images were captured at the 24-hour mark if any foam persisted. All trials were repeated 3 times for variability assessment.
Results:
Perfluorocarbons resulted in a significant increase in foam stability compared to air. When air was used, we observed 100% foam decay within 30 minutes, while C3F8 and C4F10 showed 25% decay. C4F10 demonstrated overall better stability at the 1, 2, and 3 hour marks compared to C3F8. C4F10 experienced 30% decay after 3 hours, while C3F8 reached 34% decay within the same timeframe. To assess the effect of total volume on foam decay, trials with constant foam volumes (4 mL) but varied gas:STS ratios were conducted. C3F8 showed 32% and 76% decay for the 1:1.5 and 1:4 ratios respectively at the 3 hour point. In the constant volume trials, 1:1.5 reached 78% decay, and 1:4 reached 68% at the 3 hour point, indicating volume's influence on decay. This pattern was consistent in trials with 1:2 and 1:3 gas to foam ratios as well. Similar trends were observed in air trials, where regular air reached 100% decay after 20 minutes for all ratios, while the same volume trials reached 100% decay at 30 minutes for 1:1.5 and 15 minutes for 1:4.
Conclusion: C3F8 and C4F10 greatly increase the stability with STS foam compared to air, and C4F10 exhibited better stability over time than C3F8.