Stability of Foam Sclerotherapy Ronald Bush, MD, FACS Midwest Vein & Laser Center Dayton, OH.

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Presentation transcript:

Stability of Foam Sclerotherapy Ronald Bush, MD, FACS Midwest Vein & Laser Center Dayton, OH

An Investigation into the Influence of Various Gases and Concentrations of Sclerosants on Foam Stability (Peterson, 2010)

Peterson and Goldman Study Demonstrated stability with room air seconds Stability with C seconds Stability with seconds Stability with C02/ seconds As room air is used with increasing concentration of Sotradecol,® increase bubble stability (Peterson, 2010)

Consider this However, only a gas bubble in blood is relevant What we see in the venous circuit on ultrasound (US) is relevant C02 bubbles in small veins are still present after 30 minutes

Histological Findings: Foam From histology on veins treated with room air/Sotradecol® and C02/Sotradecol® No difference was noted at comparable times (Bush Venous Lectures, 2011)

Boring Physics Bubble size inversely related to differences in density between a liquid and a gas C02 (1.5) and 02 (1.14) as dense as room air thus foam bubbles are smaller (? more contact)

Laplace Law Pressure between inside and outside of bubble inversely proportioned to bubble radius and directly proportional to surface tension

Surface Tension Surface tension < with surfactant Pressure difference between inside and outside of bubble (Reynold’s no.) Most stable foam is in ration of 1:4 or 1:5

Physics Bubble persistence is directly proportional to the radius and gas density inside bubble Inversely related to saturation factor SO WHAT DOES ALL THIS MEAN?

Conclusion Bubbles made with room air are more stable in vitro and vivo Bubbles made with C02/02 are comparable to room air at lower Sotradecol® concentrations Bubbles with C02 are less stable in vitro and vivo in the larger veins and arterial circulation

Conclusion With a PC02 of 48 in venous blood, half the bubbles should equilibrate until shear forces and gas re-distribution occurs 02 formed bubbles last longer in arterial circulation If clinically, histologically, C02 is effective in the venous circulation and dissolves quickly in the arterial system HAVEN’T WE FOUND THE IDEAL GAS?