Characterisation and optimisation of foams for varicose vein sclerotherapy. 2020

T G Roberts, and S J Cox, and A L Lewis, and S A Jones
Department of Mathematics, Aberystwyth University, UK.

Foam sclerotherapy is the process of using an aqueous foam to deliver surfactant to a varicose vein to damage vein wall endothelial cells, causing the vein to spasm, collapse and ultimately be re-absorbed into the body. Aqueous foams are complex fluids that can exhibit a significant yield stress and high effective viscosity which depend on their composition, particularly the bubble size and liquid fraction. To characterise the properties of foams used for varicose vein sclerotherapy and determine their effectiveness in the displacement of blood during sclerotherapy. Foams are modelled as yield stress fluids and their flow profiles in a model vein are predicted. Values of the yield stress are determined from experimental data for three different foams using the Sauter mean of the bubble size distribution. Along with the measured liquid fraction of the foams, this information is collected into a Bingham number which entirely characterises the process of sclerotherapy. Polydispersity in bubble size has a strong effect on the yield stress of a foam and the Sauter mean of the size distribution better captures the effects of a few large bubbles. Reducing the polydispersity increases the yield stress, and a higher yield stress results in a larger plug region moving along the vein, which is more effective in displacing blood. The width of the plug region is proportional to the Bingham number, which also has a quadratic dependence on the liquid fraction of the foam. Assuming typical values for the rate of injection of a foam, we predict that for a vein of diameter 5 mm, the most effective foams have low liquid fraction, a narrow size distribution, and a Bingham number B ≈ 4.5. The Sauter mean radius provides the most appropriate measure of the bubble size for sclerotherapy and the Bingham number then provides a simple measure of the efficacy of foam sclerotherapy in a vein of a given size, and explains the ability of different foams to remove varicose veins. Foams containing small bubbles, with a narrow size distribution, and a low liquid fraction are beneficial for sclerotherapy.

UI MeSH Term Description Entries
D011092 Polyethylene Glycols Polymers of ETHYLENE OXIDE and water, and their ethers. They vary in consistency from liquid to solid depending on the molecular weight indicated by a number following the name. They are used as SURFACTANTS, dispersing agents, solvents, ointment and suppository bases, vehicles, and tablet excipients. Some specific groups are NONOXYNOLS, OCTOXYNOLS, and POLOXAMERS. Macrogols,Polyoxyethylenes,Carbowax,Macrogol,Polyethylene Glycol,Polyethylene Oxide,Polyethyleneoxide,Polyglycol,Glycol, Polyethylene,Glycols, Polyethylene,Oxide, Polyethylene,Oxides, Polyethylene,Polyethylene Oxides,Polyethyleneoxides,Polyglycols,Polyoxyethylene
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077423 Polidocanol An alkyl polyglycol ether of LAURYL ALCOHOL, chemically defined as an alcohol ethoxylate having an average alkyl chain of 12–14 carbon atoms, and an ethylene oxide chain of 9 ethylene oxide units. It is used as a detergent, and medically as a local anesthetic, and as a sclerosing agent for the treatment of ESOPHAGEAL AND GASTRIC VARICES and VARICOSE VEINS. Aethoxysclerol,Aethoxysklerol,Aetoxisclerol,Atossisclerol,Atoxysclerol,Brij 30,Brij-30,Dodecyl Ethyleneglycol Monoether,Ethoxysclerol,Hydroxypolyethoxydodecane,Laureth,Laureth 9,Laureth-1,Laureth-4,Laureth-7,Laureth-9,Lauromacrogol,Lauromacrogol 400,Lauromacrogols,Lubrol 12A9,Lubrol-PX,Nonaethylene Glycol Monododecyl Ether,Nonaethyleneglycol Monododecyl Ether,Polyethylene Glycol Monododecyl Ether,Polyethylene Glycol-7-lauryl Ether,Polyoxyethylene 9-lauryl Ether,Polyoxyethylene Lauryl Ether,Polyoxyethylene(4) Lauryl Ether,Polyoxyethylene-4-dodecyl Ether,Polyoxyethylenedodecyl Ether,Tetraethylene Glycol Dodecyl Ether,Tetraethyleneglycol Lauryl Ether,Thesit,alpha-Dodecyl-omega-hydroxypoly(oxy-1,2ethanediyl),Brij30,Dodecyl Ethyleneglycol Monoethers,Ether, Nonaethyleneglycol Monododecyl,Ether, Polyethylene Glycol-7-lauryl,Ether, Polyoxyethylene 9-lauryl,Ether, Polyoxyethylene Lauryl,Ether, Polyoxyethylene-4-dodecyl,Ether, Tetraethyleneglycol Lauryl,Ethyleneglycol Monoether, Dodecyl,Laureth 1,Laureth 4,Laureth 7,Laureths,Lauryl Ether, Tetraethyleneglycol,Lubrol PX,Monododecyl Ether, Nonaethyleneglycol,Monoether, Dodecyl Ethyleneglycol,Nonaethyleneglycol Monododecyl Ethers,Polidocanols,Polyethylene Glycol 7 lauryl Ether,Polyethylene Glycol-7-lauryl Ethers,Polyoxyethylene 4 dodecyl Ether,Polyoxyethylene 9 lauryl Ether,Polyoxyethylene 9-lauryl Ethers,Polyoxyethylene Lauryl Ethers,Polyoxyethylenedodecyl Ethers,Tetraethyleneglycol Lauryl Ethers
D012597 Sclerosing Solutions Chemical agents injected into blood vessels and lymphatic sinuses to shrink or cause localized THROMBOSIS; FIBROSIS, and obliteration of the vessels. This treatment is applied in a number of conditions such as VARICOSE VEINS; HEMORRHOIDS; GASTRIC VARICES; ESOPHAGEAL VARICES; PEPTIC ULCER HEMORRHAGE. Injections, Sclerosing,Sclerosant,Sclerosing Agent,Sclerosing Agents,Sclerosing Injection,Sclerosing Solution,Sclerosants,Sclerosing Drugs,Sclerosing Injections,Agent, Sclerosing,Agents, Sclerosing,Drugs, Sclerosing,Injection, Sclerosing,Solution, Sclerosing,Solutions, Sclerosing
D014648 Varicose Veins Enlarged and tortuous VEINS. Varices,Varix,Varicose Vein,Vein, Varicose,Veins, Varicose
D015911 Sclerotherapy Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. Sclerotherapies
D042783 Endothelial Cells Highly specialized EPITHELIAL CELLS that line the HEART; BLOOD VESSELS; and lymph vessels, forming the ENDOTHELIUM. They are polygonal in shape and joined together by TIGHT JUNCTIONS. The tight junctions allow for variable permeability to specific macromolecules that are transported across the endothelial layer. Capillary Endothelial Cells,Lymphatic Endothelial Cells,Vascular Endothelial Cells,Capillary Endothelial Cell,Cell, Capillary Endothelial,Cell, Endothelial,Cell, Lymphatic Endothelial,Cell, Vascular Endothelial,Cells, Capillary Endothelial,Cells, Endothelial,Cells, Lymphatic Endothelial,Cells, Vascular Endothelial,Endothelial Cell,Endothelial Cell, Capillary,Endothelial Cell, Lymphatic,Endothelial Cell, Vascular,Endothelial Cells, Capillary,Endothelial Cells, Lymphatic,Endothelial Cells, Vascular,Lymphatic Endothelial Cell,Vascular Endothelial Cell

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