Sodium Tetradecyl Sulfate Foam Research Articles

Usefulness of antegrade foam sclerotherapy for portal hypertensive variceal bleeding.

This study investigates the usefulness of antegrade variceal embolization using sclerosant foam to evaluate technical success and clinical outcomes in cases of hypertensive variceal bleeding. A total of 16 patients underwent percutaneous antegrade variceal embolization using foam sclerotherapy from August 2019 to January 2022. Among the patients, 12 cases were of gastroesophageal varices, two were rectal varices, and one case each was duodenal and jejunal varices, respectively. Sodium tetradecyl sulfate (STS) foam was used as a detergent for variceal bleeding sclerotherapy at various anatomical locations. The detergent was used in a foam form to promote clinical outcomes and enable the effective embolization of the entire blood vessel wall, including the ventral side, against gravity. Furthermore, STS foam could be used to help sufficiently deliver the drug to distal segments. A balloon catheter was also used to block the antegrade flow and prevent the dilution of the sclerosant. Technical success was defined as the completion of sclerotherapy for variceal bleeding as planned before the procedure to achieve the disappearance of variceal bleeding. Clinical success was defined as the complete obliteration of varices without recurrent bleeding during the follow-up period after the procedure. Technical success was 81.3%, and clinical success was 84.6%. Additionally, 15/16 of the procedures were emergencies, and there were no complications related to the procedure. Antegrade foam sclerotherapy using 3% STS for variceal bleeding is clinically safe and effective. Moreover, antegrade foam sclerotherapy can be a useful treatment option for patients with active variceal bleeding in emergency cases.

Laser-Assisted Vascular Malformation Resection: A Novel Surgical Approach.

Vascular malformations can be treated using sclerotherapy agents like alcohol, polidocanol, or sodium tetradecyl sulfate foam and embolization treatments. These endovascular treatments may cause severe complications as pulmonary embolism and thrombosis. 980-nm diode lasers (DLs) are common devices used by many specialties as plastic surgeons, dermatologists, and vascular surgeons. Laser energy is excellently absorbed in water and hemoglobin, which makes it ideal for adipose tissue and deep lesions. We treated our patient using a DL. Our surgical approach allowed total excision of the arteriovenous malformation (AVM), which decreased the size of the tumor allowing a smaller incision and eased the dissection plane. We believe that lasers will be used more frequently on AVM treatments.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

Injection sclerotherapy for varicose veins.

Injection sclerotherapy for varicose veins.

Adverse neurological events after sodium tetradecyl sulfate foam sclerotherapy - A prospective, observational study of 8056 treatments.

Ultrasound guided foam sclerotherapy (UGFS) is a flexible and highly utilised tool in the treatment of varicose veins (VVs), both as a primary treatment and as an adjunct to other treatments. Concern remains regarding the risk of neurological adverse events (AEs) such as migraine, visual disturbance and serious adverse events (SAEs) such as cerebrovascular accident that have been reported after UGFS treatments. To determine the incidence of neurological AEs and SAEs after UGFS. A prospective, multicentre, post-authorisation safety study across Europe (both private and government) was performed between January 2015-2020. Neurological adverse events after UGFS with Fibrovein® (Sodium Tetradecyl Sulfate) 1 and 3% physician generated foam. 8056 patients underwent treatment. There were 46 AE (including 5 SAEs), 30 (65%) SAEs were in female patients. Mean age was 55 years with mean body mass index (BMI) of 27. Univariable logistic regression demonstrate that UGFS only treatment (i.e. no adjunctive treatment), liquid-to-gas ratio, gas type and total foam volume (1% sodium tetradecyl sulfate, STS) were significantly associated with the odds of experiencing the outcome. Multivariable logistic regression model exhibits that migraine and total foam volume (1% STS) maintained statistical significance thus associated with the odds of adverse events. This study demonstrates that UGFS with Fibrovein is safe with a very low incidence of neurological AEs and SAEs. Past history of migraine, use of physiological gas (O2/CO2) and increasing volumes of 1% foam increase the risk of AEs.

Aneurysmal bone cysts in the spine, causing neurological compromise: safety and clinical efficacy of sclerotherapy utilizing sodium Tetradecyl sulfate foam.

To assess the clinical efficacy, technical feasibility, and safety profile of percutaneous sclerotherapy utilizing sodium tetradecyl-sulfate foam (STS) as a first-line treatment strategy for aggressive spinal aneurysmal bone cysts (sABCs) presenting with neurological compromise. Between July 2013 and September 2019, eight consecutive patients (5 males; 3 females; mean age 22±17, range 7-52) underwent fluoroscopic/CT-guided intraosseous sclerotherapy for sABCs. Pain and/or neurological compromise was the primary indications. Procedural data, complications, imaging, and clinical results were analyzed. Technical success was achieved in all cases. Mean procedure time was 25±15min (range 6-167); 1 to 5 repeat treatment cycles (mean 3.7±1.2) utilizing a mean 2.6mls±1.3 (range 1-6) of agitated 3% STS, with a DLP mean dose of 158±91mGy*cm (range 62-331) per procedure. One reported a minor complication (pain), but no significant complications. Two patients had persistent neurological deficit due to cord compression despite successful sclerotherapy, requiring surgical resection (and were thereby excluded from the final outcome analysis). The remaining six patients demonstrated a significant reduction in tumor volume (p = 0.028), pain (p = 0.027), and SINS (spinal instability neoplastic score) (p = 0.027) at up to 5years of follow-up (mean 20 ± 16.7, range 7-51months). Percutaneous sclerotherapy with STS is a minimally invasive, technically feasible, safe, and effective first-line treatment for primary sABCs causing pain and neurological compromise, alleviating the need for extensive surgery. It is most effective with three or more treatment cycles, in patients with higher SINS, pain scores, or tumor volumes at the initial presentation.

Balloon occlusion as an adjunctive technique during sclerotherapy of Puig's classified advanced venous malformations.

Puig types 2 through 4 venous malformations (VMs) are challenging to treat with sclerotherapy given their robust systemic outflow. Endovenous balloon occlusion offers a means of temporarily occluding systemic venous outflow to allow for more complete sclerotherapy. This study reviews our experience of implementing this technique in patients with Puig advanced (types 2 through 4) VMs. An IRB approved review of treated venous malformations from 2013-2016 revealed 10 patients fitting inclusion criteria. Patient demographics, pre-procedural imaging, intra-procedural technical parameters, and post-procedural follow-up outcomes were recorded. All patients underwent temporary balloon occlusion of a systemic or major draining vein during sclerotherapy. Embolic agents included n-butyl cyanoacrylate glue, sodium tetradecyl sulfate foam, and coils. Standard 5 French angioplasty balloons ranged from 4 to 8 mm diameter and 2 to 8 cm length depending on vessel requiring occlusion. All patients underwent minimum 3-year follow-up questionnaire administration re-assessing resolution of lesion symptomology and post-procedural quality of life (QoL) measures. Of the 10 VMs treated, 2 were Type 2, 6 were Type 3, and 2 were Type 4. More than one sclerotherapy session was required in 7/10 patients (mean: 2, range: 1-4). Most common sites of VM systemic drainage included subclavian, popliteal, internal/external jugular, and basilic veins. All patients had no indication for further sclerotherapy following adjunctive balloon occlusion. No non-target embolization or immediate post-procedural complications occurred. Follow-up questionnaires (mean interval: 3 years 6 months, range: 3 years-3 years 11 months) confirmed the persistence of embolization effects, improved QoL, and no additional sclerotherapy sessions for all patients in the cohort. Endovenous balloon occlusion as an adjunct to sclerotherapy can be considered when treating patients with types 2-4 venous malformations. This technique lowers the risk of non-target systemic venous embolization, allowing for operator-driven deeper intralesional sclerosant penetration and subsequently maintained treatment efficacy.

Abstract No. 223 Liquid versus non-liquid (particles) embolic agents in portal vein embolization prior to major liver resection: comparison of volumetric and clinical outcomes

To compare the future liver remnant (FLR) hypertrophy, degree of hypertrophy and kinetic growth rates in patients embolized with liquid embolics (3% Sodium Tetradecyl Sulfate (STS) Foam or N-butyl cyanoacrylate NBCA) versus particles (Calibrated microspheres) following right portal vein embolization (PVE) prior to major liver resection.

S1680 Stercoral Ulcer Complicating Rectal Varix Leading to Massive Lower Gastrointestinal Bleeding

INTRODUCTION: Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, with an estimated prevalence of up to 56% among patients with cirrhosis. While bleeding occurs in only about 5% of those with rectal varices, the morbidity and mortality of bleeding rectal varices is high. Here we present a case of a stercoral ulcer overlying a rectal varix, leading to massive lower gastrointestinal bleeding (LGIB). CASE DESCRIPTION/METHODS: A 68-year-old male with chronic lower back pain on opioids and decompensated hepatitis C virus cirrhosis complicated by multifocal hepatocellular carcinoma presented with abdominal distention, constipation, and rectal pain. Shortly after admission, he developed hematochezia. Lab work showed a drop in hemoglobin from 9 gm/dL to 6 gm/dL. CT of the abdomen showed significant stool burden. He underwent an extended colonoscopy preparation. A flexible sigmoidoscopy demonstrated a large nonbleeding polypoid rectal lesion that was superficially ulcerated and partially obstructing the anal canal. Endoscopic ultrasound was subsequently performed to further characterize this lesion. No endosonographically masses were noted. Instead, multiple medium sized varices were seen, one of which had a clean based ulcer without evidence of active bleeding, corresponding to the lesion previously identified on flexible sigmoidoscopy. The following day the patient developed additional episodes of hematochezia, requiring transfusion of packed red blood cells. The rectal varices were then embolized using a combination of coils and sodium tetradecyl sulfate foam via a transhepatic approach. He had no further episodes of rectal bleeding and was discharged home on a bowel regimen. DISCUSSION: Both stercoral ulcers and rectal varices can cause significant LGIB, but there are no prior reports in the literature of both lesions presenting simultaneously. While an actively bleeding stercoral ulcer can typically be managed endoscopically, endoscopic options for the management of rectal varices are limited, particularly in the setting of concomitant rectal pathology. As such, gastroenterologists should consider early consultation with interventional radiologists, particularly in the setting of LGIB presenting with rectal varices with high risk stigmata. In addition, this case highlights the importance of aggressive management of constipation in patients with known rectal varices, particularly in those on chronic opioids.Figure 1.: Flexible Sigmoidoscopy image of stercoral ulcer.Figure 2.: EUS image of stercoral ulcer.

A new automated system for the preparation of sclerosant foam: A study of the physical characteristics produced and the device settings required.

To determine the quality of sclerosant foam produced with an automated preparation system with multiple combinations of sclerosing agents, gases, and device settings. Single-use mixing capsules filled with air or O2/CO2 and polidocanol (0.25, 1, or 3%) or sodium tetradecyl sulfate (0.2 or 1%) were coupled to a customized magnetic stirrer. Stirring speed and time were adjusted between 1500 and 4000 r/min and 30 and 60 s, respectively, and characteristics of the foam produced were measured: half-life, bubble diameter, and gas-to-liquid ratio. With optimized device settings, the following foam characteristics were obtained: half-life range, 1.4 ± 0.9 to 5.2 ± 0.6 min; bubble diameter, 84 ± 14 to 119 ± 6 µm; and gas-to-liquid ratio, 5:1-7:1. Sodium tetradecyl sulfate foam was quicker to form than polidocanol but faster to degrade. Foams with low sclerosant concentrations and O2/CO2 required higher speed and longer time. Suitable foam characteristics could be obtained with all combinations of sclerosing agent, concentration, and gas.

Identifying the Most Stable State of a Foam Sclerosant for Foam Sclerotherapy.

Foam sclerotherapy is an effective treatment strategy for vascular malformations, and its sclerosing power depends on foam stability. Twenty quick passages have been widely used as an indicator of the most stable state of sclerosants, but the universality of their effectiveness has not been proven yet. We aimed to identify simple and objective indicators of the most stable state of commonly used sclerosants and provide practitioners with suggestions to judge when foam producing is completed in sclerotherapy. The universality of the effectiveness of 20 passages was tested by producing bleomycin foam with different passages. Further study was performed by testing modified bleomycin, polidocanol, and sodium tetradecylsulfate foam. The bleomycin foam became denser as passages were added, and the sound of each passage became almost silent after 40 passages. The almost silent sound can be an indicator of foam stability for most sclerosants. It has a different application range compared with 20 quick passages. We suggest that practitioners choose a different indicator depending on the foam used.

Conjunctival Retention Cysts: Outcomes of Aspiration and Sclerotherapy With Sodium Tetradecyl Sulfate

To assess the outcome of aspiration and sclerotherapy with sodium tetradecyl sulfate in the management of conjunctival inclusion cysts. Retrospective interventional case series of 6 patients with clinical diagnosis of conjunctival inclusion cysts treated with cyst aspiration and foam sclerotherapy with 3% sodium tetradecyl sulfate. The volume of the sclerosant was 20% of the aspirated cyst volume. Four patients had an inclusion cyst in anophthalmic sockets and 2 patients in sighted eyes. Average time lag between primary surgery and cyst formation was 14.6 months (range 2-30 months). Average amount of fluid aspirated from cyst was 3.07 ml (range 1-9 ml). Average volume of sclerosant injected was (20% of the aspirated volume) 0.55 ml (range 0.2-1.1 ml). All 6 patients showed complete resolution of cyst at a mean follow-up period of 15.6 months (range 9-24 months). All but one showed complete resolution of cyst with single injection sclerosant. Only 1 patient required a second sclerosant injection. There was no ocular surface or implant-related complications in this cohort. Cyst aspiration and sodium tetradecyl sulfate foam sclerotherapy is a minimally invasive procedure for the management of conjunctival inclusion cysts in anophthalmic sockets and sighted eyes. The injection of sodium tetradecyl sulfate in a dose of 20% of the aspirate is effective in the management of conjunctival inclusion cysts over a follow-up period of 13 months. The procedure is safe, with insignificant inflammation and without ocular surface or implant complications.

Recent development of balloon-occluded retrograde transvenous obliteration.

Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.

Effects of Different Mixing Agents on the Stability of Sodium Tetradecyl Sulfate (STS) Foam: An Experimental Study.

To evaluate the effect of air, CO2 and contrast medium-air on the dwell time (DT) stability of sodium tetradecyl sulfate (STS) foam. Three types of foam sclerosants (air-foam, CO2-foam, contrast-air-foam) were injected eight times into an inclined straight plastic tube (internal diameters 4mm and 10mm) filled with a blood substitute. Injections were captured by CCD camera, and images were transferred for digital analysis and calculation of DT. Contrast-air-foam and air-foam in a 4-mm tube showed 5.6-/3.3-fold greater DT compared to CO2-foam, respectively (P = 0.001). Contrast-air-foam in a 10-mm tube showed 2.1-fold greater DT compared to CO2-foam (P = 0.0167). A mixture of air and iodinated contrast improves the stability of STS foam compared to mixtures using only air or CO2. Further, animal and clinical studies are needed to validate this in vitro result.

Abstract No. 619 Percutaneous transhepatic obliteration of bleeding rectal varices utilizing sodium tetradecyl sulfate foam and interlocking detachable coils: a single-center experience

Bleeding rectal varices are a rare but serious complication in patients with cirrhosis and portal hypertension. While medical and endoscopic approaches may be favored at many institutions, percutaneous transhepatic obliteration can be a safe and effective option, and an excellent adjunct or alternative to TIPS for select patients. We report our obliteration technique and clinical outcomes. This review was performed with institutional IRB approval. A retrospective review was performed of all cases at our institution from 2011 to 2017. A total of 5 transhepatic obliteration procedures were performed in 5 patients (3 male/2 female; mean age 60), 4 with active rectal variceal bleeding requiring transfusions and 1 with a history of recurrent rectal variceal bleeding episodes. MELD score was 0-10 in 3 patients, 11-20 in 1 patient, and >20 in 1 patient. In all patients, medical and endoscopic therapies were attempted unsuccessfully prior to variceal obliteration. All cases were performed using sodium tetradecyl sulfate foam and interlocking detachable coils from a percutaneous transhepatic approach. One patient underwent TIPS prior to variceal obliteration. Immediate postprocedural technical success, defined as the lack of continued opacification of rectal varices on postprocedural angiography, was 100%. One patient developed a right flank hematoma and small volume hemoperitoneum discovered at paracentesis on postprocedure-day 2 which did not require intervention. One patient was lost to follow-up following discharge. Over a median clinical follow-up time of 1 month, no patients required repeat endoscopic or endovascular intervention. One patient reported bleeding requiring hospitalization and transfusion at 4 months following the procedure, which subsequently resolved spontaneously. Percutaneous transhepatic obliteration is a safe and effective treatment for rectal varices related to cirrhosis and portal hypertension. Additional follow-up is needed to evaluate the longer-term efficacy for controlling and preventing bleeding.

4:20 PM Abstract No. 389 Percutaneous sclerotherapy of slow-flow vulvar vascular malformations

To assess the safety and efficacy of percutaneous sclerotherapy of slow-flow vulvar vascular malformations. An IRB-approved retrospective review was undertaken of all patients who underwent percutaneous sclerotherapy of slow-flow vulvar vascular malformations between January 2008 and August 2017. Patient demographics, lesion characteristics, procedural factors, and clinical outcomes were identified through a review of the electronic medical record and relevant imaging. Seven female patients (ages 7-32 years) with slow-flow vulvar vascular malformations underwent a total of 14 percutaneous sclerotherapy treatments using the 3% sodium tetradecyl sulfate foam technique. Two cases were associated with Klippel-Trénaunay syndrome and one with Servelle-Martorell syndrome. Presenting symptoms included generalized pain or discomfort (n = 6), dyspareunia (n = 1), voiding difficulties (n = 1), and cosmetic concerns (n = 1). All sclerotherapy procedures were technically successful. Clinical follow-up was available in six patients. Two patients reported near-complete resolution of symptoms after a single treatment. Three patients experienced initial relief but developed symptomatic recurrence after one year and required repeat treatment with subsequent resolution of symptoms. One patient experienced a gradual improvement in symptoms requiring a total of five treatments. One procedure (7.1%) resulted in minor labial cutaneous ulceration which resolved with conservative management. There were no major complications. Percutaneous sclerotherapy of slow-flow vulvar vascular malformations proved safe and effective in this limited cohort. While repeat therapy was necessary in the majority of cases, nearly all patients experienced durable symptomatic relief.

Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option

IntroductionExtensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment. We sought to demonstrate the safety and efficacy of combined Nd:YAG laser and sclerotherapy under the same anesthetic administration. MethodsRetrospective review of 8 patients (Age 6 mo −74 yrs, x͂ 31) with extensive cervicofacial VM with significant airway involvement. Patients were treated with combined suspension laryngoscopy with Nd:YAG laser of airway VM followed by image guided direct puncture sclerotherapy using bleomycin in the airway VM and sodium tetradecyl sulfate (STS) foam in the cervicofacial VM during the same anesthetic encounter. ResultsAll 8 patients had extensive cervicofacial VMs that were symptomatic with snoring or orthopnea. Four of the patients had previously been treated at outside institutions with residual disease or significant complications. All patients remained intubated post procedure (Avg. 1.07 days) and tolerated extubation without re-intubation or any major complications. The average length of hospital stay was 3.2 days, of which 1.9 days were spent in the ICU. Patients reported symptomatic improvement or had decreased VM disease on MRI follow up. ConclusionCombined Nd:YAG laser therapy and sclerotherapy allows treatment of both superficial and deep components of VMs in a safe and efficient manner. In addition, suspension laryngoscopy provides improved visualization and access for the interventional radiologist in difficult to reach areas for sclerotherapy.

Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam.

The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS). The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution. The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome.The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain. Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae.

Mo1364 - Safety and Efficacy of 3% Sodium Tetradecyl Sulfate Foam Sclerotherapy for the Treatment of Liver Cysts in Patients with Autosomal Dominant Polycystic Kidney Disease

Mo1364 - Safety and Efficacy of 3% Sodium Tetradecyl Sulfate Foam Sclerotherapy for the Treatment of Liver Cysts in Patients with Autosomal Dominant Polycystic Kidney Disease

Abstract No. 560 - Comparing efficacy of n-butyl cyanoacrylate glue vs. sodium tetradecyl sulfate (STS) foam for portal vein embolization: initial results

Abstract No. 560 - Comparing efficacy of n-butyl cyanoacrylate glue vs. sodium tetradecyl sulfate (STS) foam for portal vein embolization: initial results