This document presents a study comparing a new foam fabrication system called the Frother to Tessari's traditional foam sclerotherapy method. The Frother system produced foam with smaller, more uniform bubble sizes and longer half-life stability compared to Tessari's method. For a 2% polidocanol foam, the Frother foam stability was over five times longer using air and twice as long using an oxygen/carbon dioxide mixture. The Frother also demonstrated versatility in producing foam with different gases. The study concludes the Frother system standardizes foam production and improves stability compared to Tessari's traditional technique.

1. Enric Roche MD , PHD
IS IT POSSIBLE TO IMPROVE TESSARI´S METHOD ?
ENRIC ROCHE, MD PhD.
Director CLINICA VASCULAR BARCELONA
Chief Vascular service HOSPITAL UNIVERSITARI SAGRAT COR & HOSPITAL GENERAL DE CATALUNYA
RAMON PONS, QD
Director INSTITUT QUÍMICA AVANÇADA , CONSEJO SUPERIOR DE INVESTIGACIONES CIENTÍFICAS
ANTONI PUIG, MD
CLINICA VASCULAR BARCELONA

2. Enric Roche MD , PHD
I declare I haven´t any conflict of interest
related to this presentation.

3. Enric Roche MD , PHD
Several strategies to ablate Major and minor saphenas
TO STRIP
BURN
ELECTRIFY
BOIL
STICK
EMBOLIZE
In your office,
Which % of Major/Minor saphenas are involved ?

4. Enric Roche MD , PHD
Main concerns…
Foam sclerotherapy has great variability
about syringes material, three way stopcock, type of gas, ratio sclerosant /gas, fabrication system, injection
system, strategy , temperature, patient position,
Safety is important
Physiological gases are safer than air, specially when a large volume of foam is used
Cabrera J, Patología Vascular. 1995; Wright D, Phlebology 2006; Morrison N. J Vasc Surg, 2008, Beckitt T,, Beckitt T,
Eur J Vasc Endovasc Surg 2011., Hesse G, Phlebology 2012,
Versatility is a plus
Easy to obtain a 1-2% stable foam …How many cases could be treated with high concentrations sclerosants ?
What about foams less concentrated ( < 0,5% …)

5. Enric Roche MD , PHD
FROTHER SYSTEM

6. Enric Roche MD , PHD
OBJECTIVE:
To demonstrate the feasibility of a new system of standardized
foam fabrication and its superiority in front of Tessari´s method in
terms of stability and versatility.
MATERIAL AND METHOD
TESSARI´S METHOD
-0,5% POLIDOCANOL Foam with AIR
- 2% POL Foam with AIR
- 2% POL Foam with O2/CO2 (50%/50%)
FROTHER
-0,5% POLIDOCANOL Foam with AIR
- 2% POL Foam with AIR
- 2% POL Foam with O2/CO2 (50%/50%)

7. Enric Roche MD , PHD
Tessari´s method:
Two 10 cc (BD Brand – latex free ) with A three-way stopcock key ( B/ Braun) . A default 1/3 ratio was decided using
3 cc of POL / 9 cc of AIR or O2/CO2. ( O2/CO2 Experiments container was filled with gas bottle)
After 20 passes
Small amount In a slide for
measurements
Syringe left in a stand position
for half-life calculation
MATERIAL AND METHOD
Foam measurements :
Diameter of bubbles & Total foam volume
A single layer of bubbles covered by a coverslip. Zeiss microscopy with a 2,5x with a Canon
Power Shot 90S was used to take pictures. ( final magnification was 2428x1821 μm2 ) .
Program used: ImageJ. Threshold particles analysis ( Size 150Infinity, Circularity 0,75-1)
Half –time life calculation:
Was defined as Time necessary to get the half amount of sclerosant ( 1,5 ml) in a liquid
state. (Total volume of sclerosant : 3 ml)
Every 30 seconds was obtained a picture of the syringes in vertically placed position with a
camera ( in a fixed position ) on a dark background.

8. Enric Roche MD , PHD
PURESPUME or FROTHER system:
Because the ratio liquid /gas is unknow is necesary to calculate
previosly the sclerosant volume.
Weight the syringe with 10 cc of foam / without foam in a precision
scale
3 ml of POL was frothed during 2 minutes
( 15sec-300rpm, 15 sec-700rpm,90 sec-1600 rpm)
( O2/CO2 Experiments container was filled with gas bottle)
After 2 min. in a slide
A sample was deposited In a slide for
measurements
A stand position for half-life calculation
MATERIAL AND METHOD

9. Enric Roche MD , PHD
RESULTS
Frother system foam 2% POL AIR
Frother system foam 2% POL O2/CO2
Tessari´s foam 2% POL AIR
Tessari´s foam 2% POL O2/CO2

10. Enric Roche MD , PHD
RESULTS 1. FOAM MEASUREMENTS
- Diameter of bubbles
- Total foam volume
% POL
FROTHER SYSTEM TESSARI
AIR O2/CO2 AIR O2/CO2
Diameter ED- σ Diameter ED-σ
0,5 %
134±33μm 109±21μm 38±17μm 25±15μm
2 %
104±22μm 74±22μm 65+/-20μm 51±20μm 40±20μm 40±15 μm
IC = 95%POL= Polidocanol
ED= Estandar deviation

11. Enric Roche MD , PHD
RESULTS 1. FOAM MEASUREMENTS
% POL
FROTHER SYSTEM TESSARI
AIR O2/CO2 AIR O2/CO2
Diameter ED- σ Diameter ED-σ
0,5 %
134±33μm 109±21μm 38±17μm 25±15μm
2 %
104±22μm 74±22μm 65+/-20μm 51±20μm 40±20μm 40±15 μm
IC = 95%POL= Polidocanol
ED= Estandar deviation
- Diameter of bubbles
- Total foam volume

12. Enric Roche MD , PHD
RESULTS
FROTHER SYSTEM 2% AIR
Diameter range of FROTHER SYSTEM is lower than TESSARI’S FOAM
TESSARI´S 2% AIR
Bubble Range: 25-150 µm Bubble Range: 25-245 µm

13. Enric Roche MD , PHD
RESULTS
2. FOAM STABILITY: Half-time life
% POL FROTHER SYSTEM TESSARI´S FOAM
AIR
minutes
ratio O2/CO2
minutes
AIR
minutes
O2/CO2
minutes
0,5%
6,5±3m
0,093
1/9
1,1±0,5m
2% 10,6±3m 0,089
1/10
2,2± 0,5m
2,0±0,5m
1,0±05m
IC = 95%
Statistical differences
POL= Polidocanol
Ratio: Proportion of sclerosant/gas

14. Enric Roche MD , PHD
RESULTS
2. FOAM STABILITY: Ratio sclerosant /gas
% POL FROTHER SYSTEM TESSARI´S FOAM
AIR O2/CO2 AIR or O2/CO2
0,5% 0,093 - 1/9 0,25 - 1/3
2% 0,089 - 1/10 0,14 - 1/6 0,25 -1/3
IC = 95%
Statistical differencesPOL= Polidocanol
Ratio: Proportion of sclerosant/gas

15. Enric Roche MD , PHD
RESULTS 2. FOAM STABILITY: Half-time life
FROTHER SYSTEM foam 2%
AIR
Tessari´s foam 2%
AIR

16. Enric Roche MD , PHD
CONCLUSIONS
2. Tessari´s foam is more heterogeneous : although there are a very little
bubbles
3. In our experiment frother´s foam is more stable than Tessari´s foam.
(five times more stable compared to Tessari´s method when using air and twice when using a
mixture of O2/CO2 )
4. 2% concentration of Polidocanol foam is more stable than 0,5% POL.
1. This system has demonstrated that it is useful in manufacturing foam
with air as well as with a gas mixture of O2/CO2.

17. Enric Roche MD , PHD
Comments
Our Tessari´s foam could be different than others foams
The standardization of parameters can be useful in offices where
sclerotherapy is a common practice
Versatility is interesting in the office
Some Improvements have been necessary in order to request
Health Authorities Approval

18. Enric Roche MD , PHD
Thank you for your attention !!