Hypersensitivity Skin Reactions After Cyanoacrylate Adhesive Closure of Varicose Veins: 5-Year Treatment Outcomes

Recently, non-thermal, non-tumescent methods have been increasingly used in the treatment of lower extremity varicose veins (LEVVs), in particular cyanoacrylate adhesive closure (CAC), which may lead to the development of a complication specific to this procedure — delayed hypersensitivity skin reaction (DHSR). Objective. To assess the incidence and risk factors for the development of cyanoacrylate adhesive-induced DHSR in patients with LEVVs. Material and methods. A retrospective analysis of data on patients with LEVVs who underwent CAC of the main saphenous veins was performed. An assessment of potential risk factors for the development of DHSR, including sex, age, body mass index and length of the obliterated segment, was done. The criterion for DHSR was the presence of at least one of the following symptoms in the projection of the obliterated vein: hyperemia (erythema), pain/tenderness, local sensation of heat, skin itching, as well as low-grade fever and urticaria. Multiple logistic regression analysis was used to identify risk factors for the development of DHSR. Results. During the reporting period, CAC was performed in 1794 patients, the total number of procedures was 2729. The majority were women — 1179 (65.7%). The mean age of patients was 61±15 (from 25 to 93) years. DHSR after CAC in the postoperative period was reported in 186 (10.4%) subjects that, in relation to the number of performed interventions, amounted to 6.8%. The reaction developed in the absolute majority of cases within a period of 7 days to one year after the intervention with a median of 16 (interquartile range 10—24) days. Among the potential risk factors for the development of DHSR, the length of of the obliterated segment demonstrated a statistically significant advantage according to the results of the corresponding analysis — odds ratio 2.40 (95% CI 1.98—2.91). Conclusion. DHSR is a common adverse event after adhesive closure. The length of obliteration is an independent risk factor for the development of this complication. Successful relief of this reaction through conservative treatment demonstrates the manageability of DHSR occurrence.