Predicting Hypersensitivity Reactions After Cyanoacrylate Closure of Lower Extremity Veins

The purpose of this study was to assess the incidence, onset and severity of hypersensitivity reactions (HSRs) after cyanoacrylate closure (CAC) of incompetent saphenous veins, as well as identify any possible risk factors for HSRs. A multiphysician retrospective review of CACs of incompetent saphenous veins was conducted. Demographic data, medical history, and procedure details as well as the incidence, onset and severity of any HSRs were recorded. 193 veins were treated with n-butyl-2-cyanoacrylate in 122 patients, and all CACs performed during the study period were included. Of the treated veins, 76.7% (148/193) were great saphenous veins, 18.7% were small saphenous veins, and the remainder were accessory saphenous veins. The patients had an average body mass index of 30.1, with an average age of 60.1 years; 62.3% of the patients were female. Twenty-five of the patients (21.2%) experienced HSRs. Symptom onset ranged from 1 to 25 days, with a mean of 7.6 days. Nineteen patients (76%) had mild HSRs that resolved with no intervention or with nonsteroidal anti-inflammatory drugs, and six patients (24%) experienced moderate HSRs that resolved with steroids. Univariate analysis identified multiple risk factors for an HSR: younger age (55.38 years vs 61.48 years without HSR; P = .0372), female sex (P = .0025), great saphenous vein intervention (P = .0388), lower CEAP score (2.71 vs 3.42; P = .0055), history of provoked superficial vein thrombosis (28% vs 8.6%; P = .0168), history of drug allergies (80% vs 52.7%; P = .0210), and a longer treated vein segment (38.5 cm vs 30 cm; P = .0205). There was no correlation identified between HSRs and the presence of skin conditions, prior cyanoacrylate treatment, history of inflammatory bowel disease, concomitant procedures, body mass index, the minimum depth of the vein treated, or the diameter of the vein treated. The overall vein closure rate post-CAC was 99.5%, and there was no significant difference in closure rates between patients with and without HSRs. CAC is gaining popularity as a highly effective treatment for axial venous insufficiency. However, there is a paucity of data on patient and procedure-specific variables associated with post-procedural HSRs. In our study, HSRs occurred in 21% of study patients after CAC, with an average onset of symptoms 7.6 days post-procedure. Younger age, female sex, great saphenous vein intervention, increased length of the vein treated, lower CEAP scores, as well as a history of provoked superficial vein thrombosis and a history of drug allergies were associated with HSRs. These factors should be interrogated and discussed with patients during procedural counseling for axial venous insufficiency.