Objectives: This study aims to evaluate the incidence of phlebitis-like abnormal reaction (PLAR), possible risk factors for the reaction, and the management of PLAR after cyanoacrylate closure (CAC) of great saphenous vein (GSV) or small saphenous vein (SSV) in patients with chronic venous insufficiency (CVI).
Patients and methods: Between June 2020 and March 2021, a total of 90 patients (35 males, 55 females; mean age: 47.6±6.0 years; range, 28 to 69 years) who underwent CAC procedure for GSV or SSV insufficiency were retrospectively analyzed. The patients were divided into two groups: those with PLAR (Group 1) and no PLAR (Group 2). Both groups were compared in terms of possible risk factors. The primary goal was to evaluate the incidence, onset time, duration, severity and possible risk factors for PLAR and Venous Clinical Severity Score (VCSS) and Visual Analog Scale-Pain (VAS-pain) scores of the patients and to compare the groups one week after the procedure. The secondary goal was to evaluate the technical success, recanalization, mortality, major adverse events, and other postoperative complications.
Results: No technical failure and device-related complications were encountered. Anatomic success rate was 100% after CAC procedures.
The incidence of PLAR was 14 cases (15.5%). All mild or moderate PLARs occurred within a week of the procedures. During the six-month follow-up period, the target veins were completely occluded in all patients (100%) without any recanalization. Although older age (p=0.042), female sex (p=0.145), obesity (p=0.145), and history of drug allergy (p=0.131) were more common in the PLAR group, they did not reveal statistical significance. Logistic regression analysis revealed that no dependent variable was a risk factor associated with the development of PLAR. All PLAR cases were seen in the target GSV. Improvement in the VCSS scores were not statistically significant between baseline and the one-week control between two groups.
Conclusion: Although PLAR can be seen at high incidence rates, it is a preventable complication with various technical modifications applied during CAC procedure as treatment strategies. According to the present results, no dependent variable was found to be a risk factor for development of PLAR and a risk model could not be devised for the development of PLAR according to any dependent variable.
Key words: Cyanoacrylate, hypersensitivity reaction, inflammation, phlebitis, varicose veins
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