Type IV Hypersensitivity Reaction after Cyanoacrylate Venous Closure. 

 -  2023 
<br/><br/> BACKGROUND: Nonthermal endovenous closure techniques are routinely utilized to treat superficial axial venous reflux. Cyanoacrylate closure is a safe and effective modality implemented for truncal closure. However, an adverse reaction of type IV hypersensitivity (T4H), unique to cyanoacrylate, is a known risk. This study aims to evaluate the real-world incidence of T4H and examine risk factors that may predispose its development.  CONCLUSIONS: This real-world multicenter study shows the overall incidence of T4H to be 10%. CEAP 3 and 4 patients of younger age and smokers predicted a higher risk of T4H to cyanoacrylate. Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.  METHODS: A retrospective review between 2012- and 2022 was performed at four tertiary US institutions to examine patients who underwent cyanoacrylate vein closure of their saphenous veins. Patient demographics, comorbidities, CEAP (Clinical [C], Etiological [E], Anatomical [A], and Pathophysiological [P]) classification, and periprocedural outcomes were included. The primary endpoint was development of T4H post procedure. Logistic regression analysis for risk factors predictive of T4H was performed. Variables with a P-value of <0.05 were deemed significant.  RESULTS: 595 patients underwent 881 cyanoacrylate venous closures. Mean age was 66.2 +/- 14.9, and 66% of patients were female. There were 92 (10.4%) T4H events in 79 (13%) patients. Oral steroids were administered to 23% for persistent and/or severe symptoms. There were no systemic allergic reactions to cyanoacrylate. Multivariate analysis revealed younger age (P = 0.015), active smoking status (P = 0.033), and CEAP 3 (P < 0.001) and 4 (P = 0.005) classifications as independent risk factors associated with development of T4H. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0890-5096 
<br/><br/><label>Standard No.: </label>10.1016/j.avsg.2023.06.002 [doi] S0890-5096(23)00315-1 [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Hypersensitivity, Delayed<br/>*Varicose Veins<br/>*Venous Insufficiency<br/>Aged<br/>Aged, 80 and over<br/>Cyanoacrylates/ae [Adverse Effects]<br/>Female<br/>Humans<br/>Hypersensitivity, Delayed/ci [Chemically Induced]<br/>Male<br/>Middle Aged<br/>Retrospective Studies<br/>Risk Factors<br/>Saphenous Vein/dg [Diagnostic Imaging]<br/>Treatment Outcome<br/>Varicose Veins/dg [Diagnostic Imaging]<br/>Varicose Veins/su [Surgery]<br/>Venous Insufficiency/dg [Diagnostic Imaging]<br/>Venous Insufficiency/th [Therapy]--Automated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Multicenter Study