Type IV Hypersensitivity Reaction after Cyanoacrylate Venous Closure.
Citation: Annals of Vascular Surgery. 95:218-223, 2023 Sep.PMID: 37301253Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter StudySubject headings: *Hypersensitivity, Delayed | *Varicose Veins | *Venous Insufficiency | Aged | Aged, 80 and over | Cyanoacrylates/ae [Adverse Effects] | Female | Humans | Hypersensitivity, Delayed/ci [Chemically Induced] | Male | Middle Aged | Retrospective Studies | Risk Factors | Saphenous Vein/dg [Diagnostic Imaging] | Treatment Outcome | Varicose Veins/dg [Diagnostic Imaging] | Varicose Veins/su [Surgery] | Venous Insufficiency/dg [Diagnostic Imaging] | Venous Insufficiency/th [Therapy] | Year: 2023ISSN:- 0890-5096
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 37301253 | Available | 37301253 |
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.
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