Risk Factors for Complex Hypersensitivity and Irritation Reactions after an Ultrasound-Guided Cyanoacrylate Closure

Purpose: Cyanoacrylate closure (CAC) has been introduced for the treatment of the incompetent saphenous vein. Although there have been no severe procedure- or device-related adverse events, the post-treatment complex hypersensitivity and irritation reactions (CHAIR) might be a troublesome complication. Methods: A retrospective review was performed from prospectively collected data of CAC patients. The CAC was performed in patients with symptomatic great saphenous veins (GSV), small saphenous veins (SSV), and/or accessory saphenous veins (ASV) in a single session. We assessed the possible risk factors for the development of a hypersensitivity reaction including the amount of injected adhesive, access site, treated segment, compression stocking application, and other clinical factors. For the statistical analyses, data were analyzed using the IBM SPSS Statistics ver. 22.0 (IBM Co., Armonk, NY, USA). P-value <0.05 was considered statistically significant. Results: During the study period, 190 saphenous veins were treated in 100 patients. Sixty-four (64%) patients were female. The mean age was 55.5 ± 12.8 years (19-84). Complete occlusion was achieved in all patients. After CAC, the mean visual analogue scale (VAS) was 2.59 and 0.32 on postoperative 0 and 7 days, respectively (P < 0.001). Post-treat-ment CHAIR occurred in 5 (5%) patients. The significant risk factors for the development of CHAIR were younger age, GSV treatment, and below-the-knee access site for the introduction of a catheter. Conclusion: CHAIR occurred when the adhesive was injected at the below-the-knee GSV segment. The mechanical irritation due to knee joint movement might be a possible mechanism for the development of the hypersensitivity reaction.