Type IV Hypersensitivity Reaction after Cyanoacrylate Venous Closure

Area of Science:

• Vascular Surgery
• Dermatology
• Allergy & Immunology

Background:

• Nonthermal endovenous closure is standard for superficial axial venous reflux.
• Cyanoacrylate closure offers safe and effective truncal closure.
• Type IV hypersensitivity (T4H) is a known risk specific to cyanoacrylate.

Purpose of the Study:

• To determine the real-world incidence of T4H after cyanoacrylate vein closure.
• To identify risk factors associated with T4H development.

Main Methods:

• Retrospective review of 881 cyanoacrylate venous closures across four US institutions (2012-2022).
• Analysis of patient demographics, comorbidities, CEAP classification, and outcomes.
• Logistic regression used to identify predictors of T4H.

Main Results:

• 10.4% T4H events occurred in 13% of patients.
• Younger age, active smoking, and CEAP classifications 3 and 4 were significant risk factors for T4H.
• No systemic allergic reactions were reported.

Conclusions:

• The overall incidence of T4H is 10% in real-world settings.
• Younger patients, active smokers, and those with CEAP 3 or 4 classifications face a higher risk of T4H.
• Findings aid in patient selection and risk stratification for cyanoacrylate closure.