Characterization of skin and soft tissue adverse reaction after saphenous vein closure using cyanoacrylate

Cyanoacrylate closure (CAC) is a minimally invasive, nonthermal treatment for varicose veins. However, regarding postoperative skin and soft tissue adverse reactions, their clinical characteristics remain poorly defined. This study compared adverse reactions after CAC and thermal ablation (TA) and characterized their features following CAC.

We retrospectively reviewed 511 patients treated for saphenous vein incompetence (300 CAC cases and 211 TA cases). Skin and soft tissue adverse reactions, defined as reactions requiring oral medication or surgical intervention, were evaluated.

Baseline characteristics were similar between the groups, and no severe systemic reactions were observed. Skin and soft tissue adverse reactions occurred more frequently after CAC than after TA (34/300 [11%] vs 8/211 [4%]; P = .004). Higher CEAP classes were associated with increased reaction rates. Adverse reactions after TA were mainly related to thermal injury, including burns, phlebitis, cellulitis, and nerve-related symptoms perceived in the skin, whereas hypersensitivity-type reactions were observed only after CAC. CAC-related adverse reactions appeared to involve multiple contributing factors and were classified into five types based on particularly prominent clinical features: allergic contact dermatitis, phlebitis, exacerbated edema with induration, generalized urticaria, and foreign-body granuloma. CAC-related adverse reactions were more frequent in great saphenous vein treatment than in small saphenous vein treatment (59/520 [11.3%] vs 23/302 [7.6%]), and occurred exclusively with below-knee access. Adverse reactions were also more common in patients with hypertension. The onset of CAC-related adverse reactions occurred immediately (2.9%), at 1 week (32.3%), 2 weeks (26.5%), 3 weeks (26.5%), 4 weeks (5.9%), or >4 weeks (5.9%), whereas 75% of TA-related adverse reactions occurred within 1 week. Persistent subjective symptoms lasting ≥1 month, including pain, neuropathy, or discomfort, were less frequent after CAC than after TA (4/300 [1%] vs 14/211 [7%]; P = .0044).

CAC was associated with more complex and delayed adverse reactions compared with TA. Awareness of these characteristic patterns is important for patient selection, counseling, risk assessment, and postoperative management.