Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA. Electronic address: Leighann.o'
Division of Vascular Surgery, Northshore University Health System, Chicago, IL.
Ann Vasc Surg. 2023 Sep;95:218-223. doi: 10.1016/j.avsg.2023.06.002. Epub 2023 Jun 8.
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.
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.
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.
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.
非热静脉腔内闭合技术常用于治疗浅表轴向静脉反流。氰基丙烯酸酯闭合是一种安全有效的方法，用于主干闭合。然而，氰基丙烯酸酯特有的 IV 型超敏反应（T4H）是一种已知的风险。本研究旨在评估 T4H 的真实发生率，并研究可能导致其发生的危险因素。
在四家美国三级医疗机构进行了 2012 年至 2022 年的回顾性研究，以检查接受静脉内氰基丙烯酸酯闭合术治疗大隐静脉的患者。患者的人口统计学资料、合并症、CEAP（临床 [C]、病因 [E]、解剖 [A]和病理生理学 [P]）分类和围手术期结果均包括在内。主要终点是术后 T4H 的发生。对 T4H 的预测因素进行了 logistic 回归分析。P 值 < 0.05 的变量被认为具有统计学意义。
595 例患者接受了 881 例氰基丙烯酸酯静脉闭合术。平均年龄为 66.2 ± 14.9 岁，66%的患者为女性。79 例（13%）患者中有 92 例（10.4%）发生 T4H 事件。23%的患者因持续和/或严重症状给予口服类固醇。没有发生与氰基丙烯酸酯相关的全身过敏反应。多变量分析显示，年龄较小（P = 0.015）、吸烟状态活跃（P = 0.033）、CEAP 3 级（P < 0.001）和 4 级（P = 0.005）是与 T4H 发生相关的独立危险因素。
这项真实世界的多中心研究显示，T4H 的总体发生率为 10%。CEAP 3 级和 4 级的年轻吸烟者发生 T4H 的风险更高。
