Frequency, severity and possible risks of development of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins

• Sannikov A.B.
• Shaydakov E.V.
• Belentsov S.M.

Abstract

Objective. The aim of this study was to determine the frequency, degree of severity and possible risk factors of the development of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins.

Patients and methods. We analyzed the results of cyanoacrylate obliteration of CEAP class C2–C3 varicose veins in a total of 175 patients operated on from 2017 to 2022. Cyanoacrylate obliteration of varicose veins was performed with the help of a foreign adhesive used in the “VenaSeal” system and the Russian-made adhesive compound “Sulfacrylate” (VenoGlue) according to the standardized techniques. All patients underwent ultrasound duplex scanning prior to surgery and at various stages of follow-up. The frequency and severity of PLAR after manipulations at various terms were evaluated in accordance with the developed Visual Analog Phlebitis Scale (VAPS) based on the scoring principle of assessing severity of pain and itching, hyperemia and infiltration of soft tissues along the occluded veins, as well as a systemic allergic reaction.

Results. It turned out that various-degree PLAR developed following cyanoacrylate obliteration of varicose veins averagely in 36% of patients after 24 hours, irrespective of the adhesive used. The duration of cyanoacrylate obliteration appeared to be a statistically significant factor of the development of PLAR observed in 56% of cases of cyanoacrylate obliteration of the entire main trunk of the great saphenous vein, in 28% – within the femur, and only in 7% of cases of cyanoacrylate obliteration limited to the proximal portion of the GSV, with the degree of PLAR according to the VAPS scoring 2.27±1.85, 1.44±0.16 and 0.63±0.12, respectively. The highest degree of PLAR among patients with extended cyanoacrylate obliteration in 100% of cases was observed on the crus, where the main trunk of the great saphenous vein was located in 50% of cases suprafascially, being maximally close to the skin. Also in 100% of cases, PLAR developed during isolated cyanoacrylate obliteration of veins in the basin of the anterior accessory (arch) vein on the crus, amongst whom in 63.6 and 36.4%, the severity score of PLAR amounted to 4–6 points and 6–7 points, respectively. In all these cases, the occluded segments were located suprafascially, adhering immediately to the skin, i. e., the thickness of the fat layer between the vein and skin amounted to only several millimeters. All patients with PLAR were treated with nonsteroidal anti-inflammatory drugs at the standard dose, with all adverse events resolving by day 7–10. There were no statistically significant differences in the incidence of PLAR depending on the diameter of the great saphenous vein. Development of PLAR regardless of the degree of severity did not influence the completeness of occlusion of the target veins, averagely amounting to 96% during 3 years.

Conclusion. PLAR after cyanoacrylate obliteration of varicose veins occurred in more than one third of patients but the degree of severity requiring active anti-inflammatory treatment was encountered in 3–5% of cases. The main factors influencing the risk of developing PLAR were found to be “local” factors such as the length of occlusion, cyanoacrylate obliteration performed on the crus, subfascial location of veins and proximity of veins to the skin.

Keywords:cyanoacrylates; sulfacrylate; cyanoacrylate obliteration of veins; chronic venous diseases; varicose veins; hypersensitivity reaction; phlebitis-like abnormal reaction