Severe adverse reactions after cyanoacrylate endovenous ablation

Abstract

Hypersensitivity reactions after endovenous ablation with cyanoacrylate are relatively common, mild, and self-limited. However, rare cases of severe hypersensitivity reactions have occurred. To date and to the best of our knowledge, only two other cases requiring vein excision have been reported, and we present the third. Even rarer are cases with severe reactions featuring cyanoacrylate extravasation with skin perforation. In the present report, we describe the second case of skin perforation after successful cyanoacrylate endovenous glue embolization. The mechanism of these severe hypersensitivity reactions is unknown. Clinicians should to consider this as a possible complication when using cyanoacrylate. Although rare, patients should also be advised of this adverse event when considering this alternative.

Keywords: Cyanoacrylate; Endovenous ablation; Hypersensitivity; Minimally invasive.

Fig 1

A, Photograph showing no skin changes after methylprednisone treatment. She had undergone VenaSeal 9 months prior. B, Photograph showing a right medial calf wound with hemosiderin deposits that had developed 1 week after steroid cessation. C, Photograph showing excised right great saphenous vein (GSV) sent for histologic analysis.

Fig 2

Photomicrograph of hematoxylin and eosin stain of right great saphenous vein (GSV) showing foreign body giant cells (thin arrows), histiocytes (thick arrows), and foci of lymphocytic inflammation (plus sign), with intraluminal foreign material (arrowhead) more visible at this magnification (high-power magnification, ×200).

Fig 3

A, Photograph showing chronic recurrence venous ulcer on right medial malleolus at initial visit. It had initially begun 9 years previously and had been open again for 6 months at presentation. B, Photograph showing healed venous ulcer malleolus at 3 months after right great saphenous vein (GSV) endovenous cyanoacrylate (CA) embolization via VenaSeal.

Fig 4

A, Hard foreign bodies consistent with solidified fragments of N-butyl cyanoacrylate (CA) and other aggregate material. B, Photograph showing multiple small wounds due to skin breakdown and rupture with glue extrusion after CA extravasation at 3 months after right great saphenous vein (GSV) embolization with VenaSeal. C, Photograph showing wounds had healed significantly, although occasional weeping of serous fluid occurred. No new wounds had developed nor had any new glue fragments extruded at 8 months after the procedure.