450 Abstracts Journal of Vascular Surgery: Venous and Lymphatic Disorders
March 2023
AVF 17
Predicting Hypersensitivity Reactions After
Cyanoacrylate Closure of Lower Extremity Veins
Vishu Chandrasekhar, Harold Waller, Julianne Stoughton. Massa-
chusetts General Hospital, Boston, MA
Objective: The purpose of this study was to assess the incidence, onset
and severity of hypersensitivity reactions (HSRs) after cyanoacrylate
closure (CAC) of incompetent saphenous veins, as well as identify any
possible risk factors for HSRs.
Methods: A multiphysician retrospective review of CACs of incompe-
tent saphenous veins was conducted. Demographic data, medical his-
tory, and procedure details as well as the incidence, onset and severity
of any HSRs were recorded.
Results: 193 veins were treated with n-butyl-2-cyanoacrylate in 122 pa-
tients, and all CACs performed during the study period were included. Of
the treated veins, 76.7% (148/193) were great saphenous veins, 18.7% were
small saphenous veins, and the remainder were accessory saphenous
veins. The patients had an average body mass index of 30.1, with an average
age of 60.1 years; 62.3% of the patients were female. Twenty-five of the pa-
tients (21.2%) experienced HSRs. Symptom onset ranged from 1 to 25 days,
with a mean of 7.6 days. Nineteen patients (76%) had mild HSRs that
resolved with no intervention or with nonsteroidal anti-inflammatory
drugs, and six patients (24%) experienced moderate HSRs that resolved
with steroids. Univariate analysis identified multiple risk factors for an
HSR: younger age (55.38 years vs 61.48 years without HSR; P ¼ .0372), female
sex (P ¼ .0025), great saphenous vein intervention (P ¼ .0388), lower CEAP
score (2.71 vs 3.42; P ¼ .0055), history of provoked superficial vein thrombosis
(28% vs 8.6%; P ¼ .0168), history of drug allergies (80% vs 52.7%; P ¼ .0210),
and a longer treated vein segment (38.5 cm vs 30 cm; P ¼ .0205). There was
no correlation identified between HSRs and the presence of skin condi-
tions, prior cyanoacrylate treatment, history of inflammatory bowel dis-
ease, concomitant procedures, body mass index, the minimum depth of
the vein treated, or the diameter of the vein treated. The overall vein closure
rate post-CAC was 99.5%, and there was no significant difference in closure
rates between patients with and without HSRs.
Conclusions: CAC is gaining popularity as a highly effective treatment
for axial venous insufficiency. However, there is a paucity of data on pa-
tient and procedure-specific variables associated with post-procedural
HSRs. In our study, HSRs occurred in 21% of study patients after CAC,
with an average onset of symptoms 7.6 days post-procedure. Younger
age, female sex, great saphenous vein intervention, increased length of
the vein treated, lower CEAP scores, as well as a history of provoked su-
perficial vein thrombosis and a history of drug allergies were associated
with HSRs. These factors should be interrogated and discussed with pa-
tients during procedural counseling for axial venous insufficiency.
Author Disclosures: V. Chandrasekhar: Nothing to disclose; H. Waller:
Nothing to disclose; J. Stoughton: Nothing to disclose.
Table I. Intercontinental variation in patients characteristics with venous thromboembolism (VTE) in the Registro Informatizado de la Enfermedad
ThromboEmbólica (RIETE) registry
Baseline characteristics Europe
Patients 53,162 (90.3)
Demographics
Age, years 65 6 17
Female 26,607 (50)
Race (n ¼ 30,275)b
White 27,195 (99)
Black 114 (0.42)
Asian 72 (0.26)
Other 44 (0.16)
Body mass index 28.2 6 5.8
Comorbidities
AVF 18
Intercontinental Variations in the Presentation and
Management of Venous Thromboembolism
Cassius Iyad Ochoa Chaar,1 Shin Mei Chan,1 Alfred Lee,1 Behnood
Bikdeli,2 Gregorio Tiberio,3 Romain Chopard,4 Ido Weinberg,5 Yugo
Yamashita,6 Reza Nikandish,7 Manuel Monreal8. 1Yale University
School of Medicine, New Haven, CT; 2Brigham and Women’s Hospital,
Boston, MA; 3Hospital Virgen del Camino, Pamplona, Spain; 4Uni-
versity Hospital Jean Minjoz, Besançon, France; 5Massachusetts
General Hospital, Boston, MA; 6Graduate School of Medicine, Kyoto
University, Kyoto, Japan; 7Abu-Ali-Sina Organ Transplant Center, Shi-
raz, Iran; 8Universidad Católica San Antonio de Murcia, Murcia, Spain
Objective: Venous thromboembolism (VTE) is a global disease with sig-
nificant morbidity and mortality. However, variations in presentation and
management of VTE between different continents have not been stud-
ied. This project compares presenting symptoms and treatment modal-
ities of patients with VTE in Europe, America, and Asia.
Methods: The data from the Registro Informatizado de la Enfermedad
ThromboEmbólica (RIETE) registry (2011-2021) was reviewed. RIETE is the
largest international registry dedicated to VTE that started in Spain and
expanded worldwide. Patient characteristics and treatments were
compared between Europe, America, and Asia.
Results: There was a total of 58,865 patients with VTE with the majority
from Europe (90.3%) followed by Asia (6.3%) and America (3.4%). Patients
diagnosed with VTE in America were significantly younger than the other
continents. VTE patients in Asia and America were significantly more
racially diverse and more likely to be females compared with Europe. Pa-
tients in Asia had the highest likelihood of having diabetes, coronary ar-
tery disease, ischemic stroke, and dialysis. Interestingly, patients in Asia
were also much more likely to be diagnosed with anemia or have recent
major bleeding and had lower mean hemoglobin level on presentation
compared with patients in the two other continents. Cancer-related
VTE was significantly higher in patients from Asia, while provoked VTE af-
ter surgery or travel was significantly more likely in patients from America
(Table I). The majority of patients (99%) in all continents were treated with
anticoagulation. However, patients treated in America for VTE were signif-
icantly more likely to be treated as outpatients and receive a direct oral
anticoagulant for the initiation and maintenance of therapy (17% and
37%, respectively). The choices of long-term anticoagulants were strikingly
different with patients in Europe more likely to receive vitamin K antago-
nists while patients in Asia receive low molecular weight heparin. Inter-
ventions for DVT in the form of mechanical thrombolysis or IVC filter
placement were more likely to be used in America. Also, patients in Amer-
ica were more likely to undergo open pulmonary embolectomy (Table II).
Conclusions: There is wide intercontinental variation in VTE presenta-
tion and management. Future analysis should evaluate the relationship
of these variations with clinical outcomes. Comparative research using
a global registry could shed light on VTE biology and treatment.
America Asia
1998 (3.4) 3705 (6.3)
59 6 17a 63 6 18a
1044 (52) 1920 (52)b
655 (92)a 1679 (78)a
a
38 (5.4) 6 (0.28)
15 (2.1)a 308 (14)a
2 (0.28) 147 (6.9)a
28.6 6 6.8 c
27 6 6.1a
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