Phlebitis after cyanoacrylate obliteration: Modern state of the problem

Phlebitis is a specific and widespread complication of cyanoacrylate obliteration (CAO). However, the definition, mechanisms of development, the incidence, and common treatment methods, have not been clarified. The study aimed to evaluate the incidence of phlebitis in a treated vein after CAO of varicose veins (VV) of the lower limbs and explore approaches for diagnosis and treatment of the latter complication. In March 2025, a systematic search for relevant papers was performed in PubMed, which included original studies with data about patients with VVs who underwent CAO and reported the incidence of post-procedure cyanoacrylate phlebitis (CAP). The primary endpoint was the presence of confirmed phlebitis and/or a phlebitis-like reaction in treated veins according to the original study criteria. Extracted data were summarized with a random effects model. A literature search identified 114 references, of which 24 full-text studies reporting 27,362 interventions were included in the analysis. Additionally, data from our study about the use of the original cyanoacrylate composition with “VACOV” technique in 53 patients were included. The incidence of CAP was 11% (95% CI: 7–14%; p < 0.001, I² = 92.4%). The subgroup analysis according to methods of glue embolization revealed significant differences in CAP incidence with VariClose (Turkey), VenaBlock (Turkey) and VenaSeal (USA): 4% (95% CI: 2–6%), 3% (95% CI: 0–5%), and 16% (95% CI: 11–21%), respectively (p < 0.001). Pain along the treated vein, palpatory tenderness, hyperemia, and swelling were the most common clinical manifestations of phlebitis. The treatment of CAP was heterogeneous and included as follows: nonsteroidal anti-inflammatory drugs, antihistamines, glucocorticoids, and antibiotics. CAP is a frequent specific complication of CAO with an incidence of 11% without defined diagnostic criteria and common treatment and prophylaxis approaches.

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