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.

Introduction. Telangiectasias and reticular veins (C1 by CEAP) cause aesthetic discomfort; standard sclerotherapy has side effects like pigmentation. Ozone-oxygen mixture offers an alternative via oxidative endothelial damage and tissue oxygenation.

Aim. To evaluate the efficacy and safety of intravascular sclerotherapy using an ozone-oxygen gas mixture for telangiectasias and reticular varicose veins of the lower extremities.

Materials and methods. The study included 30 patients (25 women and 5 men) with telangiectasias and reticular varicose veins (class C1 by CEAP). All patients underwent a course of sclerotherapy consisting of intravascular injections of an ozone-oxygen mixture into the affected superficial veins using a microneedle (ozone concentration was 70%). Procedures were performed on an outpatient basis once per week; the mean number of sessions per patient was 4.2 ± 1.1. Treatment efficacy was evaluated at 30 days after completion of therapy based on the degree of vascular network disappearance and patient satisfaction.

Results. 93% of patients (28/30) achieved complete or significant (>75%) obliteration of telangiectasias and reticular veins after the treatment course. No serious complications were observed. Side effects were limited to transient erythema, mild edema and moderate pain at injection sites, which resolved spontaneously. No cases of skin hyperpigmentation, necrosis or scarring were noted. The cosmetic outcome was high: 97% of patients were satisfied with the results.

Conclusion. Ozone-oxygen injection sclerotherapy is an effective and safe method for sclerobliteration of telangiectasias and reticular varicose veins, providing excellent cosmetic results with minimal invasiveness. The technique does not induce typical adverse reactions such as hyperpigmentation or scarring, and it expands options for minimally invasive treatment of early-stage varicose vein disease, thereby improving patients’ quality of life.