J Surg Ultrasound.  2020 Nov;7(2):42-46. 10.46268/jsu.2020.7.2.42.

The Cause of Abnormal Skin Findings after Ultrasound-Guided Injection of Cyanoacrylate Glue in an Animal Model

• Chung SY
• Cho S
• Joh JH

• KMID: 2511904
• DOI: http://doi.org/10.46268/jsu.2020.7.2.42

Abstract

Purpose
Cyanoacrylate closure has been recently introduced as a non-thermal method for the treatment of varicose veins. An abnormal skin finding can be an extremely worrisome complication after a cyanoacrylate closure. This study aimed at identifying if joint movement could be a possible cause for this reaction using a pig model.
Methods
The pigs were administered general anesthesia and monitored by a veterinarian. After aseptic preparation, the cyanoacrylate glue was injected into the leg vein through a delivery catheter, or into the ear vein through a 22G needle. The pigs were divided into 2 groups according to the involvement of the joints, with the injected glue. Ten days after the glue was injected, the veins were harvested, and pathologic findings were analysed.
Results
We obtained 6 vein specimens with the surrounding tissue. Both the groups, involving the joint, and not involving the joint included one leg vein and 2 ear veins. The pathologic finding in the group not involving the joint showed that inflammatory cells (mainly lymphocytes) infiltrated the vein wall. In the group involving the joints, the same inflammatory cells infiltrated both the vein wall and surrounding tissue.
Conclusion
In this animal study, the injected glue triggered an inflammatory reaction. When the glue was injected across a joint, an inflammatory reaction developed in the vein wall as well as the surrounding tissue. It may be assumed that cyanoacrylate glue injected during closure of the vein can result in an abnormal skin finding if there is an active movement of the joint involved.

Keyword

Varicose veins; Cyanoacrylates; Inflammation; Lymphocyte; Pathology

Figure

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  Fig. 1 Procedure details. (A) After access of superficial vein in the hindlimb, cyanoacrylate glue was injected using 5F delivery catheter. (B) For the injection of glue into the ear vein, direct injection was done using 3 ml syringe and 21-gauge angiocath.

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  Fig. 2 After injecting the glue, ultrasound imaging confirmed the complete occlusion of vein (arrows) and acoustic shadowing below the glue (dotted arrows).

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  Fig. 3 Typical feature of abnormal skin change in joint-involvement group. Along the vein injected glue, erythematous change was observed (arrows).

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  Fig. 4 Pathologic finding. The lymphocyte infiltration was seen mainly within the vein wall (A1, 2, 3) in the joint non-involvement group. But, in the joint involvement group, the lymphocytic infiltration was seen both in vein wall and surrounding tissue (B1, 2, 3).

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  Fig. 5 Typical finding of the patient with phlebitis reaction after cyanoacrylate closure. The inflammatory change such as erythema, pain, and induration was seen along the course of treated saphenous vein (arrows).

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