Possible mechanisms of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins

Abstract

Based on their own research and a review of the literature, the authors analyze the possible cellular mechanisms of the development of an inflammatory reaction after the obliteration of varicose veins with cyanoarylate adhesive compounds (CAO), which received the name phlebitis- Like abnormal Reaction (PLAR) in foreign sources. Despite the existing opinion about the “abnormal” nature of the inflammatory reaction, it is noted that the main stages of its development are fully consistent with the currently known molecular and cellular mechanisms of the response of biological tissues to contact with a foreign antigenic substance and are of a natural nature. The cause of the development of acute alterative inflammation in the vein wall is the direct contact of the endothelium with an aggressive environment, which is cyanoacrylate. A specific feature of the development of chronic inflammation in the vein wall is its productive interdaily character, which is replaced by proliferative processes. The main role in the development of successive stages of PLAR development is played by monocytic, mast and giant cells of foreign bodies, as well as the mechanisms underlying the regulation of the functional activity of these cells. During the period of cyanoacrylate biodegradation, its cellular environment corresponds to all morphological features of a phagocytoma, whose activity decreases with the biodegradation of cyanoacrylate with simultaneous connective tissue proliferation. The development of possible chronic granulomatous inflammation is based on a local autoimmune process associated with the formation of giant multinucleated epithelioid cells (Langerhans cells). In conclusion, it is emphasized that today, when using various cyanoacrylate compounds for the purpose of adhesive obliteration of veins, taking into account the accumulated clinical data and morphological studies, the final answers to the existing reasonable objections about the complete safety of the use of cyanoacrylates in clinical practice should be given by fundamental immunohistochemical and genetic studies.