Effectiveness of treatments of varicose veins. Systematic review and evidence synthesis

Objectives. This paper conducts a systematic review and network meta-analysis of current and emerging technologies for treatment of varicose veins. Design. We compare the effectiveness of current technologies - conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA) – with emerging technologies–mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). Methods. A systematic review of the literature was conducted. For current technologies the review only considers evidence from RCTs. Evidence from non-randomised studies was included in a secondary analysis. Outcomes were re-intervention on the truncal vein and health-related quality of life (HRQOL) measured by Aberdeen Varicose Vein Questionnaire (AVVQ) and EQ-5D. Results. The rate of re-interventions on the truncal vein is similar between EVLA, RFA and surgery, while greater for UGFS and conservative care. HRQOL is similar at 1-13 weeks between surgery, EVLA, RFA, MOCA and CAE. HRQOL is similar between surgery, EVLA, RFA at longer term follow-up from 6 months to 5 years. UGFS is associated with lower HRQOL than EVLA measured by EQ-5D at short term and long term follow-ups. Non-randomised studies indicate the rate re-intervention after MOCA might be similar to other interventions but there are insufficient published data to draw definite conclusions. Conclusions. This study is the first systematic review that has conducted a meta-analysis of reintervention. The main risk of bias in the RCTs appears to be the high rate of attrition. High quality studies comparing MOCA and CAE to other modalities are needed.