Efficacy and safety of cyanoacrylate ablation vs endovenous radiofrequency ablation for varicose veins in chronic great saphenous vein insufficiency: A systematic review and meta-analysis.

OBJECTIVE

Endovenous radiofrequency ablation (RFA) and cyanoacrylate ablation (CA) are widely used for the treatment of chronic great saphenous vein (GSV) insufficiency. Compared with traditional surgery, both modalities have demonstrated well-recognized therapeutic benefits. However, controversy remains regarding the optimal choice between RFA and CA. The aim of this study was to conduct a systematic review and meta-analysis to compare the early and mid-term clinical outcomes of RFA vs CA.

METHODS

A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies. Randomized controlled trials, cohort studies, and case-control studies evaluating RFA and CA for the treatment of GSV incompetence were included. The primary outcomes were GSV occlusion rate and Venous Clinical Severity Score (VCSS). Secondary outcomes included skin pigmentation, phlebitis, deep vein thrombosis (DVT), ecchymosis, and procedure-related phlebitis. Data extraction and quality assessment were independently performed by two reviewers. Statistical analyses were conducted using Review Manager 5.3.

RESULTS

A total of 21 studies were included, encompassing 7844 patients and 9677 limbs. In terms of efficacy, there were no significant differences between CA and RFA in GSV occlusion rate or VCSS. Regarding safety, pooled data showed that CA was associated with a lower incidence of ecchymosis (5.96% vs 10.97%; P = .01) and paresthesia (1.24% vs 2.97%; P = .04). No significant differences were observed between the two groups in the incidence of phlebitis, DVT, or pigmentation. In addition, the procedure time was significantly shorter in the CA group than in the RFA group (P < .001).

CONCLUSIONS

For the treatment of incompetent saphenous veins, CA provides comparable efficacy to RFA. However, CA is associated with lower rates of skin pigmentation and ecchymosis, as well as a shorter procedure time.