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Войти в исследования Journal of vascular surgery. Venous and lymphatic disorders · 2026
Cryolaser cryosclerotherapy versus isolated sclerotherapy for telangiectasias and reticular veins: A systematic review and meta-analysis.
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Simoni Gabriel Henrique, Madera Dario, Papatheodorou Nikolaos, Neves Samantha, Pizarro Varella Ana Clara, Alonso Julia Gonçalves, Mahfouz Nasser
Аннотация
OBJECTIVE: To compare the incidence of adverse events between cryolaser cryosclerotherapy (CLaCS) and isolated sclerotherapy for lower limb telangiectasias and reticular veins and to determine pooled adverse event rates after CLaCS.
METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception through February 2025 for studies of adults with telangiectasias or reticular veins (Clinical, Etiological, Anatomical, and Pathophysiological C1-C2) treated with CLaCS, reporting quantitative adverse event data. Risk ratios (RRs) were pooled using Mantel-Haenszel random-effects models for comparative studies. Single-arm proportions were pooled using Freeman-Tukey double arcsine transformation. Primary outcomes were telangiectatic matting, microthrombi formation, and hyperpigmentation. Secondary outcomes were ecchymosis and skin necrosis. An additional single-arm pooled proportion of satisfactory vessel clearance was estimated as a secondary efficacy outcome.
RESULTS: Six studies (833 patients) were included; three provided direct comparative data (363 CLaCS vs 259 sclerotherapy). CLaCS was associated with significantly lower rates of matting (RR, 0.07 [95% confidence interval [CI], 0.01-0.36]), microthrombi (RR, 0.18 [95% CI, 0.06-0.54]), and ecchymosis (RR, 0.43 [95% CI, 0.32-0.58]). No significant difference was found for hyperpigmentation (RR, 0.29 [95% CI, 0.06-1.44]; I2 = 92.1%) or skin necrosis (RR, 0.13 [95% CI, 0.02-1.00]). Pooled single-arm rates after CLaCS were 0.00% for matting, 0.00% for skin necrosis, 6.31% for microthrombi, 7.38% for hyperpigmentation, and 22.41% for ecchymosis. The pooled single-arm rate of satisfactory vessel clearance after CLaCS was 90.68% (95% CI, 76.74-98.87; I2 = 94.6%) across five studies. Patient satisfaction, reported in three studies and synthesized narratively because of instrument heterogeneity, was consistently high (∼85%-90%) across techniques.
CONCLUSIONS: CLaCS was associated with significantly lower rates of matting, microthrombi, and ecchymosis compared with isolated sclerotherapy, with near-zero incidence of matting and skin necrosis. High heterogeneity in hyperpigmentation highlights the need for trials with standardized outcome measures. CLaCS also achieved a high pooled rate of satisfactory vessel clearance and consistently high patient satisfaction across studies, supporting its efficacy alongside its favorable safety profile.
METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception through February 2025 for studies of adults with telangiectasias or reticular veins (Clinical, Etiological, Anatomical, and Pathophysiological C1-C2) treated with CLaCS, reporting quantitative adverse event data. Risk ratios (RRs) were pooled using Mantel-Haenszel random-effects models for comparative studies. Single-arm proportions were pooled using Freeman-Tukey double arcsine transformation. Primary outcomes were telangiectatic matting, microthrombi formation, and hyperpigmentation. Secondary outcomes were ecchymosis and skin necrosis. An additional single-arm pooled proportion of satisfactory vessel clearance was estimated as a secondary efficacy outcome.
RESULTS: Six studies (833 patients) were included; three provided direct comparative data (363 CLaCS vs 259 sclerotherapy). CLaCS was associated with significantly lower rates of matting (RR, 0.07 [95% confidence interval [CI], 0.01-0.36]), microthrombi (RR, 0.18 [95% CI, 0.06-0.54]), and ecchymosis (RR, 0.43 [95% CI, 0.32-0.58]). No significant difference was found for hyperpigmentation (RR, 0.29 [95% CI, 0.06-1.44]; I2 = 92.1%) or skin necrosis (RR, 0.13 [95% CI, 0.02-1.00]). Pooled single-arm rates after CLaCS were 0.00% for matting, 0.00% for skin necrosis, 6.31% for microthrombi, 7.38% for hyperpigmentation, and 22.41% for ecchymosis. The pooled single-arm rate of satisfactory vessel clearance after CLaCS was 90.68% (95% CI, 76.74-98.87; I2 = 94.6%) across five studies. Patient satisfaction, reported in three studies and synthesized narratively because of instrument heterogeneity, was consistently high (∼85%-90%) across techniques.
CONCLUSIONS: CLaCS was associated with significantly lower rates of matting, microthrombi, and ecchymosis compared with isolated sclerotherapy, with near-zero incidence of matting and skin necrosis. High heterogeneity in hyperpigmentation highlights the need for trials with standardized outcome measures. CLaCS also achieved a high pooled rate of satisfactory vessel clearance and consistently high patient satisfaction across studies, supporting its efficacy alongside its favorable safety profile.