Efficacy and safety of foam sclerotherapy for great saphenous vein reflux: a systematic review and meta-analysis of RCTs.

OBJECTIVE

This systematic review and meta-analysis compared the efficacy and safety of foam sclerotherapy vs. HL/S for great saphenous vein (GSV) reflux.

METHODS

We searched eight databases from inception to July 2026 for randomized controlled trials (RCTs) of foam sclerotherapy for GSV reflux. Risk of bias was assessed using the Cochrane risk of bias tool. Random-effects meta-analyses were performed to pool the effects for each outcome with the longest follow-up time, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to rate the certainty of evidence.

RESULTS

Twenty-three trials (3,122 patients) were included. Foam sclerotherapy may provide benefits over HL/S for symptom improvement (low certainty: RR, 1.09, 95% CI, 1.03-1.16) and several perioperative outcomes (low to very low certainty), including shorter surgery duration (WMD -35.28 min), reduced hospital stay (WMD -3.72 days), lower costs (WMD -4622.34€), and less blood loss (WMD -50.48 mL). However, foam sclerotherapy had a significantly lower occlusion rate (low certainty: RR, 0.65, 95% CI, 0.49-0.86), and no statistically significant difference was observed in recurrence rates (very low certainty: RR, 0.56, 95% CI, 0.25-1.23).

CONCLUSIONS

Foam sclerotherapy may yield better symptom improvement, safety, and perioperative outcomes than HL/S for GSV reflux despite a lower occlusion rate. While comparable recurrence rates were noted between treatments, this result does not confirm equivalent long-term durability of the two interventions. The overall certainty of evidence was low, warranting further high-quality standardized long-term studies.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537972, identifier [CRD42024537972].