Endovenous Microwave Ablation versus Radiofrequency Ablation for Lower Limb Varicose Veins: A Systematic Review and Meta-Analysis.

PURPOSE: To compare the effectiveness and safety of endovenous microwave ablation (MWA) versus radiofrequency ablation (RFA) for treating lower limb varicose veins (LLVVs).

MATERIALS AND

METHODS

A comprehensive search of PubMed, Embase, Scopus, and Web of Science databases identified relevant randomized controlled trials (RCTs) and observational studies comparing MWA and RFA for LLVV. Primary endpoints were occlusion rates and quality of life (QoL). Secondary outcomes included hospitalization days, procedural time, blood loss, and adverse events (AEs). Study quality was assessed using Cochrane Risk of Bias Tool and Newcastle-Ottawa scale. A random-effects meta-analysis was conducted with Review Manager 5.4 (The Cochrane Collaboration, Copenhagen, Denmark), including a leave-one-out sensitivity analysis.

RESULTS

Four studies (1 RCT and 3 cohort studies) with 887 patients (436 who underwent MWA and 451 who underwent RFA) were included. At 1 month, occlusion rates were 100% for both; at 1 year, the pooled occlusion rates remained similarly high (MWA, 97.5%; RFA, 98.0%), with no significant difference observed between groups (odds ratio, 0.80; 95% CI, 0.33-1.92; P = .620; I2 = 0%). QoL scores also showed no significant difference between techniques at 1 year. For secondary outcomes, both procedures demonstrated comparable effectiveness (hospitalization days and procedural time) and AE rates. Sensitivity analysis favored RFA, with fewer hospitalization days (mean difference [MD], 0.14; 95% CI, 0.01-0.27; P = .050; I2 = 0%) and shorter procedural time (MD, 8.68; 95% CI, 6.45-10.90; P < .00001; I2 = 38.0%).

CONCLUSIONS

MWA and RFA are safe and highly effective for treating LLVV, demonstrating similar 1-year occlusion rates (97.5% vs 98.0%) and low clinical severity scores.