The quality of evidence is downgraded by study limitations (lack of blinding), and by inconsistency.
A Cochrane review [Abstract] 1 included 24 studies with a total of 5 135 subjects with varicosities of the great saphenous vein (GSV). Duration of follow-up ranged from 5 weeks to 8 years.
Endovenous laser ablation (EVLA) versus radiofrequency ablation (RFA):There was no difference in technical success up to 5 years (OR 0.98, 95% CI 0.41 to 2.38; 5 studies, n=780), or over 5 years (OR 0.85, 95% CI 0.30 to 2.41; 1 study, n=291). There was no clear difference in recurrence at 3 years (OR 1.53, 95% CI 0.78 to 2.99; 1 study, n=291), but a benefit for RFA ws seen at 5 years (RFA 129 per 1000 and EVLA 291 per 1000; OR 2.77, 95% CI 1.52 to 5.06; 1 study, n=291).
EVLA versus ultrasound-guided foam sclerotherapy (UGFS):Technical success tended to be better with EVLA up to 5 years (OR 6.13, 95% CI 0.98 to 38.27; 3 studies, n=588), and over 5 years (OR 6.47, 95% CI 2.60 to 16.10; 3 studies, n=534). There was no clear difference in recurrence up to 3 years (OR 0.68, 95% CI 0.20 to 2.36; 2 studies, n=443) and at 5 years (OR 1.08, 95% CI 0.40 to 2.87; 2 studies, n=418).
EVLA versus high ligation and stripping (HL/S):Technical success was better with EVLA up to 5 years (OR 2.31, 95% CI 1.27 to 4.23; 6 studies, n=1 051). No clear difference in technical success was seen at 5 years and beyond (OR 0.93, 95% CI 0.57 to 1.50; 5 studies, n=874). Recurrence was comparable within 3 years (OR 0.78, 95% CI 0.47 to 1.29; 7 studies, n=1 459) and at 5 years (OR 1.09, 95% CI 0.68 to 1.76; 7 studies, n=1 267).
RFA versus mechanochemical ablation (MOCA):There was no difference in technical success (OR 1.76, 95% CI 0.06 to 54.15; 3 studies, n=435), or recurrence (OR 1.00, 95% CI 0.21 to 4.81; 3 studies, n=389). Long-term data was not available.
RFA versus HL/S:No difference in technical success was detected up to 5 years (OR 5.71, 95% CI 0.64 to 50.81; 2 studies, n=318), and over 5 years (OR 0.88, 95% CI 0.29 to 2.69; 1 study, n=289). No clear difference in recurrence was detected up to 3 years (OR 0.93, 95% CI 0.58 to 1.51; 4 studies, n=546); but a possible long-term benefit for RFA was seen (OR 0.41, 95% CI 0.22 to 0.75; 1 study, n=289).
UGFS versus HL/S:There was a benefit for HL/S compared with UGFS in technical success up to 5 years (OR 0.32, 95% CI 0.11 to 0.94; 4 studies, n=954), and over 5 years (OR 0.09, 95% CI 0.03 to 0.30; 3 studies, n=525). No clear difference was detected in recurrence up to 3 years (OR 1.81, 95% CI 0.87 to 3.77; 3 studies, n=822), and after 5 years (OR 1.24, 95% CI 0.57 to 2.71; 3 studies, n=639).
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