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Background/aims <p>Varicose veins affect 17% of females and 15% of males globally, significantly impairing quality of life. Endovenous ablation techniques, including thermal methods such as Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA), as well as non-thermal approaches like Mechanochemical Ablation (MOCA) and cyanoacrylate adhesive (NBCA), offer minimally invasive alternatives to traditional surgery. This systematic review and meta-analysis, including 13 studies, evaluated the efficacy, safety, and patient-reported outcomes of these interventions, integrating 2023 Society for Vascular Surgery guidelines and the 2022 European Society for Vascular Surgery (ESVS) guidelines.</p> Methods <p>This study followed PRISMA guidelines, using a random-effects model to compare occlusion and recurrence rates (primary outcomes). Secondary outcomes included quality-of-life improvements (Aberdeen Varicose Vein Questionnaire [AVVQ] and Venous Clinical Severity Score [VCSS]) and adverse events.</p> Results <p>EVLA and RFA achieved high occlusion rates (94.9% and 94.4%), comparable to surgical stripping (92.0%). Non-thermal methods had slightly lower occlusion (88.7%), but reduced early postoperative pain (MOCA: 1.2/10 vs. EVLA: 3.8/10). Five-year recurrence rates were 38.6% for EVLA, 18.7% for RFA, and 34.6% for surgery; non-thermal methods reported lower short-term recurrence but limited long-term data. Quality of life improved across treatments, with AVVQ scores decreasing by 7.8 points and VCSS scores by 3.5 points, indicating significant symptom relief and clinical improvement. Adverse events were higher for thermal ablation (6.8%) and surgical stripping (8.0%) than non-thermal methods (&lt; 2.5%).</p> Conclusion <p>Endovenous ablation techniques provide high success rates and significant quality-of-life improvements, reinforcing its role as first-line therapy for varicose veins. Non-thermal methods may reduce pain and complications, which makes them very attractive alternatives for selected patients. However, long-term studies are warranted to confirm the durability and safety of these emerging treatments.</p>

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Clinical effectiveness and patient-reported outcomes of endovenous ablation and surgical stripping in varicose vein management: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月13日

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  • En Qing Lim,
  • Aaron Jun Ket Lim,
  • Aongus Twomey

摘要

Background/aims

Varicose veins affect 17% of females and 15% of males globally, significantly impairing quality of life. Endovenous ablation techniques, including thermal methods such as Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA), as well as non-thermal approaches like Mechanochemical Ablation (MOCA) and cyanoacrylate adhesive (NBCA), offer minimally invasive alternatives to traditional surgery. This systematic review and meta-analysis, including 13 studies, evaluated the efficacy, safety, and patient-reported outcomes of these interventions, integrating 2023 Society for Vascular Surgery guidelines and the 2022 European Society for Vascular Surgery (ESVS) guidelines.

Methods

This study followed PRISMA guidelines, using a random-effects model to compare occlusion and recurrence rates (primary outcomes). Secondary outcomes included quality-of-life improvements (Aberdeen Varicose Vein Questionnaire [AVVQ] and Venous Clinical Severity Score [VCSS]) and adverse events.

Results

EVLA and RFA achieved high occlusion rates (94.9% and 94.4%), comparable to surgical stripping (92.0%). Non-thermal methods had slightly lower occlusion (88.7%), but reduced early postoperative pain (MOCA: 1.2/10 vs. EVLA: 3.8/10). Five-year recurrence rates were 38.6% for EVLA, 18.7% for RFA, and 34.6% for surgery; non-thermal methods reported lower short-term recurrence but limited long-term data. Quality of life improved across treatments, with AVVQ scores decreasing by 7.8 points and VCSS scores by 3.5 points, indicating significant symptom relief and clinical improvement. Adverse events were higher for thermal ablation (6.8%) and surgical stripping (8.0%) than non-thermal methods (< 2.5%).

Conclusion

Endovenous ablation techniques provide high success rates and significant quality-of-life improvements, reinforcing its role as first-line therapy for varicose veins. Non-thermal methods may reduce pain and complications, which makes them very attractive alternatives for selected patients. However, long-term studies are warranted to confirm the durability and safety of these emerging treatments.