Comparison Between Cyanoacrylate Embolization and Radiofrequency Ablation for Superficial Venous Incompetence: A Systematic Review and Meta-analysis

BACKGROUND Chronic venous disease is a debilitating condition involving great saphenous vein (GSV) incompetence. OBJECTIVE To investigate the efficacy and effectiveness of cyanoacrylate embolization (CAE) versus radiofrequency ablation (RFA) in patients with incompetent GSVs. MATERIALS AND METHODS PubMed, Embase, and the Cochrane library were searched. The primary outcomes were the Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), closure rate, and visual analog scale (VAS) for pain. RESULTS This meta-analysis included 378 and 590 patients who underwent CAE and RFA, respectively. Cyanoacrylate embolization was comparable with RFA in VCSS (weighted mean difference [WMD] = −0.03, 95% confidence interval [CI]: −0.18 to 0.12, p = .686), AVVQ (WMD = −0.08, 95% CI: −0.38 to 0.21, p = .570), closure rate (odds ratio [OR] = 0.61, 95% CI: 0.18–2.01, p = .414), and VAS (standardized mean difference [SMD] = 0.24, 95% CI: −0.59 to 1.06, p = .523). There were no significant differences between CAE and RFA regarding the occurrence of phlebitis (OR = 1.22, 95% CI: 0.70–2.13, p = .479) and pigmentation (OR = 0.48, 95% CI: 0.18–1.31, p = .153), but CAE had a lower risk of ecchymosis (OR = 0.45, 95% CI: 0.25–0.81, p = .007) and paresthesia (OR = 0.16, 95% CI: 0.03–0.99, p = .049). CONCLUSION Cyanoacrylate embolization and RFA demonstrated no significant differences in VCSS, AVVQ, closure rate, and pain score for patients with incompetent GSVs. Patients in the CAE group had a lower risk of ecchymosis and paresthesia compared with the RFA group.