Treatment modalities for small saphenous vein insufficiency: Systematic review and meta-analysis

Doeke Boersma*, Verena N.N. Kornmann, Ramon R.J.P. Van Eekeren, Ellen Tromp, Çagdas Ünlü, Michel M.J.P. Reijnen, Jean Paul P.M. De Vries

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

66 Citations (Scopus)


Purpose: To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. Methods: A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A randomeffects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. Results: The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). Conclusion: Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.

Original languageEnglish
Pages (from-to)199-211
Number of pages13
JournalJournal of Endovascular Therapy
Issue number1
Publication statusPublished - 1 Feb 2016
Externally publishedYes


  • Endovenous laser ablation
  • Foam sclerotherapy
  • Incompetent vein
  • Mechanochemical ablation
  • Meta-analysis
  • Pharmacomechanical ablation
  • Radiofrequency ablation
  • Reflux
  • Small saphenous vein
  • Varicose vein
  • Venous insufficiency


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