OBJECTIVES

: Cyanoacrylate embolization (CAE) with the VenaSeal™ Closure System is a relatively new technique for varicose vein treatment. There is paucity of data on the performance of CAE relative to other available treatments. Therefore, this study aimed to establish the safety and efficacy of CAE compared to multiple treatment options for varicose veins through a network meta-analysis (NMA).

METHODS

: A systematic literature review of RCTs comparing two or more of the available treatments (surgery, foam sclerotherapy, laser, RFA, and cyanoacrylate) was considered for the analysis. Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. Frequentist NMA conducted in accordance with the general principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the ISPOR guidelines, was applied to synthesize the direct and indirect evidence between VenaSeal™ and all other treatment arms.

RESULTS

: The literature review identified 3,225 studies, among which 19 RCTs were finally included for the NMA based on the inclusion criteria. As there were no direct studies comparing CAE with surgery and other treatment modalities for varicose veins, a network was created with 1-7 studies included in each network. The anatomic success of CAE at follow-up was the highest (predicted means estimate 0.99; 95% CI, 0.92-1.00) followed by RFA (0.96; 95 % CI, 0.89-1.00), which was higher than all other treatment arms including surgery (0.76; 95% CI, 0.71-0.81). CAE led to significant improvement in other clinical outcomes including venous clinical severity score (P<0.0001), pain reduction (P<0.0088) and quality of life measures (P<0.0001) compared to surgery. CAE was not associated with any serious adverse events.

CONCLUSIONS

: In the absence of head-to-head trials comparing CAE with other techniques except RFA, this NMA indicates that CAE is superior to surgery and non-inferior to other treatment modalities for varicose veins.