title: Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  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 random-effects 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands doekeboersma@gmail.com.
authors.forename: Doeke
authors.initials: D
authors.lastname: Boersma
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Verena N N
authors.initials: VN
authors.lastname: Kornmann
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Ramon R J P
authors.initials: RR
authors.lastname: van Eekeren
authors.affiliation: Department of Epidemiology and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Tromp
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Çagdas
authors.initials: Ç
authors.lastname: Ünlü
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Michel M J P
authors.initials: MM
authors.lastname: Reijnen
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
mesh_terms: D017115:Catheter Ablation / Q000009:adverse effects; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D015911:Sclerotherapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014689:Venous Insufficiency / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*
keywords: endovenous laser ablation; foam sclerotherapy; incompetent vein; mechanochemical ablation; meta-analysis; pharmacomechanical ablation; radiofrequency ablation; reflux; small saphenous vein; varicose vein; venous insufficiency