Efficacy and Safety of Endovenous Microwave Ablation Versus Endovenous Laser Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency: A Meta-Analysis.

BACKGROUND

Although guidelines have established endovenous laser ablation (EVLA) as the first-line option for patients with varicose veins (VVs) in chronic great saphenous vein (GSV) insufficiency; however, chronic vein insufficiency remains a significant health-care burden. Endovenous microwave ablation (EMA) is a promising alternative. This review aims to analyze EMA versus EVLA for VVs in chronic GSV insufficiency.

METHODS

Randomized controlled trials (RCTs) and cohort studies across PubMed, Scopus, Science Direct, and the Cochrane Library up to November 11, 2024 were searched. Risk of bias was evaluated using the Cochrane Risk of Bias Tool for RCT and Newcastle-Ottawa Scale for Cohort studies. Meta-analysis was done using Review Manager 5.4.0 using an inverse variance random-effects model with Duval and Tweedie trim-and-fill sensitivity analysis.

RESULTS

Overall, a total of 2 RCTs and 1 cohort study included. In treating GSV VVs, EMA has proven to have shorter duration of operation significantly compared to EVLA (mean difference: -6.62 [95% confidence interval: -11.91 to -1.32, P = 0.01]) although heterogeneity is high. EMAs have similar profiles in efficacy compared to EVLA (Aberdeen score of quality of life, visual analog scale score, length of hospital stays, and recanalization rate in 6 months). In terms of safety, the incidence of ecchymosis was found to be lower in the EMA group compared to the EVLA group significantly (odds ratio: 0.58). Other safety profiles were found to be similar.

CONCLUSION

EMA might lower operating time, potentially reducing procedure risks, and is equally effective as EVLA in treating VVs in chronic GSV insufficiency. Further research comparing these techniques with extended follow-up periods (over 12 months) and standardized study methodologies are still needed.