Novel Nonthermal versus Thermal Endovenous Ablation in Superficial Venous Incompetence: A Systematic Review and Meta-analysis of Comparative Studies

Objective: In recent years novel nonthermal ablation (NTA) techniques in the form of mechano-chemical ablation (MOCA) and cyanoacrylate vein ablation (CAVA) techniques have been suggested to further reduce peri-operative morbidity. This study compares the use of both thermal and novel nonthermal endovenous ablative techniques in the management of superficial venous incompetence. Methods: A search of online databases was performed in December 2018. Comparative studies comparing NTA with thermal ablation (TA) were included. The primary outcome was technical success. Secondary outcomes including operative pain, complications, modification of disease severity and quality of life. Results: Six studies describing 1 236 participants and 1 256 truncal ablations were analysed. Regarding overall technical success 458/483 (94.8%) of those receiving NTA and 521/553 (94.2%) undergoing TA had successful truncal ablation at the study endpoint (pooled risk ratio [RR] = 1.01, 95% confidence interval [CI] 0.99 – 1.04). Subgroup analysis identified no difference at various time points up to 36 months. Postprocedural pain was generally lower in those undergoing NTA with a mean difference of –18.11 (95% CI –36.7 to 0.48). Those undergoing NTA experienced significantly lower rates of ecchymosis (RR = 0.43; 95% CI 0.23 – 0.78) with no difference identified with regard to rates of paraesthesia, phlebitis, and skin pigmentation. Further assessment of quality of life (mean difference –0.27, 95% CI –0.57 to 0.04) and venous clinical severity scores (–0.52, 95% CI –1.05 to 0.01) revealed no difference between groups. Included data were deemed of moderate methodological quality. Conclusion: Nonthermal techniques are as effective as standard TA with fewer peri-operative complications. Furthermore, quality of life and modification of disease severity data tended to favour NTA.