A systematic review and network meta-analysis of the effectiveness of sclerotherapy for venous malformation.

OBJECTIVES: Sclerotherapy for venous malformation has been widely used; however, there are no guidelines to assess the effectiveness of different sclerotherapy agents. We conducted a systematic review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformation.

METHODS: Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias by various approaches.

RESULTS: Seven studies with 547 patients in six arms were included in the study. We defined response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to response (ethanol vs. bleomycin, ethanol vs. polidocanol, ethanol vs. sodium tetradecyl sulfate, polidocanol vs. sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. Based on the evidence network, it was revealed that in response, ethanol ranked first, followed by pingyangmycin, polidocanol, sodium morrhuate, bleomycin, and finally sodium tetradecyl sulfate; in complete response, pingyangmycin had the best results, followed by sodium morrhuate, polidocanol, ethanol, bleomycin, and finally sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling and necrosis, occurred mostly in the ethanol group and rarely in the other groups. Owing to limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. There was no verified inconsistency or publishing bias to be detected in this study via the existing approaches.

CONCLUSIONS: Ethanol showed a statistically better response than the other agents. However, ethanol also acquired the highest complications. Pingyangmycin showed second-best response, best complete response, and low rate of complications, respectively. Overall, pingyangmycin achieved excellent performance and balance in terms of different outcomes. However, they were not adequately recommended based on the available data. More superior trials, especially randomized controlled trials, are needed in the future.