A Systematic Review on Ablation Techniques for Larger Saphenous Veins in Patients with Symptomatic Superficial Venous Disease.

OBJECTIVE: To summarize the existing evidence for the treatment of saphenous veins >10 mm in diameter, determine whether there were vein size limits for treatment modalities and if there are specific technical considerations for treatment of large veins.

METHODS: We searched the literature for reports of treatment methods and outcomes for patients with large-diameter saphenous veins treated with various ablation methods between 1993 and 2023. These studies were evaluated for the size of the vein determined as "large diameter," type of ablation method, study type, outcomes, adverse events, and any technical considerations noted. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The COVIDENCE software was used for full-text screening and data extraction. Three reviewers reviewed the data, and the content expert served as the tiebreaker.

RESULTS: Seventy-one records were identified, of which, twenty-four studies were deemed appropriate for extraction. Most of the studies identified reported outcomes of endovenous thermal ablation (EVTA) modalities. There were fewer studies on non-thermal non-tumescent techniques (NTNT) and these studies reported an overall lower occlusion rate compared to EVTA techniques.

CONCLUSIONS: Large head-to-head trials or randomized controlled that compare all the modalities over a long follow-up duration are yet to be performed. In the existing literature, there is considerable heterogeneity in terms of the study size, design, definition of large veins, site of vein measurement and follow-up periods making it challenging to make fair comparisons and draw firm conclusions. Currently available evidence supports the use of endothermal ablation techniques for the treatment of veins > 10 mm in diameter as they have a more favorable efficacy and safety profile and have a larger body of evidence available compared to NTNT techniques or surgery.