Original Title: Tratamiento endovascular de venas varicosas en extremidades inferiores: Ablación por radiofrecuencia y mediante adhesivo venoso cianocrilato

Authors' objectives: To assess the safety and efficacy of radiofrequency thermal endovenous ablation or of endoluminal closure with cyanoacrylate in the treatment of varicose veins compared to other endovenous techniques or surgery. To analyse patient perspectives and preferences for the endoluminal techniques covered in this report.

Authors' results and conclusions: The published evidence on efficacy and safety seems to suggest that both CA sealing and endovenous ablation via RFA are not inferior to their comparators, i.e. thermal techniques (RFA or LA) in the first case, and LA or surgery in the second. The duration of CA intervention was shorter than thermal endovenous ablation techniques (RFA or LA), and the recovery time was similar to RFA, but shorter than LA. Furthermore, no differences were found between RFA or LA endovenous ablation with respect to these variables. Compared to varicose vein surgery, the evidence seems to suggest that RFA endovenous ablation has a shorter procedure and patient recovery time. After reading the full text, 2 systematic reviews, 13 primary studies on safety and/or efficacy and 4 ongoing studies were included. Regarding the systematic reviews, one of them evaluates the clinical efficacy of endoluminal closure using CA, while the other one focuses on the evaluation of endovenous ablation using RFA. Of the included primary studies, 2 evaluate CA versus endovenous ablation by LA, RFA or surgery (with or without stripping) and 9 compare RFA versus LA or surgery (with or without stripping). Based on the evidence reviewed, the main clinical outcomes of the endoluminal techniques evaluated are summarised below: -Both CA sealing and endovenous ablation with RFA had an occlusion rate (60- 90%) and survival free from renacalisation (90%), evaluated in the long term (36-60 months) no lower than the comparison techniques (RFA or LA in the first case and LA or surgery in the second). -No significant differences in clinical severity and quality of life were reported in patients treated with CA or RFA compared to the comparator group (RFA or LA and LA or surgery respectively) (up to 60 months), with both groups showing an improvement over baseline values. -CA sealing or endovenous ablation with RFA does not appear to be associated with an increased rate of major adverse events (pulmonary thromboembolism or deep vein thrombosis) or minor adverse events (pain, phlebitis, ecchymosis, cyst, scarring, etc.). -In addition, the studies reviewed showed that the procedure time of CA sealing was shorter than that of thermal endovenous ablation techniques (RFA or LA), while the recovery and return to daily activities/work of the patient treated with CA was similar to the group treated with EVA, but shorter than the group treated with LA. Furthermore, no differences were found between RFA or LA with respect to the aforementioned variables. However, the evidence seems to suggest that endovenous ablation by RFA has a shorter intervention and patient recovery time than varicose vein surgery. -Three of the RCTs reviewed found that the level of satisfaction of patients treated with CA or RFA was between 80-99%, with most patients expressing a willingness to undergo reintervention if necessary.

Authors' recommendations: Not reported

Authors' methods: Specific search strategies were designed to identify studies assessing the efficacy and safety of endoluminal sealing with CA and endovenous thermal ablation with RFA, as well as patient perspectives and preferences. These searches were carried out in August 2020 in the principal biomedical databases. Study specific tools were used to assess the risk of bias of the studies. Both the data extraction from the studies and the synthesis and assessment of the evidence were performed by two investigators independently and blindly.

Authors' identified further research: Not reported

Project Status: Completed

Year Published: 2020

URL for published report: https://runa.sergas.gal/xmlui/bitstream/handle/20.500.11940/14821/CT202101Ablacion%20varices.pdf?sequence=1&isAllowed=y

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)