Update of a Living Network Meta-Analysis Comparing Non-compounded Polidocanol 1% Endovenous Microfoam (Varithena) Ablation versus Endovenous Thermal Ablation in Chronic Venous Insufficiency.

Authors

Lowell S Kabnick, Omar L Esponda, Juan C Jimenez, Lina M Vargas, Larry Gache, Diana Frame, Candace Gunnarsson, Kathleen Ozsvath

Published in

Journal of vascular surgery. Venous and lymphatic disorders. Pages 102648. Oct 26, 2026. Epub Oct 26, 2026.

Abstract

We previously published a network meta-analysis showing no statistically significant difference between commercially manufactured polidocanol 1% endovenous microfoam and endovenous thermal ablation for vein closure or deep vein thrombosis, when polidocanol endovenous microfoam was distinguished from physician-compounded foam. This living network meta-analysis updates the previous analysis comparing the effectiveness and safety of polidocanol endovenous microfoam ablation versus endovenous thermal ablation for the primary treatment of adult patients with venous insufficiency caused by lower-extremity truncal vein incompetence.
Systematic review searches following the prespecified protocol were conducted quarterly through March 2026. No changes were made to selection criteria. Vein closure, deep venous thrombosis, and ulcer healing were summarized as odds ratios with 95% confidence intervals. A composite outcome of disease-specific quality of life or symptom improvement scales was summarized with Hedges' g standardized mean difference.
The updated search yielded 507 new citations and 11 new eligible studies, for a total of 24 studies (235,413 patients). Polidocanol endovenous microfoam was not statistically different from endovenous thermal ablation for vein closure (odds ratio 0.71, 95% confidence interval 0.42 to 1.21). A sensitivity analysis at longest follow-up (mean 28 months, range 12-72 months) showed similar results (odds ratio 0.71, 95% confidence interval 0.45 to 1.11). There was no evidence of increased deep venous thrombosis risk with polidocanol endovenous microfoam versus endovenous thermal ablation (odds ratio 0.83, 95% confidence interval 0.29 to 2.43). Post-treatment improvement in disease-specific quality of life or venous insufficiency symptoms showed no statistically significant difference between polidocanol endovenous microfoam and endovenous thermal ablation (standardized mean difference [Hedges' g] 0.04, 95% confidence interval -0.16 to 0.25), though the network was not fully connected. Finally, ulcer healing data was limited, but an exploratory analysis found no evidence of a statistically significant difference.
This living network meta-analysis update reinforced the original findings that polidocanol 1% endovenous microfoam is not statistically different from endovenous thermal ablation for venous closure or deep venous thrombosis in the treatment of chronic venous insufficiency, and adds new preliminary information on outcomes relevant to the patient experience. There was no evidence of a statistically significant difference between polidocanol endovenous microfoam ablation and endovenous thermal ablation for a composite of disease-specific quality of life and symptom improvement, or for ulcer healing. The living approach maintains rigor and efficiently keeps evidence current as new studies emerge.

PMID:
42933600
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.

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