A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies to Study the Efficacy of Ultrasound-Guided Foam Sclerotherapy for Varicose Vein Treatment

Varicose veins are common disorders that affect the quality of life of sufferers due to the symptoms they cause. The efficacy of different varicose vein treatments has been studied extensively, with varying success rates. Less invasive treatments, such as sclerotherapy, can be mentioned among the proposed therapies. This study investigates the efficacy of ultrasound-guided foam sclerotherapy (UGFS) for treating varicose veins. In this study, the results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol. By searching in 11 databases as well as the Google Scholar search engine using the keywords “varicose vein,” “foam sclerotherapy,” “occlusion,” “success,” “Duplex-guided foam sclerotherapy,” “efficacy,” and “Ultrasound-Guided Foam Sclerotherapy,” randomized clinical trial (RCT) and cohort articles published until July 2022 were collected. The required information was extracted and analyzed using Comprehensive Meta-analysis (CMA) software version 2. Data analysis of 35 randomized clinical trial articles showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 78% (95% CI: 73–83; P value < 0.001) ( I 2 = 89.11, P value < 0.001). The subgroup analysis showed that the success of this method is more in the form of sodium tetradecyl sulfate and polidocanol 2% foam and in a period of fewer than 3 months from the start of treatment and in the Asian race. Also, the analysis of 8 cohort studies showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 81% (95% CI: 65–91; P value < 0.001). The most prevalent complications of this method in the treatment of varicose veins were induration, thrombophlebitis, bruising, dyspigmentation, hematoma, pain, and phlebitis. Present study illustrated that the effectiveness of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is high. However, it was significantly less successful than published meta-analyses on other less invasive methods such as radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). Also, this method showed more major complications than our previous study on the effect of endovenous laser ablation in the treatment of varicose veins. Factors such as foam type, follow-up duration, and racial differences can affect the study’s results.