Interventions for the treatment of lower limb telangiectasias and reticular veins: a systematic review and network meta-analysis.

Abstract

Objective: To assess the safety and efficacy of available interventions in the treatment of lower limb reticular veins and telangiectasias.

Data sources: An electronic research was performed on Scopus, Embase, and Google scholar.

Review methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Following data extraction and processing, a Bayesian network meta-analysis and meta-regression was undertaken. The primary endpoint was telangiectasia-reticular vein clearance.

Results: Nineteen studies, 16 randomised controlled trials and three prospective case series, including 1 356 patients and 2 051 procedures, were finally incorporated. All interventions, apart from 0.5% sodium tetradecyl sulfate (STS) and 0.25% STS displayed statistically significant superior telangiectasia-reticular vein clearance compared with normal saline (N/S), Meta-regression analysis employing the type of the venule treated (telangiectasia or reticular vein) as a covariate, revealed a positive correlation between Nd:YAG 1064-nm laser and telangiectasia clearance (β = 1.38, 95% CI 0.56 - 2.14). Further exploration unveiled the superiority of Nd:YAG 1064-nm in the treatment of telangiectasias compared with all included interventions except 72% chromated glycerin (CG). STS 0.25% increased the risk for hyperpigmentation compared with all interventions besides 0.5% STS, and 1% polidocanol. CG 72% decreased the risk for matting compared with polidocanol foam (risk ratio [RR] 0.14, 95% CI 0.02 - 0.80) and STS (RR 0.31, 95% CI 0.07 - 0.92). Non-statistically significant differences were identified between interventions regarding pain outcomes.

Conclusion: This network meta-analysis has displayed a proportional relationship between sclerosant potency and side effect occurrence in the treatment of telangiectasias-reticular veins and the superiority of laser therapy compared with injection sclerotherapy in treating telangiectasias. The transition of telangiectasia-reticular vein treatment from highly potent detergent solutions to equally effective but milder sclerosants could potentially reduce undesirable adverse events.