Abstract
BACKGROUND: Commercial premixed foam sclerosants such as Varithena, a polidocanol endovenous microfoam, have been developed and marketed as better alternatives to physician-compounded foams (PCFs). The aim of this study was to evaluate the efficacy of Varithena compared with PCFs in foam sclerotherapy for the treatment of truncal varicose veins. METHODS: A systematic review was performed according to PRISMA and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42024494805) using Medline and EMBASE databases from inception to June 17, 2025, by two reviewers. Randomized controlled trials that reported on occlusion rates after truncal varicose vein treatment with foam sclerotherapy were included. A network meta-analysis was performed. RESULTS: Six randomized controlled trials with a total of 1726 patients were identified. Complete occlusion was defined as elimination of saphenofemoral junction reflux or occlusion of the saphenous vein on duplex imaging. The median follow-up was 39 weeks (range, 12-52 weeks). No significant difference was observed between Varithena and PCF with respect to occlusion rates at follow-up (risk ratio [RR], 1.12; 95% confidence interval [CI], 0.93-1.35; I(2) =71%). Moreover, similar rates of adverse events were observed between the Varithena and PCF groups (RR, 2.89; 95% CI, 0.64-12.97; I(2) = 0%). Compared with foam sclerotherapy with Varithena, surgical removal and endovenous laser ablation showed a significantly higher occlusion rate at follow-up (RR, 1.31; 95% CI, 1.18-1.47; I(2) =71% and RR, 1.32; 95% CI, 1.18-1.49; I(2) =71%, respectively). CONCLUSIONS: In patients with saphenous varices, there was no indication that Varithena was superior to or associated with fewer complications than PCFs Further trials are required to define the role of Varithena in the treatment of varicose veins, especially within the context of less expensive alternatives.