Great saphenous vein (GSV) incompetence can be treated by open surgery or endovenous modalities; comparative effectiveness and safety across techniques remain variably reported. This study aimed to compare endovenous laser ablation (EVLA), radiofrequency ablation (RFA), endovenous steam ablation (EVSA), and surgery for efficacy, safety, and patient-reported outcomes in randomized controlled trials (RCTs). PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were scrutinized, supplemented by citation searching. RCTs enrolling adults with primary truncal venous reflux (predominantly GSV) and comparing EVLA, RFA, EVSA, or surgery; outcomes included anatomic success (occlusion/reflux-free on duplex), complications (nerve injury), reand patient-reported measures (VCSS, AVVSS/AVVQ). Adults undergoing EVLA, RFA, EVSA, or high ligation with stripping; trials ranged from single- to multicenter and included short- to long-term follow-up. Two investigators screening and extraction and risk of bias assessed across randomization, deviations from intended interventions, missing data, outcome measurement, and reporting. Both random- and fixed-effects meta-analyses were applied to pool risk ratios (RRs) or mean differences (MDs). Between-study heterogeneity was quantified using the I² statistic, small-study effects were evaluated using funnel plots and Egger’s test, and leave-one-out sensitivity analyses were undertaken. Of 1,824 database records, 57 full texts were assessed; 38 reports representing 27 RCTs were included in qualitative and quantitative synthesis. EVLA vs. surgery for occlusion showed no difference (10 eligible reports; RR = 0.98, 95% CI 0.90–1.06; p = 0.63; I² = 0%). EVLA vs. RFA was likewise equivalent (10 eligible reports; RR = 1.01, 95% CI 0.95–1.07; p = 0.80; I² = 0%). RFA vs. surgery showed no difference (5 eligible reports; RR = 1.00, 95% CI 0.89–1.13; p = 0.94; I² = 0%). EVLA reduced nerve injury versus surgery (10 eligible reports; RR = 0.47, 95% CI 0.29–0.76; p < 0.01; I² = 0%); EVLA vs. RFA and RFA vs. surgery showed no significant differences. VCSS, AVVSS, and AVVQ improvements were comparable between modalities. EVSA was non-inferior to EVLA, and UGFS showed inferior long-term anatomic durability versus EVLA/RFA/surgery. EVLA and RFA achieve anatomic success equivalent to surgery with fewer sensory complications for EVLA and similar patient-reported benefits. EVSA appears promising but requires more long-term RCTs, while UGFS is less durable for primary GSV reflux. Registration INPLASY202590092 (https//doi.org/10.37766/inplasy2025.9.0092).
Sayarer et al. (Sat,) studied this question.