Cryo-Laser Cryo-Sclerotherapy Versus Isolated Sclerotherapy for Telangiectasias and Reticular Veins a Systematic Review and Meta-Analysis

Objective To compare the incidence of adverse events between cryo-laser cryo-sclerotherapy (CLaCS) and isolated sclerotherapy for lower limb telangiectasias and reticular veins, and to determine pooled adverse event rates after CLaCS. Methods PubMed, Embase, and Cochrane CENTRAL were searched from inception through February 2025 for studies of adults with telangiectasias or reticular veins (CEAP C1-C2) treated with CLaCS, reporting quantitative adverse event data. Risk ratios (RR) were pooled using Mantel-Haenszel random-effects models for comparative studies. Single-arm proportions were pooled using Freeman-Tukey double arcsine transformation. Primary outcomes were telangiectatic matting, microthrombi formation, and hyperpigmentation. Secondary outcomes were ecchymosis and skin necrosis. An additional single-arm pooled proportion of satisfactory vessel clearance was estimated as a secondary efficacy outcome. Results Six studies (813 patients) were included; 3 provided direct comparative data (363 CLaCS vs 259 sclerotherapy). CLaCS was associated with significantly lower rates of matting (RR, 0.07 [95% CI, 0.01-0.36]), microthrombi (RR, 0.18 [95% CI, 0.06-0.54]), and ecchymosis (RR, 0.43 [95% CI, 0.32-0.58]). No significant difference was found for hyperpigmentation (RR, 0.29 [95% CI, 0.06-1.44]; I 2 = 92.1%) or skin necrosis (RR, 0.13 [95% CI, 0.02-1.00]). Pooled single-arm rates after CLaCS were 0.00% for matting, 0.00% for skin necrosis, 6.31% for microthrombi, 7.38% for hyperpigmentation, and 22.41% for ecchymosis. The pooled single-arm rate of satisfactory vessel clearance after CLaCS was 90.68% (95% CI, 76.74%-98.87%; I 2 = 94.6%) across 5 studies (548 patients). Patient satisfaction, reported in 3 studies and synthesized narratively due to instrument heterogeneity, was consistently high (∼85%-90%) across techniques. Conclusions CLaCS was associated with significantly lower rates of matting, microthrombi, and ecchymosis compared with isolated sclerotherapy, with near-zero incidence of matting and skin necrosis. High heterogeneity in hyperpigmentation highlights the need for trials with standardized outcome measures. CLaCS also achieved a high pooled rate of satisfactory vessel clearance and consistently high patient satisfaction across studies, supporting its efficacy alongside its favorable safety profile.