Efficacy and safety of sclerosants in the treatment of venous malformations: A network meta-analysis of randomized controlled trials

Abstract

BackgroundVenous malformations (VMs) are the most common low-flow vascular malformations. Although various sclerosants are effective, their relative effects have not yet been well established. MethodsWe searched the PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases for randomized clinical trials up to April 1, 2021. We estimated odds ratios using pairwise analysis and network meta-analysis (NMA) with random-effects. We calculated the surface under the cumulative ranking curve for each treatment and performed a cluster analysis. ResultsA total of 22 randomized clinical trials (1 805 patients) comparing 11 different therapeutic regimens were identified. Polidocanol foam and ethanol showed significant improvement in VMs compared with bleomycin and sodium morrhuate, while polidocanol foam and polidocanol combined with bleomycin were significantly superior to ethanol and sodium morrhuate in terms of safety. Bleomycin foam was ranked as the most effective treatment; however, the evidence stems from one small study, and most comparative effect estimates were not statistically significant. Ethanol ranked second only to bleomycin foam in terms of its efficacy. The surface under cumulative ranking curve (SUCRA) cluster analysis demonstrated that bleomycin, polidocanol, polidocanol foam, bleomycin combined with dexamethasone, and polidocanol combined with bleomycin were the five treatments with higher SUCRA values for both outcomes compared with those of the second group of sodium morrhuate and sodium tetradecyl sulfate. The last cluster included only ethanol, which was characterized by relatively good efficacy and obvious side effects. ConclusionPolidocanol foam and ethanol are more effective than bleomycin and sodium morrhuate in treating VMs, whereas ethanol and sodium morrhuate are associated with obvious adverse effects.