Efficacy and Safety of Sclerosants in the Treatment of Venous Malformations: A Network Meta-Analysis of Randomized Controlled Trials

Background: Venous malformations (VMs) are the most common low-flow vascular malformations. Various sclerosants have been shown to be effective, but their relative effects are not well established. Methods We performed a Bayesian network meta-analysis (NMA) to assess the efficacy and adverse effects of different sclerosants for VMs. We searched PubMed, Embase, Cochrane Library, Scopus and Web of Science for randomized clinical trials up to April 1, 2021. We estimated odds ratios using pairwise and network meta-analysis with random effects. We also calculated the surface under the cumulative ranking curve for each treatment and carried out the cluster analysis. Findings: A 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 statistically significantly superior to ethanol and sodium morrhuate in safety. Bleomycin foam was ranked high as the most effective treatment, but the evidence stems from one small study and most comparative effect estimates were not statistically significant. Ethanol ranked second only to bleomycin foam in efficacy. SUCRA cluster analysis demonstrated that bleomycin, polidocanol, polidocanol foam, bleomycin combined with dexamethasone and polidocanol combined with bleomycin are the five treatments with higher SUCRA values for both outcomes compared with the second group of sodium morrhuate and sodium tetradecyl sulfate. Last cluster only included ethanol, characterized by the relatively good efficacy and obvious side effects. Interpretation: Polidocanol foam and ethanol are more effective than bleomycin and sodium morrhuate in VMs, while ethanol and sodium morrhuate are associated with severe adverse effects. Funding: None to declare. Declaration of Interest: None to declare.