Comparison of polidocanol endovenous microfoam (Varithena) to physician-compounded foam in sclerotherapy treatment of truncal varicosities: A systematic review and network meta-analysis

Background Commercial pre-mixed foam sclerosants such as Varithena TM , 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 TM compared to PCFs in foam sclerotherapy for the treatment of truncal varicose veins. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42024494805) using Medline and EMBASE databases from inception to 17 th June 2025 by two reviewers. Randomised controlled trials that reported on occlusion rates following truncal varicose vein treatment with foam sclerotherapy were included. A network meta-analysis was performed. Results Six randomised controlled trials with a total of 1,726 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 TM and PCF with respect to occlusion rates at follow-up (RR 1.12, 95% CI 0.93-1.35, I 2 =71%). Moreover, similar rates of adverse events were observed between Varithena TM and PCF groups (RR 2.89, 95% CI 0.64-12.97, I 2 =0%). Compared to foam sclerotherapy with Varithena TM , 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 TM was superior to or associated with less complications than PCFs Further trials are required to define the role of Varithena TM in the treatment of varicose veins, especially within the context of cheaper alternatives.