Does concomitant treatment of tributary varicose veins improve the results of standard endovenous thermal ablation of the great or small saphenous trunk? A systematic review and metanalysis

The optimal management of tributary varicose veins during Endovenous Thermal Ablation (EVTA) of the saphenous trunk for Chronic Venous Disease (CVD) remains an area of ongoing clinical debate. This study compares the “hybrid” approach (EVTA with concomitant treatment of tributaries) with the “standard” approach (EVTA alone). A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched up to December 2025 for comparative studies, including Randomized Controlled Trials (RCTs) and observational studies (Supplementary Table 1). The primary outcome was the need for re-intervention for residual or recurrent varicose veins at ≥1 year. Secondary outcomes included improvement in Quality of Life (QoL) and clinical severity, assessed using validated scores. A random-effects model was used to calculate pooled Odds Ratios (ORs). Nine studies enrolling 1,954 patients were included; re-intervention data for the primary outcome were available for 1,830 patients (916 hybrid; 914 standard). Meta-analysis showed that hybrid treatment significantly reduced the need for re-intervention compared with standard treatment, with a pooled OR of 0.15 (95% CI: 0.04-0.62; p=0.009, I2=93%). Clinical severity scores were significantly lower in the hybrid group, and most studies reported a faster improvement in QoL. Complications were uncommon and similarly distributed between groups. Hybrid treatment appears to reduce re-intervention rates compared with isolated saphenous trunk ablation and may accelerate clinical improvement. This strategy should be considered a preferred approach in patients with saphenous insufficiency and significant tributary varicose veins.