Mechanical occlusion chemically assisted ablation (MOCA) and high intensity focused ultrasound (HIFU) for chronic venous disease

Endovenous ablative technologies continue to evolve. Currently, all endovenous technologies can be classified under two general categories: thermal tumescent (TT) or nonthermal nontumescent (NTNT), first introduced in 2014.1 A new category has since been added: thermal nontumescent (TNT) with the development of HIFU. This will be discussed later in this chapter. The TT technologies include radiofrequency and laser. NTNT technologies encompass MOCA ablation, cyanoacrylate, ScleroSafe, and polidocanol endovenous microfoam, with others continuing to emerge. The NTNT segment is the fastest growing due to some inherent advantages: minimal nerve or skin injury, safety when clinically indicated to treat disease below the knee and/or to the ankle, decreased patient discomfort due to the decreased needle sticks by avoiding tumescence, and the elimination of any capital equipment (generator). As with TT techniques, all NTNT approaches can be performed in an office setting in under an hour. Most patients can return to normal activity almost immediately (Table 45.1).2,3