Nonthermal Ablation of Saphenous Reflux

Nonthermal nontumescent (NTNT) technologies for saphenous vein ablation encompass mechanicochemical (MOCA) ablation, cyanoacrylate adhesive embolization (CAE), and polidocanol endovenous microfoam (PEM), with others emerging. The NTNT segment is the fastest growing due to some inherent advantages: minimal nerve or skin injury; safety when treating disease to the ankle; decreased patient discomfort due to the decreased needle sticks by avoiding tumescence; and the elimination of any capital equipment (generator). There are two components to the MOCA device/technique: (1) mechanical damage to the endothelium by a rotating wire, and (2) chemical installation of a detergent liquid sclerosant simultaneously. Regarding the use of CAE, a proprietary formulated cyanoacrylate adhesive is delivered into the target vein utilizing a catheter that does not allow solidification of the glue within it. Once in the vasculature, the glue sets and causes immediate occlusion. A foreign body reaction incites an inflammatory response in the vessel, ultimately leading to fibrotic occlusion. PEM is a low-nitrogen (