Emerging endovenous technology for chronic venous disease: Mechanical occlusion chemically assisted ablation (MOCA), cyanoacrylate embolization (CAE), and V block-assisted sclerotherapy (VBAS)

Endovenous ablative technologies continue to evolve, with the development of mechanical occlusion chemically assisted (MOCA) ablation, cyanoacrylate embolization (CAE), and V block-assisted sclerotherapy (VBAS). MOCA ablation has the longest follow-up and was the first of the new non-thermal non-tumescent (NTNT) technologies to be reported. With MOCA ablation, the vein is immediately occluded, but it takes 3–6 months longer to contract. MOCA ablation currently has the longest follow-up of any NTNT technology. CAE is another NTNT technology that has similar advantages to MOCA ablation: minimal nerve injury, no tumescence, and results that are equal to or better than thermal tumescent techniques. CAE has similar results to MOCA ablation with similar advantages. The main challenge as of this writing is reimbursement for MOCA ablation, CAE, VBAS, and polidocanol endovenous microfoam. All centers had significant radiofrequency technique experience and there was a roll-in period for CAE before trial entry so that investigators were over the learning curve.