Endovenous laser and RF are the gold standard in venous ablation
MOCA is derived from the English term "Mechanochemical ablation" and means "mechanical + chemical vein ablation". MOCA was first described in 2011 and, like other ablation methods, is used to destroy veins with venous insufficiency causing varicose veins. In MOCA, mechanical + chemical effects, not heat, are used for this purpose. The procedure is generally similar to laser or radiofrequency ablation. After entering the vein to be ablated under ultrasound guidance, the MOCA catheter is inserted into the vein. With MOCA catheter, mechanical damage is created with a very fast rotating wire, while chemical damage is created with a sclerosing (destructive) substance injected slowly through the catheter. With this dual effect, the incompetent vein is destroyed and eliminated by the body over time.
The advantages of MOCA are that it may not require tumescent anesthesia and does not cause thermal damage to the surrounding tissue. The fact that it does not require tumescent anesthesia provides convenience especially for physicians who do not have ultrasound experience and therefore have difficulties with tumescent anesthesia. However, the patient is also deprived of the benefits of tumescent anesthesia. For example, while thrombophlebitis (clotting) is very rare in laser and RF ablation where blood in the vein is emptied with tumescent anesthesia, it is much more common in MOCA. In contrast, MOCA may be safer than laser and RF in the area below the knee, since the surrounding tissue damage is less. MOCA is a relatively new method and has not been used as much as laser and RF. Despite that, the results of studies on great saphenous vein and small saphenous vein ablations have demonstrated that the method is quite successful. In conclusion, MOCA is a successful ablation technique that has advantages and disadvantages compared to thermal ablation methods such as laser and RF and can be used in suitable patients. Although MOCA is actually introduced as a technique that does not require anesthesia, we think that doing it with tumescent anesthesia will increase the efficiency and safety.
Application of tumescent anesthesia may increase efficiency and safety of MOCA ablation also.