In-Soo Park
Nationality
Korea
Current Position
MD / Director
Organization
Charm Vascular Clinic
Venous Reflux Session

Topic: Strategies for varicose vein treatment with MOCA technique

Abstract

MOCA is a NTNT which is known to have less pain, no nerve damage, and a faster recovery compared to conventional thermal treatment. Many studies have been published on the equivalent efficacy compared to conventional treatments. However, it is also true that there are limitations. Based on the experience of treating about 900 patients using MOCA ClariVein from June 2018, the author intends to share the experience to treat them more strategically and efficiently.
First, for the dose of the sclerosant, it seems that up to 3% 10cc can be used on STS basis. Converting this, it seems possible up to 1.5% 20cc or 2.0% 15cc. In my experience, there was one patient who developed acute kidney injury after using 1.5% 18cc. However, there seems to be no problem up to 15cc. Approximately, 1cc STS can cover 5cm length, so 15cc can be up to 75cm. Therefore, AK lesion of both GSVs can be treated in patients who are not tall. However, both GSVs can be difficult to treat if the patient is tall or consider BK treatment.
Second, there are many studies using 1.5% concentration on an STS basis. However, there are some reports that the closure rate increases when the concentration increases. In my experiences, in terms of the closure rate, it seems to be more advantageous to use 2% rather than 1.5%.
Third, care should be taken when treating epifascial GSV. In my experiences, thrombophlebitis and pigmentation appear more frequently, and there are a study supporting this. In the case of epifascial segments, it seems better to strategically use skipping partial segment or partial stripping.
Fourth, when the wire becomes a stuck or is excessively bent, the metallic wire catheter may be damaged. In this case, it is difficult to inject a certain amount of sclerosant, which can lead to incomplete treatment. Therefore, it is important to escape quickly when it becomes a stuck, and to manage the catheter well so that it does not rapidly angulate. Also, although it is rare, there is a battery issue, and since mechanical rotation is not enough.
MOCA ClariVein has many advantages compared to other treatments, but running curve is little long and we need a more delicate attention. I personally think it's an interesting treatment.

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