Are Non-Tumescent Ablation Procedures Ready to Take Over?

Tumescent anesthesia refers to the percutaneous administration of large volume anesthetic to cause the target tissue to become swollen or firm. The use of tumescent anesthesia is essential for the treatment of refluxing truncal veins using endothermal technologies. In order to obviate the use of tumescent anesthesia as an adjunct to treatment, one has to evaluate the technologies that do not employ thermal energy as the modality for treatment. These technologies include foam sclerotherapy, mechanicochemical ablation (MOCA), and the use of glue (Sapheon™ closure system). The following review juxtaposes the literature supporting the use of tumescent-based techniques to the literature supporting the use of tumescent-less techniques.