Physicians over centuries have experimented and studied different approaches to providing relief for patients. The gamut of therapies range from large incisions and physically stripping the veins to injecting salt or sugar water or various chemicals into them. In the last 15-20 years, we shifted from checking patients into the hospital, putting them under anesthesia, and surgically “stripping” the vein out to less invasive treatments using lasers or radiofrequency energy to thermally ablate the vein. Although these techniques are well studied and show 90+ percent success rates, they involve injecting an anesthetic multiple times along the course of the vein in order to prevent other soft tissue from burning during the procedure (burning the vein is okay, but the tissue surrounding it would be very bad). Although much less invasive than vein stripping, physicians and patients are looking to technology to take “minimally invasive” to a new level.
NTNT, is a category of advanced vein treatments gaining popularity in the venous community. NTNT stands for Non Thermal Non Tumescent. They are vein treatments that rely on non thermal techniques to ablate or destroy the vein. Examples include chemical, adhesive, and mechanical combined with chemical solutions to inject into the vein using ultrasound guidance and compression maneuvers. Because these treatments do not require tumescent or anesthesia, one can literally have a treatment with just one needle stick. This also translates to less downtime or time off. There is less pain, bruising, and swelling.
So why are we still doing RF or laser ablations instead of NTNT treatments on everyone? Currently, only Medicare and a few private payers will cover these procedures. Preliminary data is promising and the success rates appear to be the same as RF or laser. We believe the other payers will follow suit. However, there are still some indications that make RF or laser a better choice, in particular, if you have very large varicose veins or a medical history of allergies or intolerance to certain medications. It’s important to talk to your vein doctor about the different types of treatments and if NTNT is right for you.
Curious about learning more about NTNT therapies? You can view the resources below for more information.