Comment to: La technique START (Sclerotherapy in tumescent anaesthesia of reticular veins and telangiectasias), by Ramelet AA. Phlebologie 2012

(Also appeared as: Sclerotherapy in tumescent anesthesia of reticular veins and telangiectasias. Dermatol Surg 2012;38:748–51.)

Having observed that treating telangectesias during the same phlebectomy session gave better results, the Authors began to associate to the sclerotherapy (Polidicanol foam 0.25-0.50%) a tumescence made with Ringer solution, in some cases adding lidocaine-epinephrine. This is carried out either before, during or after sclerotherapy, usually with a 20-50 mL syringe or by a perfusion pump. After the procedure, the patient rests for a few minutes, and then puts on 20-30 mmHg stockings; these will be used for three weeks.
During the last six years, 300 patients presenting refractory telangectasias (not disappearing after 3 treatments) or large telangectatic areas otherwise needing several sessions, were selected. Patients who preferred to receive the sclerotherapy treatment in local anesthesia were also included.
The results were very good; the majority of the patients needed only one session, and a stable outcome was achieved. Complications, such as hematoma, thrombosis, pigmentation, small necrosis and matting, although a possible complication with Polidocanol, were more frequent than usual, probably due to the higher risk associated with this difficult pathology. The efficacy of this technique may be related to the high perivenous pressure achieved during and after treatment, lasting at least an hour, similar to that suggested by Thibault and Parsi (i.e. infiltration of the saphenous space after saphenous injection).