Albert-Adrien Ramelet

Complications of Ambulatory Phlebectomy

BACKGROUND. Ambulatory phlebectomy, as described by Muller, IS a remarkable esthetic, effective, and cost‐sparing technique for definitive removal of varicose veins. As this technique is becoming more and more popular, potential complications and incidents have to be recognized by all phleboiogists. OBJECTIVE. To review all possible complications after ambula‐tory phlebectomy and establish their frequency, relevance, treatment, and prevention. METHODS. Extensive review of the European and American literature devoted to phlebectomy, with particular consideration of the complications, are discussed in comparison with the authors personal experience. CONCLUSIONS. Notable adverse incidents after ambulatory phle‐bectomy are rare. Minor inconveniences are common, depending partially on surgical indications, operators skill, and experience. Adequate training allows one to minimize untoivard reactions. A great risk of ambulatory phlebectomy is the presumed facility of this surgical technique combined with its easy accessilyiUty to poorly trained physicians in phlebology and dermatologic surgery.

Delayed Nicolau's livedoid dermatitis after ultrasound-guided sclerotherapy.

Nicolau’s livedoid dermatitis (NLD) is a rare adverse effect of intramuscular injection. Pain at the site of injection is acute, massive, and immediate. It precedes the occurrence of a livedoid plaque that usually evolves toward skin necrosis. We report the first case of delayed NLD after ultrasoundguided injection of polidocanol foam. Surprisingly, pain and signs of cutaneous ischemia happened after 4 symptom-free days. Under steroid and heparin therapies, the patient healed without sequelae.

Sclerotherapy in Tumescent Anesthesia of Reticular Veins and Telangiectasias

Background Some leg telangiectasias may be refractory to treatment, including sclerotherapy and lasers. Objective To describe the innovative Sclerotherapy in Tumescent Anesthesia of Reticular veins and Telangiectasias (START) approach to achieving good results in such patients, which also proves effective in treating reticular veins. Method Because compression enhances the rate of success of sclerotherapy of C1 veins (telangiectasias and reticular), Ringer solution (with or without lidocaine‐epinephrine) was injected subcutaneously before, during, or immediately after sclerotherapy of therapy‐refractory C1 veins. This tumescence ensures an intratissular compression of the injected vessels for at least 1 hour. Results In the last 6 years, we have treated more than 300 patients. Telangiectasias that had resisted several previous treatments faded or disappeared in the majority of the cases treated, but the rate of complications (pigmentation, necrosis of small areas, and tiny scars) was higher than with usual sclerotherapy. Conclusion Developed after observing the good results achieved by perioperative sclerotherapy of telangiectasias during ambulatory phlebectomy, the START technique is an effective and economic treatment of therapy‐resistant telangiectasias, although because the rate of complications is higher than with usual sclerotherapy of C1 veins, it should be performed only by experienced phlebologists and only on therapy‐refractory vessels.

Principles and Technique of Ambulatory Phlebectomy

Phlebectomy, first described by Cornelius Celsus (25 bc-45 ad), was performed until the Middle Ages. Not until the 1500s did phlebectomy resume with phlebectomy hooks illustrated in the Textbook of Surgery by WH Ryff, published in 1545.1 Lost again, this technique was rediscovered in 1956 by Dr Robert Muller, a Swiss dermatologist in private practice in Neuchâtel (Switzerland). Dr Muller developed his method,2,3 modestly calling it Celsus’ phlebectomy, and eagerly taught this technique to over 300 physicians who visited his office.4,5,6