FAQ

Q) How did you develop this method, which I believe is the only rational therapy for varicose disease?
A) Basically, it’s a matter of common sense, a quality that is often lacking in those who are not self-critical and slavishly follow what they have been taught by outdated masters. Remember, mistakes are passed down from generation to generation and from book to book.
This method was taught to me by my father, who directed the Institute of Human Anatomy and founded the Institute of Histology. Anatomy must be considered first. Next come physiology and pathophysiology, and finally the therapy is planned. My colleagues need to answer this question: is the venous circulation two-dimensional or three-dimensional? Obviously, it is three-dimensional, and this rule out all the irrational and harmful two-dimensional therapies, such as sclerotherapy, phlebectomy, burning with lasers and gluing with Loctite. Indeed, it is a great mistake to eliminate the “gateways” through which the non-visible circulation can be treated. The “escape valves” of hemodynamic hypertension must not be eliminated without having first eliminated the incontinence of the perforating veins, which is the anatomical cause of varicose disease. Weakening of the venous walls creates valvular incontinence in the perforating veins, causing reflux that dilates the vessels. The dilated vessels are therefore subjected to excessive hydrostatic thrust (which causes leg ulcers). In a dilated vessel, the blood flows less quickly, owing to the laws of conservation of energy; thus, lateral pressure increases, which dilates all the vessels connected to it.
The regenerative solution enters the circulation through the “gateways” of the veins, venules and telangiectasias, and travels to the most dilated and dilatable vessels; it narrows and strengthens these vessels by reducing the capacitance of the circulation. In just a few treatment sessions, the feeling of “heavy legs” is alleviated.
The principles that my father (Anatomy first) taught me also allowed me, as a plastic surgeon, to perform mastopexy without touching the mammary gland. After modeling the breasts by means of de-epithelialization, I implant two or three elastic threads, one of which is an elliptical suspension thread which raises the breasts, even heavy ones, and enhances the volume of the upper pole. This procedure, like all the others that I have designed, is based on anatomical concepts. In the case of mastopexy, I have recreated a sort of Cooper’s ligament that is more functional and more resistant to gravitational ptosis.

Q) We see a lot of needles in the video
A) When telangiectasias are injected, the needle has to be changed frequently; if the tip of the needle is not sharp, it displaces the small vessels, making intraluminal injection difficult.

Q) Why is EDTA added in subjects predisposed to phlebitis?
A) I add a very small amount of EDTA in order to exploit its chelating action on the free iron that is formed when the regenerative solution comes into contact with the blood. This stratagem eliminates generalized inflammation of the circulation. EDTA also exerts a considerable antioxidant action. It should be noted that all the components of the regenerative solution (Sodium Salicylate, Lidocaine, Glycerol, EDTA) are bactericidal.

Q) If all the capillaries do not disappear with this method, what can be done?
A) To create the regenerative solution, you can use the 10% pure solution (2 vials instead of 3) and fill the syringe up to 20 ml and not 24 ml. Again, this solution must be injected into the small, dilated capillaries.

Q) So telangiectasias are caused by hemodynamic hypertension?
A) Yes, but also by contusive injury. Miopragia of the venous walls may occur in the reticular veins or only in the capillary and venular circulation. If there are varices, there are no telangiectasias. If the reticular veins do not dilate, there are only telangiectasias. Patients who only have telangiectasias require a much greater number of sessions.

Q) The amount of regenerative solution injected ranges from 3 to 12 ml. What determines the amount to inject?
A) Injecting 3 ml of 3% regenerative solution into the foot can be very effective; 12 ml injections are indicated especially in the veins of the legs, which have a very complex venous circulation. If the veins rupture easily at the beginning of the injection, even small amounts of solution can be useful, as they strengthen the venous walls and allow correct injection in subsequent sessions. It should always be borne in mind that the result is dose-dependent. To be very effective, the solution must wet the entire endothelium of the perforating veins and reach the deep veins.

Q) You always start from the bottom. Where exactly?
A) In the medial and lateral regions, treatment starts from the veins and capillaries of the foot. The two-syringe technique is never used here. Only the 3% solution is injected. In the concave areas of the foot, compression can be applied by means of TRAP tumescence; alternatively, the area can be compressed with adhesive foam rubber. In the posterior region, where there is no foot, we start by injecting the first visible vein.

Q) Which dilution liquid is preferable?
A) Certainly, 10% glycerol in saline solution, as it does not pollute. A 500 ml flask can be stored in the refrigerator. The 2 g of EDTA that is added to the glycerol helps to keep it sterile. Remember that sodium salicylate and lidocaine are also powerful bactericides.

Q) What function does the EDTA have?
A) EDTA chelates the iron ions that are released when the blood comes into contact with the regenerative solutions, which are all hypertonic. This prevents the treatment from causing inflammation. Eliminating inflammation means preventing phlebitis in subjects who have a familial predisposition. Patients with connective tissue disease and those who have been vaccinated against Covid require particular attention. These patients should take one capsule of Angiovein in the morning, and one 100 mg tablet of cardioaspirin in the evening on alternate days. Angiovein is a herbal medicine containing 9 components which exert 64 actions. It can be taken continuously because it does not cause accumulation phenomena. Let us remember that our youth depends on that of our blood vessels.

Q) When do you inject 72 ml of 3% regenerative solution?
A) In the first session, we always inject 48 ml. In the following sessions, 72 ml can be injected if the patient weighs more than 52-55 kg.

Q) Is the second syringe always necessary when injecting telangiectasias? How much do you inject with the second syringe?
A) The 3% regenerative solution is injected into less fine ectatic capillaries. If the capillaries are very fine and the operator is careful, the second syringe can be avoided if the 6% solution is injected. However, if the concentration is increased to 8% or 10%, it is always advisable to use the two-syringe technique. As the second syringe has to reduce the wheal caused by the injection of concentrated solution, the operator must inject into the injection site an amount of diluent that is sufficient to reach a tissue concentration of 3% or lower.

Q) Why do you advise against the use of lasers?
A) Because lasers close the access gateways through which we regenerate the underlying circulation; because a three-dimensional pathology must be treated with three-dimensional methods; because a rectilinear energy also damages tissues that must not be damaged; because lasers can leave skin scars, etc. Phlebectomy and sclerotherapy are also techniques that should not be used in the lower limbs.

Q) So, in venous pathology of the lower limbs, are traditional techniques completely wrong?
A) Yes.

Q) In Three-dimensional Regenerative Ambulatory Phlebotherapy, is the tumescence TRAP solution only used to compress the dilated veins that have been injected which are situated in regions that are difficult to compress?
A) No. It is also used to cleanse the veins, to dilute any of the regenerative solution that might end up outside the veins, and to reduce post-sclerotherapy patches.
Q) What can be done about these patches?
A) We can perform TRAP, which restores the venous walls and corrects hemodynamic hypertension; we can perform tumescence TRAP, which chelates the free iron that is present, and, finally, we can perform Electroporo-Cosmesis, followed by the application of a saturated solution of resorcin, which is left in situ. This latter form of mixed peeling helps to reduce melanin pigmentation. If the patch is small, we can use 0.5 mixed peeling, which permeabilizes the epidermis.
Q) How many years of research were required in order to revolutionise phlebology and send into retirement the traditional techniques of treating veins: sclerotherapy, saphenectomy, multiple phlebectomy, functional ligature, laser etc.?
A) We have been working on this since 1993, the year in which we created the solution that, when appropriately diluted, enabled us to regenerate the walls of the veins.

Q) How has TRAP been received by patients?
A) Patients see it as their last hope of solving their venous problems. Even though it is young, TRAP is able to do this.

Q) How has TRAP been received by colleagues?
A) With great interest, especially by the youngest and the oldest doctors. If you key in the word “Phlebotherapy” on the Internet, you will find, as of now (January 2011), 1350 references. When I coined the term “Phlebotherapy”, this word did not exist on the Internet. TRAP is spreading very rapidly, and the patients themselves are contributing to the spread of this new treatment every year, I am always invited by the Société Française de Phlébologie.

Q) In this video, I notice that a larger syringe (12 cc) and a 26 G needle are used. Why have you modified the technique of injection?
A) This video is a completion and a simple update of the previous ones. By using a larger syringe, we can inject a greater amount of regenerative solution in each single injection. A greater amount of solution comes into contact with a greater endothelial surface, making the result more rapid and more stable. It must be borne in mind that we have to treat the walls of the non-visible vessels, which constitute the rich network of perforating and communicating vessels that connect the superficial circulation with the perforating circulation.

Q) What do you think of the laser?
A) Even without making any reference to the conservative concepts of TRAP, multiple phlebectomies no longer have any reason to be performed. The only reason why they used to be carried out was that they did not leave permanent post-sclerotherapy pigmentation, as the old sclerosing solutions did. Today, by using the solution of sodium salicylate in a hydroglycerine vehicle at sclerosing concentrations (6%, 8%, 10%), we can sclerose veins without causing permanent post-sclerotherapy pigmentation. Obviously, it is much better to perform a simple injection than to strip out a vein. We should also remember that stripping out a vein often causes damage to nerves and lymphatic vessels, leading to oedema and paresthesia.

Q) In this case, injecting the regenerative solution into the perforating veins, which were made visible by the Veinviewer, yielded an excellent result and shows the importance of the perforating veins in the pathogenesis of varicose disease. I wonder whether this treatment, carried out exclusively on the perforating veins, can be applied in all patients or only in cases like this.
A) When the Veinviewer is used, the dilated perforating veins are easy to inject. In other patients, tele-injection is used; i.e. the superficial vessels are injected and the solution is made to penetrate in depth, into the perforating and communicating veins, under manual pressure.

Q) How much solution is injected?
A) As much as 3-5 ml for each single injection. There is no need to be afraid!

Q) Using a larger syringe – 10 ml or 30 ml – seems to be advantageous, especially in patients with large reticular veins?
A) Yes, it is. It enables us to inject a surely efficacious quantity of Bisclero solution, which can be prepared rapidly.

Q) It is easy to inject the solution into the perforating veins revealed by the Veinviewer because the needle is inserted perpendicularly to the surface of the skin, which is the same direction as the vein). The operator judges whether the perforating vein has been injected correctly exclusively by the pressure applied to the plunger of the syringe. By contrast, when ectatic vessels of the superficial circulation are to be injected with the aid of these new techniques of reflection and absorption of light, a certain amount of practice is necessary. When the Veinlite is used, the blood can be seen to flow away if the solution is correctly injected into the vessel. When the Veinviewer is used, the blood cannot be seen to flow away and it is more difficult to know whether or not the needle is in the vein. What do you think?
A) Yes. I think the invention of these new diagnostic instruments shows that phlebological therapy is evolving towards the thorough study of the vascular territory, especially that of the small perforating veins. At one time, these veins were thought to be of little importance, as they could not be seen by means of Colour Echo-Doppler. Our current research is aimed at identifying the limits and precise indications of the new instruments available.

Q) Do you inject a different concentration of Bisclero solution from the concentration used to treat venous insufficiency?
A) No, the concentration is the same; to begin with, a solution of 3% sodium salicylate in a buffered hydroglycerine vehicle is injected. All vessels visible by means of transillumination are injected with a quantity of solution that is sufficient to reach the perforating veins, up to 5 ml for each single injection.

Q) Does the limb have to be bandaged?
A) Bandaging or the use of elastic stockings is essential, as this facilitates the regeneration of the vessel wall.

Q) This ulcer healed in three weeks without any changes being made to the medication used. This underlines the importance of functional correction of the circulation. How important is it?
A) Very important. If traditional or even advanced medications are used, the ulcer may indeed close. However, it is highly likely that it will re-open, as its anatomical cause has not been remedied. Traditional treatments are of little use, and indeed are sometimes harmful, precisely because they do not adequately correct the anatomical cause of the disorder. It must be borne in mind that venous disease is three-dimensional and extends to the entire perforating and superficial circulation.

Q) The video mentions prevention. How important is it?
A) If prevention is undertaken, ulcers do not form and the skin does not suffer the trophic damage that makes it difficult to inject ectatic vessels.

Q) What does the future hold for TRAP?
A) We are making every effort to register our solution. Unfortunately, however, we are shackled by the irrational red tape that stifles initiative in the western world. In Italy, for now at least, all doctors can order the solution and use it freely. Abroad, doctors who wish to use the solution have to find a laboratory that can produce it, and then contact our group. In conclusion, the treatment for the most frequent disease in the world has received the attention that the West deserves.

 

Korpo thanks Medical Video Journal CRPUB.ORG open access for the material placed at our disposal.