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.