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English

01. Tree-dimensional regenerative ambulatory phlebotherapy (TRAP) a new concepts for treating varicose disease

KEYWORDS: varicose disease, sclerotherapy, phlebectomy, phlebotherapy, hydrostatic thrust.

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I thank Prof. Jean Marc Chardonneau for inviting me to the prestigious congress of the French Society of Phlebology, and extend cordial greetings to all my colleagues.
Three-dimensional regenerative ambulatory phlebotherapy (TRAP) is a technique of non-obliterative injection which acts on the perforating and superficial circulation. It “cures” varicose disease of the lower limbs by strengthening the vessel walls, shrinking the lumen, restoring valvular function and causing all visible vessels to disappear, whether they be varicose veins, spider veins or telangiectasias. To describe these effects, we use the term “regeneration.” This term highlights the restoration of the vascular structure.

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Figure 1 (Left) Histological section of skin (fixed in 10% buffered formalin, paraffin embedded and routinely processed; Weigert stain; enlargement 20 X). Dermal venule of medium-large calibre. The structure of this type of venule is characterised by sparse elastic fibres – not organised into a true, continuous elastic lamina – in the context of fibrous connective tissue of the wall. The vessel (visible “in vivo” as a phlebectasia) has a large eccentric lumen. The wall displays a non-uniform thickness and disorganised layers at several sites, and is permeated by a scant inflammatory infiltrate consisting mainly of lymphoid and monocytoid cells. The endothelial lining lacks continuity. Sub-endothelial microvacuolation is also seen.
(Right) Histological section of skin. The same patient, the same area and a vein of equal size, seen after treatment with 6% Bisclero. Weigert stain; enlargement 20 X. The wall is of regular thickness. The internal endothelial layer is continuous. The wall shows no inflammatory infiltrate. Bisclero treatment has restored uniform wall thickness, reduced the calibre of the lumen and consolidated the connective structure of the vessel wall. We have summarised these effects with the term “regeneration”.

Three-dimensional regenerative ambulatory phlebotherapy is based on the hypothesis that the most frequent cause of varicose veins and telangiectasias in the lower limbs is weakening of the walls of the perforating veins, leading to valvular incontinence. To strengthen the walls and reduce the diameter of the vessels, thereby restoring valvular continence, a non-obliterative solution of sodium salicylate in a buffered hydroglycerin vehicle is injected into all vessels that are visible to the naked eye or on transillumination. As miopragia involves the entire superficial and perforating circulation, albeit to different degrees, a sufficient quantity of the solution to reach the perforating veins is injected. A three-dimensional pathology requires a three-dimensional treatment.
The efficacy of this treatment is manifested by the disappearance of the vessels of the superficial circulation.
TRAP uses a 2.5 ml syringe, 30½ G or 27G needles, and a sclerosing solution at a non-obliterative concentration. We use a 4% – 6% solution of sodium salicylate in a buffered alkaline hydroglycerin vehicle. The lower limb is subdivided into three functional regions: medial, posterior and lateral.

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First, the medial regions of the foot, lower leg and thigh are injected. Subsequently, the posterior regions are injected, followed by the lateral regions, and so on. From 12 ml to 45 ml of solution is normally injected. The efficacy of the treatment is dose-dependent.
The operator begins by injecting the phlebectatic corona in the foot.

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Capurro S.(2008): Three-dimensional Regenerative Ambulatory Phlebotherapy (TRAP), a new concepts for treating varicose disease. CRPUB video journal. Phlebotherapy section. http://www.crpub.org

Italian

01. Fleboterapia Rigenerativa Tridimensionale Ambulatoriale (TRAP) un nuovo concetto di trattamento della malattia varicosa

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French

01. La phlébothérapie régenératrice tridimensionnelle ambulatoire (TRAP.) concept innovant de traitement de la varicose

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