Phlebotherapy Forum

Forum of Three-dimensional Regenerative Ambulatory Phlebotherapy (T.R.A.P.)


The fact that an opinion is strongly supported
does not mean that it cannot be completely absurd.
B. Russel

Why obliterate or remove the veins when they can be cured?
Sergio Capurro

American College of Phlebology reviews

This is the second review by the American College of Phlebology. On the basis of this review, my paper, which was almost identical to the version published in the Appendix to the Proceedings of the World Phlebology Congress (15thWorld Congress Rio) was rejected. The reasons for rejection are followed by my observations. I have now (March 2006) decided to set up an Internet "Forum" to question the deeply-rooted concepts that have, until today, guided phlebological treatments. This Forum will enable us to answer the questions raised by those wishing to know more about our proposed treatment for venous insufficiency: Three-dimensional Regenerative Ambulatory Phlebotherapy (T.R.A.P.). We believe that superficial veins dilate as a result of hemodynamic hypertension caused by the miopragia of the walls of the perforating vessels, the valves of which, on account of this dilation, are no longer continent. Incontinence is, for the most part, dynamic, becoming static only subsequently (Indeed, most perforating veins are not visible on Colour Echo-Doppler). Three-dimensional regenerative phlebotherapy treats the perforating circulation with a non-aggressive solution. The solution reaches its target through the "gateways" constituted by the superficial vessels, which are visible to the naked eye or by means of transillumination. Injected through all such gateways (truncal veins, reticular veins and telangiectasias), the solution reinforces, shrinks and "regenerates" the walls of the perforating vessels responsible for the visible pathology. No longer subjected to anomalous hypertension, the superficial circulation simply disappears from view. This result is permanent. T.R.A.P. is an injectable cure which respects the functional anatomy of the circulation. Moreover, in such a complex three-dimensional network of tubes as the venous circulation in the lower limbs, what could be more efficacious and less traumatic than injecting the cure through the tubes themselves?

To American College of Phlebology
Dermatologic Surgery (DSU), official publication of the American College of Phlebology


Dear Sir,
Having read the reviewers’ comments on my paper "Three-dimensional Regenerative Phlebotherapy (T.R.A.P.)", which has been rejected for the second time by Dermatologic Surgery(DSU), the official publication of the American College of Phlebology, I feel obliged to respond to the points raised.

R) Weak sclerosant solutions can routinely produce fibrotic change without complete obliteration in the walls of treated vessels.
Capurro) This is precisely what I call “regeneration”, in order to distinguish the non-obliterative action of T.R.A.P. from the obliterative effect of traditional sclerotherapy. However, with regard to the treatment of venous insufficiency, I have never read of the routine exploitation of this non-obliterative action, nor of its extension to the entire perforating circulation. That is what makes T.R.A.P. different.

R) In addition, fibrotic changes resulting in condensation of vascular lumina are a common outcome of endovenous laser and EVLT therapy.
Capurro) True enough. What the reviewer seems not to have grasped, however, is that T.R.A.P. utilizes this effect systematically and, as specified above, extends it to the entire perforating circulation. Moreover, laser and EVLT are supposed to be obliterative, are they not?

R) There’s nothing in this article which suggests that “regeneration” is occurring.
Capurro) According to [Blakeston Gould’s Medical Dictionary, 1979, “regeneration” means “the repair of structures or tissues lost by disease or by injury”. I have used the term to indicate the repair or restoration of the functional capacity of the vessels, which is why it appears in inverted commas throughout the article. What suggests that such a process is occurring ? The histological picture, the short-term images and the clinical appearance.

R) Fig. 1 which purportedly shows a “normalization” of a vessel could also be interpreted as a coexisting normal vessel in the treated area.
Capurro) Of course this possibility exists. However, the reviewer’s comment suggests either incompetence or, worse, bad faith on my part. Forgive me if I find this somewhat offensive. Moreover, the vessel examined is, logically, still dilated, otherwise I would not have been able to see it in order to remove it for histological examination. In addition, as I have already explained, the reduction in diameter is clearly visible merely on observing the surface of the skin.

R) No drug is completely without side effects.
Capurro) Quite right.

R) Acetylsalicylic acid has caused focal hemorrhage and cell death in rats and certain types of seizures (Neuroscience 2000 991:1-17).
Capurro) The reviewer’s reference to acetylsalicylic acid is a little puzzling, since T.R.A.P. utilizes a solution of sodium salicylate in a buffered hydroglycerin vehicle. It should, however, be borne in mind that even very slight differences in the formulae of chemical compounds can cause different clinical effects.

R) The assertion that T.R.A.P. constitutes a “step forward” is most certainly immodest and not supported by the data presented in this article.
Capurro) The data presented in this article concern 300 patients, seven years of experimentation, photographic documentation and the results of histological examinations. In my view, what is demonstrated is an innovative and efficacious approach to a tricky problem. The reviewer evidently feels that the expression “a step forward” is presumptuous; I leave that judgement to others.


R) The theories presented are interesting but do not provide credible support to the superiority of this technique over other accepted alternative protocols.
Capurro) Years of study have taught me that, in the treatment of venous insufficiency, the most compelling evidence of the superiority of one technique over another lies in the clinical result, how rapidly it can be obtained, how long it lasts, and whether complications arise. In my experience, three-dimensional regenerative phlebotherapy (T.R.A.P.) has proved clinically superior to any other technique that I have used. I therefore feel duty-bound to publicize it. To this end, it is my intention to utilize the internet, through which I will welcome any questions and comments from colleagues, including those emerging from your two reviews.
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Given that the miopragia of the vessel walls involves the entire superficial and perforating circulation, all the visible vessels must be injected, including those visualized by means of transillumination. Moreover, the solution, which obviously must not be obliterative, will need to be forced into the underlying vessels.