The ideal solution for use in T.R.A.P. must not be obliterative; rather, it must elicit mild fibrosis in the ectatic vessels without causing post-sclerotherapy hyperpigmentation or other complications, even if injected in small quantities outside the vessels. Moreover, as its efficacy has to be maintained even at a distance from the injection site, it must not dilute immediately, as aqueous or alcoholic solutions do. It must be well tolerated, even at high doses, cause little inflammation, no residual hyperpigmentation and no pain, as obliterating sclerosants do, and must exert a constant action. The main characteristics of what we regard as the ideal solution for the treatment of venous insufficiency are illustrated in Table 1.

Suitable for injection at high doses
(normally up to 31.5 ml)

Low systemic toxicity

Low absorption

Constantly efficacious in all patients

Anti-platelet action (if possible)

“Regenerative” action

Efficacy in proportion to the quantity injected

Efficacy correlated with contact time

Non-allergenic

No adverse events

No permanent post-sclerotherapy pigmentation

Must not cause necrosis if it leaks out

Poorly inflammatory

Causes little oedema

Rarely thrombogenic

Must not affect the eyesight

Absence of microhaematuria, even at high doses

Must be risk-free in treating the ectatic crown in the foot

Should preferably create vasospasm of the intact capillary network

Should preferably exert an antibacterial and preserving effect

Must be easy to inject into the vessels

Must cause practically no post-injection pain