Venous Disorders Specialists NY - Frequently Asked Questions

Venous insufficiency can be associated with many physical complaints including heaviness of the legs, aching, discoloration and browning of the skin around the ankles and lower legs, pain, discomfort, itching and burning, swelling of the legs, restless legs, and leg ulceration. Not all of these occur in any given individual, but some patients with vein disease will have several of these complaints as a direct result of venous insufficiency.

The EVLT laser system treats venous insufficiency at the saphenofemoral junction and saphenopopliteal junctions utilizing either an 810 nm laser generator or a 1470 nm laser system.


The 1470 nm EVLT Never Touch laser is used to treat segmental venous reflux involving the great and lesser saphenous veins.

The 1470 nm EVLT Never Touch laser is also used to treat perforator venous reflux disease.

EVLT and VNUS procedures are superior to old fashioned vein stripping in that they minimize the surgical risk and scarring.The majority of patients who have undergone laser vein treatment using EVLT have a single tiny scar on the inner thigh that is about 0.2 cm wide. This is about half the length of a pencil tip and is easily disguised within months after the procedure.Varicose vein treatment and treatment of venous reflux has been revolutionized with these endovenous nonsurgical and minimally invasive procedures.Surgical scarring is also minimized and the patients are able to recover quickly after the procedure.

Varicose veins and vein disease can affect men and women of all age groups. In fact, certain developmental problems can affect adolescents and teenagers with bulging varicose veins.The EVLT, Clarivein, and Venefit procedures can be performed on healthy individuals of all age groups, provided there is documentation of venous reflux. These vein procedures offer the benefits of an outpatient procedure that is minimally invasive with little to no scarring.Most of our patients will resume normal activities soon after their vein procedure.

An ultrasound uses sound waves to look deeply into the tissues of the legs and thighs, thus allowing Dr. Karamanoukian to examine your legs to determine which veins are working properly and which veins are unhealthy.Once this is identified, the EVLT or Venefit procedure is performed to collapse and destroy the diseased vein before it leads to further circulatory problems.

Sclerotherapy is a specific injection treatment for small spider veins and thread like veins.Some patients may also benefit by injection sclerotherapy for larger reticular veins and smaller varicose veins.If you have significant vein problems and wish to undergo treatment with a spider vein injection or laser therapy, we would recommend that you use an arnica supplement after your procedure in order to minimize bruising and swelling associated with injections.Endovenous laser patients may also benefit from arnica treatment after the procedure.Our surgical director recommends Bruise Pak for the procedure.

The treated vein is no longer needed as the blood reroutes normally.The vein becomes fibrosed and the body simply absorbs the redundant material and collagen.Over time, the vein will eventually become a small area of collagen surrounded by the normal tissue.Dr. Karamanoukian will evaluate you in intervals after your procedure to make sure that your vein treatment is healing as planned.

Venous stasis ulcers are chronic open wounds that occur on the inner ankle and leg.They are often associated with chronic venous insufficiency and venous hypertension.Venous ulcers can be particularly problematic as they never seem to close off on their own, necessitating chronic wound care. Our office performs ultrasound examination and duplex scanning for patients with venous stasis ulcers to determine if there is underlying venous reflux or an abnormal vein perforator.If there is venous reflux, then the EVLT should help in the healing of the venous stasis ulcer.In addition Unna Boot therapy can also help in the local exudate and control of venous stasis ulcers.

Most, if not all, patients will undergo the EVLT endovenous laser treatment while awake under local anesthesia.Treatments are well tolerated with minimal pain and discomfort.Our Los Angeles vein clinic specializes in non-invasive and non-surgical vein treatments.During your consultation, we will discuss all of your options, including EVLT and Venefit.

Treating varicose veins and spider veins does not have to be a painful or major procedure. Using minimally invasive laser options, board certified vein surgeon Dr. Raffy Karamanoukian can identify the root cause of your varicose veins and destroy them at their source. This technique for the treatment of venous reflux is known as endovenous laser ablation and has high utility in the treatment of painful and uncomfortable varicose veins. At the santa Monica Vein Center, we advocate the use of minimally invasive and nonsurgical options for varicose veins and spider vein. We emphasize high safety and low risk with every vein procedure performed at our office. We have treated thousands of patients and have a high succuss rate that is unparalleled.

A decade ago, varicose vein removal required major surgery.An advancement in minimally invasive varicose veins treatment led to a procedure known as endovenous laser ablation.In this treatment known as EVLT, a tiny nick in the skin is used to direct a laser into a problematic vein in order to collapse it from the inside.This simple technique avoids unnecessary pain and discomfort, and minimizes surgical downtime.If you have questions about endovenous ablation, Dr. Karamanoukian at the Santa Monica Vein Center can help you with your vein problems.This is especially true if you have a family history of vein problems and have a genetic predisposition to the development of unwanted varicose veins or bulging veins.Recovery is relatively short, with most patients being able to return to normal activities immediately after the procedure.Dr. Karamanoukian has extensive experience in endovenous laser ablation of varicose veins and has seen many patients return to work immediately after their procedure.

The major insurance carriers in the Los Angeles area do provide for medically related varicose vein treatment.The first step in considering insurance coverage for varicose vein treatment begins with a consultation with Dr. Karamanoukian in which he will evaluate your varicose veins and spider veins to determine whether they are most likely a medical problem or a cosmetic problem.After extensive vein mapping and vein evaluation, Dr. Karamanoukian may also recommend a vein ultrasound in order to determine the extent of the medically related varicose veins.Some patients may qualify for medical varicose vein treatment, while others may only have a cosmetic spider vein concern.Consultations are often required and include a vein mapping in order to determine the extensive vein problems in your legs and thighs.The patients who have varicose vein disease can seek a consultation with Dr. Karamanoukian, at which time he will dictate a consultation note to be sent to your insurance carrier.A consultation note will specify reason for inclusion by your insurance carrier.Call 310-998-5535 to schedule your consultation for varicose veins and to determine whether varicose veins are covered by your insurance.Unfortunately, the insurance companies can not deny or accept claims for varicose veins without a comprehensive vein consultation.

Most, if not all of the endovenous laser or RF treatments performed in our Los Angeles vein clinic are performed while a patient is awake.Awake procedures minimize anesthesia and allow for a quicker return to normal function.If there are any reasons to undergo the procedure under anesthesia, please discuss these with Dr. Karamanoukian and our office will make arrangements to perform the procedure under anesthesia, if indicated.

Our office utilizes the endovenous systems EVLT, Clarivein, and Venefit over traditional vein stripping surgery.Most longterm studies have shown equivalent results between EVLT, Clarivein, and VNUS vs. vein stripping, with vein stripping having increased risks and morbidity.During your vein consultation in Los Angeles, our office will review the guidelines for endovenous ablation and discuss your expected benefits and risks.

Some veins that are bulging can be difficult to treat with laser.In these cases, a procedure known as ambulatory phlebectomy is performed to remove abnormal veins and sometimes tie them off at their root base.Ambulatory phlebectomy is often a minor procedure with minimal downtime and patients should not be overly concerned about risks with this procedure, as it is generally considered a safe and effective minimally-invasive procedure.

Both men and women are at risk for developing varicose veins.In our Los Angeles vein clinic, we see healthy adult men and women who have developed painful leg symptoms as a result of varicose veins and vein disease. Men are less likely to seek early treatment and this is an unfortunate cause of many leg vein ulcers and advanced vein symptoms we see in our clinic.

Varicose veins are the bulging veins that pop out of the skin.Bulging varicose veins are typically not treated with sclerotherapy in our Los Angeles vein clinic.Rather, ambulatory phlebectomy with or without treatment of venous reflux is suggested.The first three steps in varicose vein treatment include an examination, vein mapping, and ultrasound to assess the degree of venous reflux.

A Cockett's perforator is an abnormal perforator vein that communicates between the deep and superficial vein system. It is usually found on the medial distal one-half of the leg. Sometimes the Cockett's perforators can be seen as bulging vein or palpated as deep fascial defects.Cockett's perforators may contribute to skin changes, bulging veins, and skin ulceration.

Vein disease is ten times more common than peripheral arterial disease (PAD). Peripheral arterial disease is due to atherosclerosis where there is insufficient oxygenated blood flow causing leg cramping and tissue loss. Although PAD generates a lot of publicity on television ads and in the news, vein disorders have been neglected until NOW! An estimated 27 percent of the adult population of the United States has some form of vein disease of the legs. Vein problems become more prevalent with age and can progress to the point of being disabling. As such, they should not be ignored.

The most common problems involving the venous system of the legs include varicose veins, chronic venous insufficiency and deep vein thrombosis (deep vein clots).

Market research indicates that over 2 million workdays are lost annually in the United States and $1.4 billion is spent each year on vein disorders.

Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as leg swelling, skin changes and venous leg ulcers. It is estimated that in America, 72% of women and 42% of men will develop varicose veins by the age of 65. Prevalence is highly correlated to age and sex with women having an increased likelihood of having vein problems in each age group category.

This chapter is from the upcoming book "Doctor, Tell Me More About Vein Disorders" by Hratch L Karamanoukian, MD and Raffy L Karamanoukian, MD

Superficial thrombophlebitis of the legs is a condition where there is inflammation of superficial, as opposed to deep veinsof the lower extremities.

Superficial thrombophlebitis can occur in any superficial vein segment along the greater or lesser saphenous system. Patients experience pain and tenderness along the course of the vein - in the case of the great saphenous vein, it can be anywhere alng a line that connects the groin to the ankle. The skin overlying the varicose vein usually is warm to the touch, red and tender.

The significance of the phlebitis is that it can get quite symptomatic and painful - even trivial movement can trigger significant discomfort along these tender areas of the phlebitic vein and its branches.

Localized injury to the saphenous vein could be the inciting cause and/or some underlying thrombogenic disorder. Sometimes it occurs spontaneously without any discernable cause (idiopathic).

Treatment is with warm compresses or heating pads and taking antiinflammatory medications for 10-14 days.

Superficial thrombophlebitis of the great saphenous vein is only dangerous if the inflammation extends into the deep veins at the level of the groin, namely into the common femoral vein with thrombus (or clot) embolizing to the lungs (pulmonary emolism).

Often, serial Duplex venous ultrasound studies are necessary in order to ensure that thrombosis of the great saphenous or small (short) saphenous does not extend into the deep veins, comon femoral vein and popliteal vein respectively.

For a video clip of thrombosed superficial veins click on the clip below:

A fan shaped pattern of small intradermal veins on the medial (inside) or lateral (outside) aspect of the ankle and foot is called corona phlebectatica, or corona phlebectasia.. Corona implies that they "crown" the ankle. Corona phlebectasiais thought to be an early sign af advanced venous reflux disease. This reflux typically originates at the saphenofemoral junction with venous blood refluxing into the great saphenous vein. Less commonly, saphenopopliteal reflux into the lesser (short) saphenous vein is the underlying cause of corona phlebectatsia. Other names for corona phlebectasia include "malleolar flare" and "ankle flare". Once the venous reflux is treated with VNUS Closure or EVLT, then the corona is treated with lasers, and rarely sclerotherapy.

Legs veins have one-way valves throughout their lengths, extending from the ankles to the groins, These valves prevent blood from flowing backwards as it moves up the legs. In essence, it is like a step ladder where blood gets pumped up into a higher level by the “leg pump” and the valve below this level closes so that blood does not go back down to the lower level. Eventually, blood clears the saphenofemoral junction and the saphenopoliteal junctions where it joins the deep veins of the leg. There are also connections between the superficial (under the skin surface) and deep veins, and these connections have valves – more on these perforator veins later. Venous reflux, also known as venous insufficiency occurs when these vein valves leak.

Vulvar varices are varicose veins in the external genitalia, i.e. vulva. They occur in 1 in 20 pregnancies, appearing in the second trimester usually. They usually present no symptoms but are considered 'unsightly' by most women and sometimes, their sexual partners. In some patients, they cause itching, burning or heaviness in the area.

It is important to exclude saphenofemoral venous reflux disease as a contributing factor - which is easily treated with VNUS Closure or EVLT.


this picture taken from phlebologia.com

Varicose veins are enlarged veins that bulge through the skin and may appear as blue or purple knot-like cords. Varicose veins can occur anywhere in the body, but are more commonly found in the lower extremities. Spider veins, also known as telangiectasias are smaller than varicose veins and often look like a sunburst or "spider web." They are red or blue in color and are commonly found on the face and legs.

The most important consideration for a patient is to recognize whether spider veins are associated with venous reflux disease. If they are associated with venous reflux disease, then this has to be treated before cosmetic procedures such as sclerotherapy or topical lasers are used to obliterate these spider veins.

Venous reflux disease is currently treated in the office setting with the VNUS Closure procedure or endovenous laser procedures (EVLT, ELVeS, etc.). Alternatively, some surgeons still perform ligation and stripping procedures. Once these procedures are done, then it is ideal to follow this with topical transdermal laser treatment of the spider veins. It is more likely for spider veins to recur if underlying venous reflux disease is not addressed.

Another important point is that venous reflux disease is associated with symptoms in the legs, whereas pure spider veins are unlikely to be associated with symptoms in the leg - such as aching, pain, heaviness, tiredness, fatigue, itching, burning, cramping, throbbing, restlessness of the legs or swelling in the ankles or legs.

Venous reflux disease can be diagnosed with special maneuvers on physical examination. More specifically, it is confirmed and documented with Duplex venous ultrasonography.

In summary, be wary of just walking into any clinic to get laser treatments done for spider veins. Make sure that you are evaluated and venous reflux disease is excluded before you proceed with topical laser therapy for spider veins. This will save you the heartache of having repeat laser treatments which are costly and the dissatisfaction that goes with having repeated cosmetic procedures that are unnecessary.

There is nothing wrong with having a general surgeon or radiologist to do your vein procedures. However, a dedicated surgeon who is also a phlebologist (vein specialist) brings a whole element of specialty care to the practice of vein disorders. At the Vein Treatment Center, the focus is not just one procedure for all patients, namely 'vein stripping', but rather a variety of procedures that are individualized and targeted to treat specific problems: varicose veins, truncal venous reflux disease, perforator venous reflux disease, vein related skin disease (trophic changes), treatment of venous stasis ulcers, VNUS FAST Closure, EVLT, ClariVein procedure, topical lasers for spider and reticular veins, SEPS, etc. For a detailed evaluation, call the Vein Treatment Center for a consulation with Hratch Karamanoukian, MD FACS. Dr. Karamanoukian is triple board certified - in general surgery (American Board of Surgery), Cardiovascular Surgery (American Board of Thoracic Surgery) and Venous Diseases (American Board of Venous and Lymphatic Medicine - previously called the American Board of Phlebology). We don't dabble in vein care, but treat it as a medical/surgical specialty. Ask your 'vein doctor' if he is Board Certified in Venous and Lymphatic Medicine (aka Phlebology).

Dr. Raffy Karamanoukian is a diplomate of the American Board of Plastic Surgery (ABPS) and Diplomate of the American Board of Venous and Lymphatic Medicine (Phlebology) who collaborates with Dr. Hratch Karamanoukian at the Vein Treatment Center. Dr. Raffy Karamanoukian is Director of the Santa Monica Vein Center and is focused on the most advanced treatments for his patients with vein disorders. He also performs specialty muscle flaps and surgical wound treatments for patients with venous stasis ulcers. Dr. Raffy can be reached through his websitewww.SantaMonicaVeinCenter.com- Dr. Raffy has been featured at least a dozen times on The Doctors TV Show with segments on 'Foam Sclerotherapy' and "Varicose Veins of the Under Eye".

Yes, especially if you don't mind wearing them. Light compression stocking use can reduce the feeling of heaviness in the legs, especially after standing for long periods of time. Flight attendants who wear light compression stockings (15 - 20 mm Hg) report markedly less leg edema (swelling) and less aching, tiredness and discomfort in the legs. Another benefit of wearing such support stockings during air travel is that it reduces the likelihood of forming blood clots (deep vein clots, DVT) in the legs. You cannot buy compression stockings off the rack from a pharmacy. For proper function, they must be fitted to accurately measured standards by professionals which are employed at medical durable supply stores. Find out from your vein specialist a list of stores who specialize in venous compression garments.

Please refer to my vein ebooks regarding compression stockings - there is over 50 pages of information that is easy to read, which explains why stockings help, how they affect venous blood retrun, and how they help reduce symptoms associated with venous insufficiency. The ebooks are in the ebook section under headings on www.VeinsVeinsVeins.com

Medication related leg edema is almost always bilateral and equal. Medications that cause leg edema include - calcium channel blockers, hydralazine, estrogen and progesterone, NSAIDs (ibuprofen), COX2 inhibitors, clonidine, minoxidil, cilostazol, gabapentin and glucocorticoids, among others. Dr. Karamanoukian will go over your list of medications at the time of consultation to see if you are on any medications that cause leg swelling. Please type all of your medications including dosages and frequency on a sheet of paper and bring it along with you to the consultation and at follow-up. This will facilitate this part of the evaluation process.

Deep venous thrombosis (DVT) is the formation of blood clots in the deep veins of the leg or arms (rarely). This potentially life threatening condition has an incidence of about 5 to 20 million cases per year in the United States.

The main clinical concern with DVT is the potential of a thrombus (blood clot) to break free, travel through the inferior vena cava, through the heart, and get lodged in the vessels of the lungs. This event, called pulmonary embolism, carries a mortality rate of roughly 20 to 30%.

The formation of DVT’s can be attributed to one or more of the following factors: venous stasis (sluggish blood flow), injury of the blood vessel wall, or hypercoaguability (increased tendency of blood to clot).

Risk factors for DVT formation include age >40, obesity, smoking, pregnancy, trauma, IV drug use, or prolonged immobilization - such as due to chronic illness or long trips in cars or airplanes.

People with cancer, congestive heart failure, lupus, or recent heart attack or stroke are also prone to DVT’s. Recent surgery, chemotherapy, and hormone replacement therapy are risk factors as well.

Patients with DVT’s of the lower extremities have pain and swelling of the affected leg about 75% of the time. Other symptoms may include increased warmth and redness of the leg and occasionally low grade fever. DVT’s usually occur in the mid to upper leg.

The most commonly used test to check for DVT is duplex ultrasonography, which has very good sensitivity and specificity in certain patients. It is most reliable when used in patients who are symptomatic, especially when the symptoms are localized above the knee and below the groin. The most accurate test for DVT is venography, in which dye is injected into the veins of the involved leg. A blood test can also be done, which checks for D-dimer fragments. The D-Dimer test is of limited usefulness, however, as it has a high rate of false positives.

DVT’s are treated by administering anticoagulants (blood thinners) such as Lovenox or warfarin. Patients are generally started on Lovenox for immediate anticoagulation, and then continued on warfarin for 6 months. Patients who are anticoagulated for 3 to 6 months have roughly half the DVT recurrence rate of those who are anticoagulated for only 4 to 6 weeks. Anticoagulants are contraindicated in patients with active bleeding or bleeding disorders. These patients may benefit from placement of a Greenfield filter in the inferior vena cava. By placing a filter in the vessel which returns blood from the legs, any thrombi are screened out before they can get lodged in the vessels of the lungs.

Unless one succumbs to the complication of DVT, such as a massive pulmonary embolism, the outcomes in patients are good.

To read more about the sequelae of DVT, read Dr. Karamanoukian's ebook about Post Thrombotic Syndrome (PTS) on this website - it is available for free on www.VeinsVeinsVeins.com or you can purchase and download on Amazon Kindle and Barnes & Noble Nook Books.

Animation of a DVT (deep vein thrombosis)


Watch this video about clotting, DVT and pulmonary embolism

VNUS Closure uses radiofrequency energy to close the great saphenous or lesser (short) saphenous vein endouminally, that is, from within the vein. Instead of stripping the vein, access is gained into the great saphenous vein through a needle puncture and a catheter is passed into the vein and advanced towards the groin. As the catheter is pulled back and out of the body, radiofrequency energy is used and the vein is "Clsoed" or sealed from within.

EVLT or endovenous laser therapy is a trademarked procedure (formerly Diomed Holdings) which utilizes laser energy to do the same thing as the VNUS Closure catheter. The latest generation of EVLT devices, such as the one used at the Vein Treatment Center, called VenaCure EVLT Never Touch is associated with less bruising, pain and discomfort than VNUS FAST Closure or the generic EVLA procedure (endovenous laaser ablation). We have both EVLT Never Touch and VNUS Closure FAST technologies available at the Vein Treatment Centers in Williamsville, NY and Clarence, NY and we have the luxury of tailoring the procedure to your needs, as opposed to offering a single procedure to all comers.

Of note, we also offer a third catheter based procedure to treat venous insufficiency, the ClariVein Procedure. It is mechanochemical ablation that uses a single puncture.

The Vein Treatment Centers of Buffalo Niagara are the only center that offer 3 different technologies to treat venous insufficiency using EVLT Never Touch, VNUS Closure FAST and ClariVein !

A reticular vein is a dilated bluish intradermal vein, usually from 1 mm in diameter to less than 3 mm in diameter. They are usually tortuous. Reticular veins are also known as blue veins and intradermal varices. In the classification of veins, reticular veins are considered type III veins. Telangiectasias (type I veins) can result from refluxing reticular veins. When such reticular veins are associated with telangiectasias, they are called "feeder veins". If sclerotherapy is chosen as the treatment for a particuar patient, the reticular veins should be injected first and the telangiectasias last. Until the reticular veins are treatd first, telangiectasias should not be targeted so as to avoid early recurrence. We utilize dynamic foam sclerotherapy and ultrasound guided foam sclerotherapy to treat reticular veins at the Vein Treatment Center.

A varicose vein is a subcutaneous dilated vein larger than 3 mm in diameter in the upright posture. Varicose veins are also known as varix, varices and varicosities. Varicose veins can occur in ten quadrants: anterior thigh, medial thigh, lateral thigh, posterior thigh, anterior leg, medial leg, lateral leg and posterior leg. They can also occur in the medial and lateral ankles. Varicose veins are primarily from the great saphenous and short saphenous system of veins. The great saphenous vein courses from the ankle to the saphenous aperture, at the level of the groin where it joins the deep veins (femoral vein). The short saphenous vein, termed the lesser or small saphenous vein, runs behind the outer ankle to the back of the lack and joins the deep vein behind the knee, also known as the popliteal vein. Varicose veins originate in the great and short saphenous veins themselves or their branches.

The Health on the Net (HON) foundation has been actively working to improve Internet access to quality health information. What are the highlights of the 8th HON Survey of Health and Medical Internet Users? Patients and physicians agree that accuracy of information is the most important issue facing users of the Internet as it relates to the retrieval of health care information. Nearly 52 percent of patients who discussed the results of their Internet searches with their physicians found that their physician became more productive. Half of the individuals surveyed used the internet for more information. The Internet will continue to be an important tool for patients seeking medical information. As always, credibility, content and disclosure are important issues for health related Internet information sites. www.VeinsVeinsVeins.com is a credible website about venous disorders, venous reflux, varicose veins, spider veins and all phlebology related issues.

Dr. Karamanoukian and his research fellows were one of the first in the world to publish the importance of Internet based medical information retrieval (1,2,3). The first studies were published in 2003 and the research for these studies were conducted nearly 10 years ago, at the dawn of the boom in the internet and proliferation of health websites! In an effort to continue such information dissemination to our patients, we have developed websites for patient education for vein disorders.

1. Semere WG, Edwards TM, Boyd D, Barsoumian R, Murero M, Donias HW, Karamanoukian HL. The world wide web and robotic surgery. Heart Surgery Forum 2003; 6(6): E111-119.
2. Semere W, Karamanoukian HL, Levitt M, Edwards T, Murero M, D'Ancona G, Donias HW, Glick PL.A pediatric surgery study: parent usage of the Internet for medical information. J Pediatric Surgery 2003; 38(4): 560-564.
3. Murero M, D'Ancona G, Karamanoukian H. Use of the Internet by patients before and after cardiac surgery: telephone survey. Journal Med Internet Research 2001 Jul-Sep;3(3):E27.

A telangiectasia is a confluence of dilated intradermal venules of less than 1 mm in size. Telangiectasias are more commonly known as spider veins and thread veins. They can be pink, red and have different hues in the red to purple blue range. Spider veins occur in 15 % of men and 25 % of women in the general population.In the classification of veins, telangiectasias are classified as type I veins. We use the Palomar Laser system as well as traditional and foam sclerotherapy techniques to treat spider veins at the Vein Treatment Center. Watch videos of spider vein treatments on the 'spider vein' section of www.VeinsVeinsVeins.com. One of the videos is from The Doctors TV Show featuring Dr Raffy Karamanoukian.

Lymphedema, unlike leg swelling (edema) due to venous reflux disease, is worse in the feet and toes. The foot and toes are involved and are described as "pillow feet and sausage toes". What descriminates lymphedema from leg sweling due to venous reflux disease is that leg elevation overnight DOES NOT relieve the swelling. Also, patients rarely complain of symptoms other than the swelling. Patients with venous reflux disease complain of leg swelling along with aching, pain, heaviness, tired legs, leg fatigue, itching, cramping and throbbing.

Lymphedema can be idiopathic (unknown cause) and isolated (primary type) or secondary, i.e., related to another process such as longstanding venous insufficiency or lymphatic obstruction or from lemphadenectomy from cancer surgery.

The end result of vein problems in the legs is venous hypertension in the forom of high pressures in the veins during ambulation or walking. This condition is called ambulatory venous hypertension. The golas of compression therapy is several fold:

1. help prevent clot formation in hospitalized patients and individuals who are inactive
2. improve the return of blood from the legs
3. counter the effects of ambulatory venous hypertension
4. help control the progression of venous disease
5. reduce and control swelling in the legs (Edema)

Compression venous garments increase tissue pressure, reduce tissue swelling (edema), increase the velocity of blood flow in the veins and reduce venous reflux, i.e. tendency for venous blood to slush back into the legs.

To get evaluated for compression garments (compression stockings for vein problems), consult a vein specialist, also known as a phlebologist. The goals of compression garments is threefold:

1. they have to treat the condition
2. they have to be comfortable to wear and properly fitted
3. they have to be reasonably acceptable to wear from a cosmetic standpoint.

For more information or evaluation, contact Dr. Karamanoukian for a consultation at the Vein Treatment Center. Our offices are not in the business of selling compression garments - this is relegated to medical durable supply companies. But, a prescription is required from a Phlebologist for you to aquire these compression stockings that are considered 'of medical necessity'.

View animation of how varicose veins form:

http://www.youtube.com/watch?v=49jUyBu4M1Q&NR=1

Researchers at Harvard published a study in May 2008 in the Archives of Internal Medicine that investigated the association of particulate air pollution to deep vein thrombosis, i.e. deep vein clots). It is well accepted that air pollution is linked to heart disease and stroke but the association with deep vein clots was unknown until this study was published. Dr. Baccarelli and colleagues studied this phenomenon in subjects living in the Lombardy region in Italy. They examined the association of exposure to particulate matter of less than 10 microns. Using 870 patients and 1210 controls, they concluded that long-term exposure to particulate air pollution is associated with altered coagulation function and deep vein clot formation risk. Of note (and perhaps too detailed for this discussion), each increase of 10 microg/m3 in particular matter in air was associated with a 70% increase in deep vein clot (DVT) risk. So, avoid living in cities with a significant burden of air pollution ro reduce this risk. By the way, living in low air pollution areas will also reduce your chances of developing asthma, heart disease and stroke.

Symptoms are usually lacking in patients with lymphedema. Patients with venous reflux disease typically have aching, pain, heaviness, tiredness, fatigue, cramping, throbbing and swelling. The foot and toes in lymphedema are described as "pillow feet and sausage toes" and the swelling is usually NOT relieved with overnight leg elevation. One of the benefits of being evaluated by a specialist who is Board Certified in Cardiac Surgery and Venous and Lymphatic Medicine (American Board of Venous and Lymphatic Medicine - ABVLM) is that you will get evaluated by a clinician who can determine the etiology of lower extremity swelling and use his diverse background and expertise to help treat swelling in your legs. We have also developed a bioflsvonoid product line to help treat lymphedema. Dr. Karamanoukian has also written a book called 'The Health Benefits of Citrus Bioflavonoids' which is availabe as a free ebook on this website

It is very interesting that VNUS Closure is marketed for varicose veins, but in fact, is FDA approved for venous reflux disease only. It is used to treat venous reflux disease involving the great saphenous vein, short (lesser) saphenous vein or perforator veins. However, it is being used for varicose veins by those who are not properly trained or who are using it for that reason. VNUS FAST Closure can obliterate saphenous veins but can leave you with tributary varicosities which may require additional expertise by a , often by a vein specialist.

Some doctors that perform VNUS or EVLT only know how to do this one procedure. Phlebology requires a whole armamentarium of treatment modalities and it behooves you to be aware of this and to seek someone who is not just a 'catheter jockey'.

Any physician can do the VNUS CLosure procedure but only experienced and properly credentialed vein specialists know how to take care of the rest of your vein issues - varicose veins, reticular veins, spider veins, perforator veins, skin hyperpigmentation, lipodermatosclerosis and , venous stasis ulcers.

The doctor who treated you is probably not experienced in these procedures and in the attempt to sign you up for the procedure promised you the world. With proper evaluation, the physician should be able to tell you up front if the varicose veins associated with venous reflux disease of the great saphenous system will go away following VNUS Closure or EVLT. In fact, depending on how far they are from the thigh and in what distribution they occur in the leg, published studies show that less than 30 % of varicose veins go away and disappear after VNUS Clousre of the great saphenous vein !

If proper evaluation is performed, a phlebologist with large experience should be able to tell you at the time of consultation if additional treatments are needed such as microphlebectomy, sclerotherapy or laser procedures for spider veins, reticular veins or feeder veins.

In any case, nothing wrong was done. You had proper treatment for venous reflux disease and now you must see a vein specialist with experience to take care of the rest of these problems. There is no one procedure which treats all of these vein problems - and they all need different types of treatments and you should have sought someone who does all of them i the first place.

Most large cities have phlebologists who take a comprehensive approach to treat vein disease. Contact the American Board of Venous and Lymphatic Medicine (Phlebology)to find out which doctors in your city are Board Certified in Venous and Lymphatic Medicine. Dr. Hratch Karamanoukian and Dr. Raffy Karamanoukian were one of the earliest in the U.S. to seek board certification in Venous and Lymphatic Medicine and recieved that status in 2009. A Board Certified physician in Venous and Lymphatic Medicine performs the whole gamet of vein care, from A to Z, and not just endovenous ablation procedures such as VNUS Closure or EVLT !

Ask for Board Certification in Venous and Lymphatic Medicine and not just 'board certified' as a general statement.