The heart is an active pump. It beats until cardiac death occurs and actively pumps oxygenated blood to the organs and legs. There is no such pump that pumps un-oxygenated blood back to the heart. We rely on the “leg pump” for this purpose. The “leg pump” serves as the “peripheral heart”. Contraction of the calf muscles push on the veins and squeeze blood out of the leg. The most important of these movements in the lower extremity is moving the ankle joint.
As such, veins are equipped with one-way valves that prevent back flow during the return of blood from the toes to the heart. These valves act as trap doors that open with each muscle contraction and close when the muscle relaxes in order to prevent back flow of blood. More about these valves in the next section! When we travel in an airplane and don’t get the opportunity to get up and walk, we can flex and extend our ankle joint and help the calf squeeze blood out of the legs. This reduces blood pooling in the leg veins and therefore, reduces the likelihood of deep vein clot formation.
Dr. Hratch Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 716-839-3638 or www.VeinsVeinsVeins.com
Dr. Raffy Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 310-998-5535 or www.SantaMonicaVeinCenter.com
Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.
Corona Phlebectasia
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. Corona implies that they "crown" the ankle. Corona phlebectatica is thought to be an early sign of 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 phlebectatica. Other names for corona phlebectatica include "malleolar flare" and "ankle flare"
image of corona phlebectasia from http://www.veinsveinsveins.com/common_vein_disorders.html
**The VNUS Closure Procedure is now called the Venefit Procedure. Same procedure, different name.
Dr. Hratch Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 716-839-3638 or www.VeinsVeinsVeins.com
Dr. Raffy Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 310-998-5535 or www.SantaMonicaVeinCenter.com
Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.
The relationship between being overweight and developing venous insufficiency was an observation in population based studies that needed 'hard clinical data'. This information has now been answered sufficiently in a group of obese patients.
Researchers in Italy have shown, using measurements of abdominal pressure, that overweight patients have larger femoral vein diameters, more likely to have venous insufficiency than thin patients, and this has been correlated with highr intrabdominal pressures.
This study was published by Parmeggiani and colleagues in Ann Ital Chir. 2012 Nov 7.
image of lipodermatosclerosis from www.VeinsVeinsVeins.com
Get comprehensive information about perforator venous reflux disease from Buffalo Vein Expert Dr. Hratch Karamanoukian and VeinGuide.com and VeinsVeinsVeins.com
Video 1 : Perforator Venous Reflux Disease and healed venous stasis ulcer by Dr. Karamanoukian of www.VeinGuide.com
Video 2 : Dodd's Perforator Venous Reflux Disease (mid thigh perforator vein) by Dr. Karamanoukian of www.VeinGuide.com
Video 3 : Cockett's II Perforator Venous Reflux Disease Treated by EVLT laser by Dr. Karamanoukian of www.VeinGuide.com
Dr. Hratch Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 716-839-3638 orwww.VeinsVeinsVeins.com
Dr. Raffy Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 310-998-5535 orwww.SantaMonicaVeinCenter.com
Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.
It is thought that venous stasis ulcers result from sustained high pressures in the venous system, even during ambulation, where the pressure in the venous system should be the lowest (compared to at rest measurements). This is called ambulatory venous hypertension:
1) from superficial and/or deep venous reflux with or without deep vein thrombosis
2) miccrovascular dysfunction
3) congenital and acquired thrombophilia
4) obesity and diet
5) dysfunction of the calf muscle pump from muscle loss (sarcopenia)
6) skin inflammatory conditions like lipodermatosclerosis
7) recruitment of white blood cells
8) production and secretion of cytokines
9) stimulation of adhesion molecules and metalloproteinases
10) disordered fibroblast function andmatrix rearrangement
11) bacterial colonization;
12) failure of epithelialization
13) acute and chronic wound necrosis
adapted from Mannello and Raffetto, Am J Transl Res 2011;3(2):149-15
We next determine which pattern of great saphenous vein (GSV) or small saphenous vein (SSV) reflux exists for classification and treatment:
- Segmental reflux - reflux source or origin from a tributary or perforating vein distal to the saphenous junction and reflux drainage through a tributary or perforating vein in the thigh, knee or calf.
- Distal reflux - reflux source or origin from a tributary or perforating vein distal to the saphenous junction and drainage through veins at the ankle.
- Proximal reflux - reflux source at the saphenous junction and drainage thorugh tributary or perforating vein at the thigh or calf, but proximal to the ankle.
- Multisegmental reflux - Two or more reflux segments with five basic types - proximal segmental, proxmal distal, segemental segmental, segmental distal and proximal segmental distal.
- Diffuse reflux - reflux source at the saphenous junction and drainage at the ankle and no discernable patern or from of the great sapehnous vein.
- Perijunction reflux -
- Normal pattern - absence of extension into the saphenous vein down to the ankle
This pattern utilized is from CA Engelhorn from Phlebology 2012; 27: 25-32.
Dr. Raffy Karamanoukian, a Board Certified Plastic Surgeon appeared on The Doctors TV Show again on 1-30-2013 where he revised a face lift for a patient who also had issues with her ear lobes.
Watch the episode on The Doctors TV Show featuring Dr. Raffy Karamanoukian of www.KareMD.com and www.Surgery90210.com
The Vein Treatment Center and www.VeinsVeinsVeins.com (Dr. Karamanoukian) is the only vein specialist in Western New York that performs the Clarivein™ Venous Ablation ablation procedures which uses a combination of mechanical ablation and chemical ablation to obliterate varicose veins. Varicose vein procedures are now state of the art and our vein clinic in Western New York utilizes the most high tech procedures to address your vein issues. Our office has recently evaluated and approved the Clarivein procedure for endovenous ablation of venous reflux.
The advantages of Clarivein™ Venous Ablation are:
1. Safe and effective
2. Excellent clinical results
3. No risk of thermal injury
4. No nerve damage or paresthesia
5. No tumescent anesthesia
6. "one needle stick' procedure
7. Minimal discomfort
8. Minimal bruising
Dr. Hratch Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 716-839-3638 or www.VeinsVeinsVeins.com
Dr. Hratch Karamanoukian welcomes patients from Ontario, Canada. Our offices are minutes away from the Peace Bridge and patients can be in and out of the office in less than 90 minutes and expect to return to work the same day in 99% of cases. Our offices will help make arrangements for those who want to spend the night in the U.S. - but 99% of our patients drive back home to Canada immediately after leaving the office.
Dr. Raffy Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 310-998-5535 or www.SantaMonicaVeinCenter.com
Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.
Dr. Hratch Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 716-839-3638 or www.VeinsVeinsVeins.com
Dr. Hratch Karamanoukian welcomes patients from Ontario, Canada. Our offices are minutes away from the Peace Bridge and patients can be in and out of the office in less than 90 minutes and expect to return to work the same day in 99% of cases. Our offices will help make arrangements for those who want to spend the night in the U.S. - but 99% of our patients drive back home to Canada immediately after leaving the office.
Dr. Raffy Karamanoukian is a member of the American College of Phlebology AND a Diplomate of the American Board of Phlebology. He can be contacted by calling 310-998-5535 or www.SantaMonicaVeinCenter.com
Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.
The relationship between being overweight and developing venous insufficiency was an observation in population based studies that needed 'hard clinical data'. This information has now been answered sufficiently in a group of obese patients.
Researchers in Italy have shown, using measurements of abdominal pressure, that overweight patients have larger femoral vein diameters, more likely to have venous insufficiency than thin patients, and this has been correlated with highr intrabdominal pressures.
So, this is the scientific backing for this emperical observation regarding the relationship between obesity and the incidence of venous insufficiency.
To be evaluated or treated for venous insufficiency, contact Dr Karamanoukian at the Vein Treatment Center with offices in Williamsville, NY, Clarence, NY and East Amherst, NY. Call 716-839-3638 or go to www.VeinsVeinsVeins.com
This study was published by Parmeggiani and colleagues in Ann Ital Chir. 2012 Nov 7.
