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Spider Veins
Spider Vein Treatment and Spider Vein 'Removal' Buffalo, Niagara and Ontario



Dr. Karamanoukian has taken care of countless patients with vein problems - spider veins, varicose veins, reticular veins, venous reflux disease, venous ulcers since 2003.


We perform a continuous analysis of our practice and integrate the latest and best techniques in Phlebology, the discipline of venous disorders and venous treatments. Dr. Karamanoukian continues to offer the most comprehensive armamentarium to treat venous disorders and problems. We have maintained very high standards in our community and also have been recognized for our expertise regionally and nationally. We also treat a large number of patients from across the border in the province of Ontario, Canada.


The main aim of the treatments offered by Dr. Karamanoukian is to provide the highest possible comfort with treatments that have efficacy and proven track record in the scientific literature. We have also strived to provide all of the above while maximizing the aesthetic results desired by patients with venous diseases. 






Foam Sclerotherapy for Spider and Reticular veins - by Dr Hratch Karamanoukian


Foam Sclerotherapy for Varicose Veins - as seen on The Doctors TV SHow - by Dr Raffy L Karamanoukian of





We have the spectrum of procedures that allow return to work 'smae day or following day' :







  • Foam Sclerotherapy


  • Topical laser treatments


  • Ultrasound guided sclerotherapy


  • Microphlebectomy



These procedures assure a high level of safety with minimal incisions and scarring potential.


Our patients return to work immediately after the procedures or the day after in more than 99% of cases. We do not encourage patients to take time off from work unless they lift heavy things (> 40 ounds) at work. The only activity we discourage is weight lifting at a gym for 48 hours after the procedure.






Is there evidence of venous reflux disease in women with spider veins, reticular veins and varicose veins ? Buffalo Niagara Vein Expert



A recent study conducted in Brazil looked at a population of women who presented to an outpatient phlebology practice. The authors (CA Engelhorn and colleagues) from Curitiba, Brazil showed that about 90% of women with spider veins (telangiectasias), reticular veins and or varicose veins had venous reflux involving the great saphenous vein. Initial segmental reflux involving the great saphenous vein remained stable for approximately 3 years and later progressed to multisegmental venous reflux disease. As such, Duplex studies and careful follow-up was recommended for women who presented with spider and reticular veins to determine progression of venous insufficiency after treatment for spider and reticular and varicose veins. The study was published in Phlebology 2012; volume 27: pages 25-32.


As such, this study has investigated the progression of saphenous vein reflux in a young population of women who presented with cosmetic concerns for spider and reticular veins. Early signs of venous valvular disease became worse and segmental disease became multisegmental with worsening symptoms. Therefore, an aggressive follow-up of such patients is recommended by these authors to diagnose and treat those who come back with worsening symptoms and worsening US Doppler evidence of multisegmental venous insufficiency.





Edinburgh Vein Study investigates the association of telangiectasias and Venous Reflux Venous Insufficiency




Telangiesctasias in the general population in Edinburgh were investigated to look for coexistent venous insufficiency. Telangiectasias are less than 1 mm in size. The study by CV Ruckley and colleagues was published in Phlebology 2012; volume 27: pages 297-302. The study shows an association between saphenous incompetence and telangiectasias. The popliteal fossa was the most frequent site for telangiectasias.



What is a Telangiectasia ?


Telangiectasias are dilatations of the venous plexus and the subpapillary portion of the skin.  They are not capillary vessels and telangiectasias are not regarded as varicose veins.  The smallest telangiectasias are defined as vessels that are 1 mm in diameter or less.  They vary in color and the smallest telangiectasias (0.1mm to 0.2 mm) are frequently red in appearance and the larger ones are typically blue in appearance. 


Telangiectasias occur in starburst patterns and are frequently a consequence of 1) an underlying feeding reticular vein,  2) underlying varicose veins originating from a saphenous vein source, 3) underlying varicose veins originating from a non-saphenous vein source,  4) an underlying incompetent perforator vein,  and 5) result from deep venous insufficiency.


Telangiectasias that arborize in the gaiter area of the inner malleolus (inner ankle) take on the characteristic appearance of what is called corona phlebectasia.  When corona phlebectasia is seen on clinical examination of the patient, this pattern is highly consistent with underlying venous insufficiency.


For the treatment of telangiectasias with sclerotherapy or lasers, contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York or call 716-839-3638.


Hratch Karamanoukian, MD FACS is triple board certified in general surgery, thoracic surgery (cardiovascular surgery), and phlebology (diseases of the venous system and lymphatic system).   and  are partners with



Spider Veins
























It has been determined that the prevalence of telangiectasias in the general population in the United States varies between 50 to 70%, depending on patient age.  Elderly patients, patients meaning patients older than 40 years have an incidence near 60 to 70%.  Telangiectasias affect woman more often than men. 



In the CEAP classification of venous disease, telangiectasias are classified as C1 disease.



It has been estimated that venous insufficiency occurs in as many as 45% of patients with telangiectasias, according to a study done by CA Engelhorn and colleagues.  This was published in Dermatologic Surgery in 2007; volume 33, pages 282 to 288. 



There is considerable debate in regards to the occurrence of symptoms in patients with telangiectasias.  Patients with telangiectasias or CEAP C1 disease often have accompanying symptoms of leg swelling, cramping in the legs, and restless legs more than patients who don’t’ have obvious venous disease (CEAP C0).



For the evaluation and treatment of telangiectasias in patients with or without symptoms, contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York or call 716-839-3638.



Hratch Karamanoukian, MD FACS is triple board certified in general surgery, thoracic surgery (cardiovascular surgery), and phlebology (diseases of the venous system and lymphatic system). and are partners with .



What is the CEAP Classification ? 

Varicose vein doctors now use the CEAP classification in order to objectively classify vein problems in patients.  In our Los Angeles vein clinic, we incorporate the CEAP classification in the management of varicose veins and vein disease.  Clinical Disease state (C), Etiology (E), Anatomic Distribution (A), and Pathophysiology (P).

Class 0 No visible signs of vein disease
Class I Telangiectasias / Spider Veins and or Reticular Veins  < 2 mm
Class II Varicose Veins, tortuous superficial veins with incompetent valves with > 4 mm
Class III Varicose Veins with Leg Edema (swelling of the leg, ankles, or feet)
Class IV Varicose Veins with advanced skin changes: dark pigmentation, eczema, lipodermatosclerosis
Class V Varicose Veins with advanced skin changes and a healed venous ulcer
Class VI Varicose Veins with advanced skin changes and an active open venous ulcer


Once patients are assessed by Dr. Karamanoukian and venous Duplex scans performed which utilizes a combination of ultrasound (B mode scanning) and Doppler scanning - together called Duplexx scanning of the venous system, the legs are mapped with both Vein Lite and Vein Viewer Infrared technology. The CEAP classification is next used to document the type of venous disease and clinical severity scores are next utilizes in addition to the morphological and pathological classification of venous diseases. 


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