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Varicose Vein Treatment
Varicose Vein Treatment Buffalo Niagara and Toronto Veins and



What Are Varicose Veins and How Are Varicose Veins Unhealthy?

Vericose Veins - The Vein Treatment Center



If you experience bulging leg veins, aching and pain in the legs, heaviness, tiredness of the legs, itching and burning along bulging veins, restless legs or leg swelling, you may have symptomatic varicose veins that warrant evaluation and treatment.


Varicose veins can become enlarged and in some cases quite prominent. They can be seen in some individuals as serpiginous (snakelike), raised lumps in the thighs, legs, calves and ankles. 


The first reference to the treatment of varicose veins is credited to Hippocrates in the 4th Century BC. He used a "slender piece of iron" to traumatize varicose veins and thereby cause clotting of the vein. Another description is of historical note with removal of a varicose vein in the Roman Consul member Caius Marcus by Plutarch - of note, no anesthesia was used and when the surgeon went to do the same operation on his other leg, he is noted to have said " I see the cure is not worth the pain". Things have changed a lot since that time and the procedures done today are done in the comfort of an office setting with little or no discomfort! Over 98% of patients who have vein procedures at the Vein Treatment Center return to work within 24 hours. We encourage all of our patients to resume ALL physical activities immediately, including using the treadmill, walking, jogging, running, elliptical machines, yoga (traditional and hot), zumba, bicycling and so on ...


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 


Dr. Raffy Karamanoukian and Dr. Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.



Research Study Concludes that Varicose Veins Are a Risk Factor for Developing Blood Clots During Pregnancy

Adjusted odds ratio of developing venous thromboembolism during pregnancy if you have this underlying problem:
previous venous thromboembolism - increases your risk 25.8 times
age over 35 - increases your risk 1.3 times
body mass index above 30 - increases your risk 5.3 times
immobility - increases your risk 7.7 times
smoking - increases the risk 2.7 times
varicose veins - increases the risk 2.4 times


Elevated circulating levels of Factor VII, Factor VIII, Factor X and Factor XII during pegnancy increase risk of developing venous thromboembolism. This risk is highest right after delivery of the baby (the puerperium).


There are also a reduction in sensitivity to activated protein C and functional protein S levels during pregnancy.


The risk of develoing venous thromboembolism during pregnancy is 0.66 per 100.


This data is from P Kesteven and colleagues and the article is published in Phlebology 2012; volume 27 Supplement: pages 73-80.


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 


Drs. Raffy and Hratch Karamanoukian have authored 6 books about venous disease. The books are available on Amazon Kindle and Nook books for download.





What occupations increase the likelihood of developing varicose veins ?



There are many occupations that predispose individuals to develop varicose veins and this has been substantiated from the phlebology literature. Phlebologists are vein specialists who take care of spider veins, varicose veins, venous insufficiency and complications arising from untreated or poorly treated vein conditions.


It has been my clinical experience that it is not only the factory laborers that develop varicose veins. Professions that are at increased risk because they stand or sit a lot are : 


Doctors and nurses


Secretaries and administrative assistants




Hair dressers and barbers


Airline pilots, flight attendants and air traffic controllers


911 dispatchers


Retail workers


Barteners and waitresses


Truck drivers, cabbies and school bus drivers


Quality control technicians

  • Factory workers and machinists


Massage therapists, Physical therapists and Occupational therapists


Coffee house baristas


Fast food chain workers




Bank tellers


and many many more



Varicose Vein Chart       Varicose Vein Valve Diagram


image from 



If you have an occupation which demands that you sit or stand for a long time, get up and move - walk regularly and move your legs. Simply walking for 1 minute every 15-30 minutes can activate your calf muscle pump and pump stagnant blood out of the legs. Stagnant bood causes chronic inflammation of the vein valves which results in venous insufficciency. Venous insufficiency is the harbinger of varicose veins, spider veins, symptoms of swelling and aching in the legs and also trophic skin changes of the skin.




What is the relationship between foot disorders and venous insufficency ?




A recent study looked at a population of patients with venous insufficiency to see if static foot disorders are a risk factor for developing venous disease. The study was done in Dijon, France by J F Uhl and his colleagues. The researchers found that in the population of patients with venous insufficiency, 31% of patients had static foot disorders - flat feet (pes planus) or hollow feet (pes cavus). These patients presented with at least CEAP C3 grade of venous disease, namely leg swelling. If the criteria was lowered to having varicose veins, meaning CEAP Classification of C2, then 38 % of patients have static foot disorders.


The study was published by JF Uhl and colleagues in Phlebology, volume 27: pages 13-18.




What is the prevalence of bilateral varicose veins at presentation to a vein specialist ?


The prevalence of bilateral varicose veins in patients seeking treatment is between 26 % and 40 %. Procedures like endovenous ablation and foam sclerotherapy can be performed selectively and safely in both limbs in a simultaneous fashion.


Dr. Karamanoukian is the first in the world to perform the VNUS and EVLT procedures in a bilateral fashion in a single office visit and presented this data at the 2009 American College of Phlebology Meeting in Palm Desert, California.




What is stasis dermatitis ? What is gravitational eczema ? What is venous stasis dermatitis ?



It is widely believed by vein specialists that stasis dermatitis is due to chronic venous insufficiency. As a matter of fact, in a cross sectional study, 3.7 % of patients with vein problems reported having venous stasis dermatitis.


Since it has been shown that patients with venous insufficiency have a higher likelihood of having contact dermatitis, researchers at the Department of Dermatology and Cardiovascular Surgery at the University Hospital at Zurich, Switzerland eliminated all factors that led to nonspecific dermatitis (contact dermatitis, allergic contact dermatitis, atopic dermatitis, dry skin, etc. The researchers found that in those patients who have venous insufficiency as the only underlying cause for the dermatitis, treatment of venous hypertension led to complete and definitive treatment and resolution of the stasis dermatitis. The study was supported by the Swiss Society of Phlebology and the lead author of the study was K Sippel (Phlebology; 2011; volume 26: 361-365).



image taken from with permission from

Dr. Karamanoukian


 Stasis Dermatitis













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. 



watch Vein Viewer technology on the Dr. Oz Show - we use the same technology at our center 


Trust a Board Certified Phlebologist (vein specialist) to take care of your vein problems. Call Dr. Karamanoukian NOW at 716-839-3638 or emal Dr. Karamanoukian at 



Foam Sclerotherapy Diagram



What treatments are used for varicose veins ? 

There are different treatments for varicose veins, from the ClariVein procedure which uses mechanical and chemical obliteration to traditional microphlebectomy where tiny puncture wounds are used to remove varicose veins. Other techniques that are employed at the Vein Treatment Center include 3 types of sclerotherapy : traditional sclerotherapy, foam sclerotherapy and ultrasound guided foam sclerotherapy. We are also utilizing infrared guided (Vein Viewer) technology to perform sclerotherapy in our offices.


Call 716-839-3638 to schedule a consultation for evaluation and treatment by Dr. Karamanoukian. Or contact Dr. Hratch Karamanoukian via








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