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Venous Reflux Treatment Buffalo Niagara
Venous Insufficiency Buffalo Niagara - VenaCure EVLT, Venefit Procedure, VNUS Closure and ClariVein



The Vein Treatment Center is a National Center of Excellence for Venous Disorders and DiseasesTM




If you experience aching and pain in the legs, heaviness and tiredness of the legs at the end of a work day, fatigue of the legs, itching and a rash in the lower legs, cramping and throbbing of the legs, or swelling of the ankles and legs, or if you have obvious varicose veins in the thighs, legs and spider veins along the ankles, you may be suffering from superficial venous reflux disease. This condition is also called venous insufficiency or venous reflux disease.


Rest assured, you are on the right website, because Dr. Karamanoukian is one of few surgeons in the U.S. that can offer you EVERY available technology to treat venous insufficiency and he has the experience of over 18,000 documented cases : 


  1. VenaCure EVLT Never Touch - 980 nm laser and the latest 1470 nm laser for the saphenous veins
  2. EVLA - 810 nm laser for endovenous laser ablation of the saphenous veins
  3. Venefit Procedure (previously called VNUS Closure)
  4. ClariVein Procedure - also known as MOCA - 'mechanicochemical ablation' of the saphenous veins
  5. VenaCure EVLT Never Touch for perforator venous reflux disease
  6. Ultrasound guided foam sclerotherapy


Superficial venous reflux can also cause symptoms in patients who have no obvious varicose veins. This means that there are patients who have all of the symptoms noted above without obvious varicose veins who may have this condition. They come in for evaluation because they have aching and pain in the legs, heaviness of the legs, tired legs, fatigue of the legs at the end of a work day, cramping and throbbing of the legs, or simply with leg swelling and restless legs.


Approximately 25 million Americans suffer from superficial venous reflux disease. Superficial venous reflux disease is not limited to unsightly varicose veins. One can have superficial venous reflux disease alone, superficial venous reflux disease associated with varicose veins, or varicose veins without venous reflux disease.


Longstanding untreated venous insufficiency could result in trophic changes in the skin - brown discoloration and pigmentation, hyper (too much) pigmentation or hypopigmentation (too little pigmentation) of the skin in the lower legs, and circumferential scarring of the lower legs - called lipodermatosclerosis. Lipodermatosclerosis means sclerosis (thickening) of the skin (derma) and fatty tissue (lipo) of the leg. The thickening of the skin causes a leathery consistency of the skin and underlying structures which makes healing of wounds very difficult and in the end stages of this process, causes ulceration of the skin. An ulcer is a wound that takes longer than 3 months to heal.


Some unfortunate patients will develop the worse complication, which is the development of venous stasis ulceration! It is imperative to intervene and treat venous insufficiency, especially if you have symptoms or if you have already developed skin changes - hyperpigmentation (CEAP classification C4), venous stasis dermatitis (CEAP classification C4a), lipodermatosclerosis (CEAP classification C4b), healed venous stasis ulcer (CEAP classification C5) and active venous stasis ulcer (CEAP classification C6).



Watch a video about superficial venous reflux disease by Dr. Karamanoukian:



Venous reflux or venous insufficiency develops when the valves that usually keep blood flowing out of your legs become diseased and don't function as one-way valves. The blood 'refluxes' back into the legs. In essence, it is like gastroesophageal reflux disease when acid in the stomach goes the wrong way - instead of moving down into the small intestine, it refluxes into the esophagus, causing acid reflux symptoms - epigastric discomfort, esophageal stricture and esophageal ulceration. Venous reflux is venous blood being pushed back into the legs, instead of it moving towards the heart and lungs for proper oxygenation.


The main treatment alternative for superficial venous reflux disease is to re-route blood flow into healthy veins. The ides is to ensure that blood in the superficial venous system (great saphenous and lesser saphenous) drain towards the heart and not pool in the legs.


Traditionally patients diagnosed with venous reflux would undergo painful vein stripping and ligation surgery. Ligation of the veins at the level of the groin would prevent blood from refluxing into the great saphenous vein. Additionally, stripping the great saphenous vein would prevent the blood from refluxing into this vein. The thought was that ligation and stripping was a "belt and suspenders" way of treating venous reflux disease. That is, tighten the belt at the groin (ligation) and strip the great saphenous vein ("suspenders").


Unfortunately, "ligation and stripping" would limit routine activities and preclude patients to return to work for 6-8 weeks, on average. More commonly, women recall the past when their aunts or mothers spent weeks and often months out of work, and worst, being wrapped from groin to ankle with ace bandages and support hose. Today, traditional vein stripping surgery is relegated to the history books. Unless there is a technical reason not to perform VNUS Closure or endovenous laser obliteration of the great or lesser saphenous veins (EVLT), most patients are good candidates for these procedures if they have symptoms that suggest venous reflux disease and Duplex studies that support this clinical diagnosis.


Based on a large body of published literature, the American College of Phlebology has published that great saphenous vein reflux is the most common underlying cause of significant varicose veins. The most most durable treatment has historically been ligation and stripping of the great saphenous vein. Thermal radiofrequency ablation with the Venefit Procedure (previously called VNUS Closure) and EVLT, having been used to treat hundreds of thousands of patients in the last decade with excellent long term results "should now be accepted as the treatment of choice for venous insufficiency of the great saphenous vein".


Now, patients can be treated with the VNUS Closure Procedure or EVLT Never Touch VenaCure proceudre - minimally invasive alternatives to painful vein stripping surgery. The Venefit Procedure (previously called VNUS Closure FAST) utilizes radiofrequency energy to obliterate the saphenous veins and the VenaCure EVLT Never Touch utilizes a 'gold jacket' tip to ablate the saphenous veins with laser energy. The VenaCure EVLT Never Touch is the latest laser technology to obliterate the saphenous veins with minimal discomfort and significant reduction in bruising in the post procedure period and quick return to fucntion. Typically, patients return to work the following day. Some self employed patients elect to return to work immediately. The only restriction is to not lift anything heavier than 30 pounds for 2 days, until patients return for a follow-up appointment and Doppler ultrasound scan.


Saphenofemoral venous reflux disease occurs at the level of the groin with deep venous blood refluxing into the great saphenous vein. The great saphenous vein courses from the groin to the ankle along the medial aspect of the lower extremity. Saphenopopliteal venous reflux is reflux at the level of the popliteal fossa (back of the knee) from the popliteal vein into the lesser saphenous vein - this vein courses in the back of the thigh and leg. Perforator venous reflux occurs throughout the lower extremity and at the level of the thigh, leg and ankle (see section on perforator veins).


The Vein Treatment Center is a National Center of Excellence for Vein Disorders. Dr. Hratch Karamanoukian is listed in the 'Guide to America's Top Surgeons' in 2008, 2009, 2010, 2011 and 2012 the Consumers Research Council of America. is a highly rated and objective portal for information about VNUS Closure, EVLT, EVLT Never Touch VenaCure, varicose veins, spider veins and reticular veins. Dr. Karamanoukian was recently rated as 2009 "Guide to America's Top Surgeons in Phlebology'. Phlebology is a specialty for venous disorders and venous surgery. Dr. Raffy Karamanoukian, a partner in the practice has been featured on The Doctors TV show for his contribution to foam sclerotherapy. To view this video click on the link below:



What is the healing rate of venous stasis ulcers in patients with saphenofemoral venous insufficiency treated with endovenous laser therapy (EVLT) ?

The healing rate of venous stasis ulcers is 81.5 % at 12 months with EVLT versus 24 % with compression therapy alone ! 

If you have a venous stasis ulcer, do not wait for it to get infected. Seek treatment aas soon as possible. Get a Duplex scan of your leg and seek a Board Certified Phlebologist. Dr. Karamanoukian can guide you through this process and design a treatment regimen that includes immediate evaluation, compression care, EVLT therapy followed by compression therapy to help heal the ulcer in conjunction with a multidisciplinary team of wound care specialists.

Call NOW for evaluation and treatment 716-839-3638 or email us at 



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