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What is a telangiectasia? What is a spider vein? What is a thread vein? What is a Varicose Vein? What is Lipodermatosclerosis? What is Phlebitis? What is a Venous Stasis Ulcer? Vein Treatment Center and www.VeinsVeinsVeins.com

A telangiectasia is a confluence of dilated intradermal venules of less than 1 mm in caliber. Telangiectasia 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. Spider veins are amenable to laser therapy and sclerotherapy. We utilize both traditional sclerotherapy and dynamic foam sclerotherapy to treat the feeder veins underlying telangiectasias - as well, we use topical lasers to obliterate telangiectasias. The Vein Treatment Center has several topical lasers to treat telangiectasias and spider veins and has expertise in traditional sclerotherapy and foam sclerotherapy. We utilize Polidochanol (Asclera) and STS as well as hypertonic saline - the decision to use one or the other is based on our vast experience in treating thousands of patients with telangiectasisas, reticular veins and varicose veins.

 

Watch a video clip of sclerotherapy for telangiectasias and spider veins by Dr. Raffy Karamanoukian.

 

Watch a video clip of foam sclerotherapy for spider and reticular veins by Dr. Hratch Karamanoukian

  


What is a reticular vein?

 

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, also known as spider veins (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. Expertise at the Vein Treatment Center for reticular veins include dynamic foam sclerotherapy and ultrasound guided foam sclerotherapy, available only in our facility. Dr. Raffy Karamanoukian has demonstrated this technique on The Doctors TV Show in 2009 and has garnered national attention and was involved in initiating the first such program in Western New York!  Dr. Hratch Karamanoukian has been performing foam sclerotherapy for spider veins, reticular veins and varicose veins since 2008.

 

Watch a video clip of foam sclerotherapy for spider and reticular veins by Dr. Hratch Karamanoukian

 

 

What is a varicose vein? 

 

A varicose vein is a subcutaneous dilated vein larger than 3 mm in diameter in the upright posture. Varicose veins are also known as a 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 ankle areas, as well as on the external genitalia in women.

Varicose veins pool blood in stagnant segments and get inflamed causing chronic phlebitis. If these symptoms of aching, pain, itching, burning and cramping are not relieved with use of compression stockings, they are amenable to the latest techniques that we employ at the Vein Treatment Center. Techniques include a combination ofendovenous ablation procedures to treat underlying venous insufficiency (venous reflux disease), microphlebectomy, sclerotherapy with or without foam, and ultrasound guided foam sclerotherapy. In some cases, we also use the ClariVein procedure to treat both venous insufficiency and varicose veins. Dr. Karamanoukian is the only vein specialist in Western New York that uses the ClariVein Procedure.

 

Video of Dr. Karamanoukian performing foam sclerotherapy for varicose veins 

 

  

 

 

What is Superficial Thrombophlebitits ?

 

 

 

 

Superficial thrombophlebitis or superficial vein thrombosis with phlebitis is a condition where superficial veins thrombose or clot and cause inflammation and i nduration of the overlying skin and erythema (redness) and palpable warmth over the course of the vein. Once the phlebitis is treated with anti-inflammatory medications, the vein should be removed using microphlebectomy technique to avoid trophic changes and hyperpigmentation of the overlying skin. Often, the redness resolves and hyperpigmentation is the residual effect with continued aching overlying the chronically inflamed cord of thrombosed varicse vein (chronic phlebitis or thrombophlebitis).

 

 

 

 

Very rarely, microphlebectomy is performed to treat large varicose veins with thrombophlebitis which have not responded to conservative treatment with non steroidal anti-inflammatory medications and/or Phlebitis PAK.

 

Video of superficial thrombophlebitis of the great saphenous vein by Dr Karamanoukian

 

  


What is 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 af advanced venous reflux disease or venous insufficiency. 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".

 

The corona phlebectasia is treated by treating saphenofemoral venous reflux disease with VenaCure EVLT, Venefit Procedure (previously called VNUS Closure) or ClariVein Procedure AND treating the ankle veins with sclerotherapy and topical laser treatments, Side effects of extensive injection sclerotherapy for dense telangiectasias and reticular veins in corona phlebectasia can result in hyperpigmentation of the ankle.

 

Treatments for venous insufficiency include EVLT, Venefit Procedure and ClariVein Procedures.

 

Watch video of corona phlebectasia which has been injected with foam sclerotherapy by Dr Karamanoukian:

 

 

What is Edema?

 

Edema is tissue fluid in the skin and subcutaneous (fat) and is measured by the amount of skin indentation left with digital pressure. It is associated with venous reflux disease. It is also associated with other conditions such as congestive heart failure, renal insufficiency and failure and other systemic disease. Dr. Karamanoukian is a cardiovascular surgeon who can help exclude other sources or etiologies of ankle edema.

 

Your extensive consultation with Dr. Karamanoukian will include history taking, clinical examination and Duplex venous study of the lower extremities. This will help determine the cause of anke and leg edema in better than 99% of cases.

 

Read about treatments for venous insufficiency with ClariVein Procedure, EVLT Never Touch and Venefit Procedure (previously called VNUS Closure).

  


 

What is Hyperpigmentation?

 

Hyperpigmentation is the discoloration (bronze-brown or purple) of the skin in patients with chronic venous reflux disease and chronic inflammation of varicose veins. Hyperpigmentation occurs in the gaiter areas of the legs including the lower legs, ankles and feet.

 

In extensive cases, the hyperpigmentation may be circumferential and associated wtih sclerosis (thickening) of the skin and subcutaneous fatty tissue (see lipodermatosclerosis below). 

 

In the CEAP classification of venous disease, hyperpigmentation is classified as CEAP C4 disease.

 

Once patients are assessed by Dr. Karamanoukian and a venous Duplex scan is performed which utilizes a combination of ultrasound (B mode scanning) and Doppler scanning - together called Duplex 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 utilized in addition to the morphological and pathological classification of venous diseases. 

 

 

What is Stasis Dermatitis?

 

Stasis Dermatitis is a type of dermatitis related to chronic venous reflux disease and inflamed varicose veins. It can be a blistering, weeping or scaling skin eruption and occurs in the thighs, legs and ankles. Stasis dermatitis is also called gravitational eczema and venous eczema.

 

Gravitational eczema is what the name implies, eczema in the lowest parts of the leg where there is most likely to have pooling of blood in veins, i.e. venous reflux with elevated venous pressures due to this venous load (venous hypertension).

 

Stasis dermatitis is most comon in the gaiter areas of the legs. Once the inflamed cords of veins are treated, venous eczema will go away. Sometimes topical steroid cremes like triamcinolone is used to treat stasis dermatitis.

 

 In the CEAP classification of venous disease, venous stasis dermatitis is classified as CEAP C4a disease.

 

Once patients are assessed by Dr. Karamanoukian and a venous Duplex scan is performed which utilizes a combination of ultrasound (B mode scanning) and Doppler scanning - together called Duplex 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 utilized in addition to the morphological and pathological classification of venous diseases.

  


What is Lipodermatosclerosis?

 

Lipodermatosclerosis is chronic inflammation with resultant fibrosis or sclerosis of the skin (derma) and subcutaneous fat (lipo) where the skin of the lower leg becomes scarred in a circumferential manner and the leg looks tapered like a 'chicken leg'. 

 

Lipodermatosclerosis has been identified under many different names for years, as membranous lipodystrophy, lipomembranous fat necrosis and stasis associated lipomembranous panniculits, among others.

 

The hallmark of lipodermatosclerosis is the leathery skin, brown discoloration, hyperpigmentation and hypopigmentation of the skin, and circuferential or near circumferential scarring and shrinking of the extremtiy.

 

In the CEAP classification of venous disease, lipodermatosclerosis is classified as CEAP C4b disease.

 

Once patients are assessed by Dr. Karamanoukian and a venous Duplex scan is performed which utilizes a combination of ultrasound (B mode scanning) and Doppler scanning - together called Duplex 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 utilized in addition to the morphological and pathological classification of venous diseases.

 

Video showing lipodermatosclerosis by Dr. Karamanoukian

 

 

 

image of advanced lipodermatosclerosis (chronic) from Dr. Karamanoukian's book - A Guide to Lipodermatosclerosis (in print)

 

Image of chronic lipodermatosclerosis.

 

  

image of chronic lipodermatosclerosis from Dr. Karamanoukian's book - A Guide to Lipodermatosclerosis (in print)

 

 

What is Atrophie Blanche?

 

Atrophie Blanche is translated from the French language, it literally means 'white atrophy'.

 

It is often circular, whitish skin (hypopigmentation) with skin atrophy associated with skin hyperpigmentation. Atrophie blanche is a sign of severe and advanced venous insufficiency, also described as advanced trophic changes of the skin due to venous disease.

 

These skin changes can result from progressive venous insufficiency or following the healing of venous stasis ulcers.

 

Video clip of atrophie blanche and lipodermatosclerosis by Dr. Karamanoukian of www.VeinsVeinsVeins.com

 

 

 

What is a Venous Stasis Ulcer?

 

A venous stasis ulcer is a nonhealing wound in the legs and ankles related to chronic venous insufficiency. 

 

For a very complete description of venous stasis ulcers, click on "venous ulcer" on the main menu of this website or read about venous stasis ulcer on VeinGuide.com.

 

Don't suffer from venous stasis ulceration - venous stasis ulcers can be quite stubborn to heal and require a multidisciplinary approach to help them heal. The Board Certified Phlebologists at the Vein Treatment Center under the direction of Dr. Karamanoukian can help you get proper treatment of your venous stasis ulcer.

Healed Venous Stasis Ulcer 
Healed Venous Stasis Ulcer with Skin Graft 

 

This video clip has a healed and healing venous stasis ulcer. It is the most downloaded video clip about venous stasis ulcers and lipodermatosclerosis on YouTube:

 

Another video about Venous Stasis Ulcers by Dr. Karamanoukian 

 

Perforator venous reflux and venous stasis ulcer by Dr. Karamanoukian:

 

 

 

image of active venous stasis ulcer - from Dr. Karamanoukian's book - A Guide to Lipodermatosclerosis

 

 

image of venous stasis ulcer - from Dr. Karamanoukian's book - A Guide to Lipodermatosclerosis

 

Bleeding from Venous Disease

 

   

Venous Hypertension causes proliferation of varicose veins under the skin.  Teh ncreased pressure in the vein/veins into the dermis (skin).  This eventually results in spontaneous bleeding.  

 

In this case the source of bleeding is reflux from a politeal perforator vein which occurs behind the knee. 

 

  

Dr. Karamanoukian has been writing books for physicians and patients since 1997. He has authored 41 books and provides free pdf copies of some of his books to his established patients. Picture of the covers of the books are shown below and 8 books are for board review and copies of borad review books are not available for sharing.  

  

Dr. Hratch Karamanoukian contributed 7 chapters to the American College of Phlebology Patient Education Book titled 'Healthy Veins .... Healthy Legs' - A Patient's Guide to Phlebology'. The book was edited by Raffy Karamanoukian MD FACS and Helane Fronek MD FACP FACPh.  

 

 

 

The book can be ordered from the American College of Phlebology website.  The American College of Phlebology is the premier organization for vein specialists in the United States. Dr. Karamanoukian is a member of the American College of Phlebology and is a Diplomate of the American Board of Phlebology.  http://www.phlebology.org/resources/patiented.html

 

You can also receive a free copy of this book at your consultation with Dr. Hratch Karamanoukian.

 

A highly recommended reading for those with venous insufficieny - 'Treatment Options for Chronic Venous Insufficiency - A Color Atlas' by Hratch Karamanoukian MD FACS and Raffy Karamanoukian MD FACS.

 

This book is available at no charge to Dr. Karamanoukian's existing patients as a pdf copy.  Just click the book below.

Treatment Options for Chronic Venous Insufficiency

 

Read Dr. Karamanoukian's book 'Post Thrombotic Syndrome and Deep Vein Thrombosis' -.   Just click the book below.

 

 Post Thrombotic Syndrome and Deep Vein Thrombosis

 

Video Summary of 'Venous Reflux Disease and Endovenous Laser Therapy' - The authors are Dr. Hratch Karamanoukian and Dr. Raffy Karamanoukian.   To read just click the book below.

 Venous Reflux Disease and Endovenous Laser Therapy

 

'Dr. Karamanoukian's Guide to Horse Chestnut Extract' is written by Hratch Karamanoukian MD FACS and Raffy Karamanoukian MD FACS.  To read  just click the book below.

 

Dr. Karamanoukian's Guide to Horse Chestnut Extract

 

 

For those suffering from aching and pain in the legs, heaviness, tiredness, fatigue of the lower extremities, throbbing and swelling of the legs and ankles, it can certainly be a hurdle in life. It can lead to a loss of physical activity, force you to give up activities that you love and even keep you from getting the exercise that you need to remain healthy. However, it can also be a sign of a serious disease – venous reflux disease, also known as venous insufficiency.

 

'The Health Benefits of Citrus Bioflavonoids and Diosmin - Treating Venous Insufficiency, Varicose Veins, Spider Veins, Venous Leg Ulcers, Leg Swelling and Hemorrhoids' by Hratch L Karamanoukian MD FACS and Raffy L Karamanoukian MD FACS

 

The Health Benefits of Citrus Bioflavonoids and Diosmin


Venous reflux disease affects an enormous number of people in America and around the world. This painful, debilitating condition can develop without you even knowing it. Moreover, it can result in some very serious problems, including skin discoloration and in some patients, left untreated, can result in the development of venous stasis ulcers. The lifetime risk of developing venous stasis ulcers in a patient with venous reflux disease is 4%. 

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