Varicose Veins

The Santa Monica Vein Center is a National Center of Excellence for Varicose Veins

Varicose veins are a very common condition found in both men and women of all age groups. In fact, over 45% of men and over 75% of women in their sixties have varicose veins. Varicose veins and spider veins may cause a variety of symptoms, including bulging leg veins, leg pain, leg discomfort, leg tiredness, leg swelling and edema, leg itching, leg cramps, and leg discoloration. If any of these symptoms are caused by varicose veins, they may be relieved by a variety of simple treatments that are performed without anesthesia in a clinic setting.

Varicose veins arise from poorly functioning vein valves as well as a weakness in the vein wall. They can occur in the ankles, legs, or thighs and can become quite enlarged with age. In some women, varicose veins and spider veins may become worse with pregnancy.

When varicose veins become prominent, they can be seen through the skin and may develop a purple or bluish color. If the skin over the varicose vein becomes thin, the area may ulcerate and may occasionally cause uncontrollable bleeding. Bleeding varicose veins and ulcerations are not uncommon in patients who have large and/or neglected varicose veins.These patients should seek immediate attention to improve their symptoms.

Commonly, however, varicose veins cause milder symptoms such as leg pain and leg swelling. It is common for patients to describe a family history of varicose veins in their mother, father, or aunts and uncles.

Various treatments are available at any stage of varicose vein disease. Even in the latter stages, there is significant benefit to be gained by newer, non-invasive techniques such as endovenous radiofrequency ablation of varicose veins (VNUS Closure) or laser-(EVLT). In either case, a micro-incision is made in the thigh to heat and close off one of the troublesome veins using a specialized venous catheter. Another procedure is a microsurgical phlebectomy, wherein tiny incisions are made overlying very troublesome varicose veins in order to remove them from the body.

These procedures are meant to improve circulation and many patients ask how the circulation improves when you remove the veins. The answer is fairly simple. Patients with large varicose veins essentially have 'pools' of blood in their varicose veins that are not efficiently circulating blood through the venous circulation. The heart really has to work harder to pump blood through these many redundant varicose vein channels. When we remove these defective varicose veins, the blood is channeled through more efficient veins in our legs. ??Most procedures to treat varicose veins are performed in a clinic setting and do not require hospitalization. You may drive home after the procedure or return to work if you like. Most varicose vein procedures employ a technique called 'single-stitch' varicose vein surgery where the whole procedure is performed using a micro-incision and closed with a single, tiny, stitch placed in the leg.

Treatment Options for Unwanted Veins:

Spider and varicose vein treatment in Los Angeles

The development of spider and varicose veins progresses with age in most healthy adults.  Both men and women can develop spider veins and varicose veins in their legs and thighs and the condition may be associated with physical activity and family history.  In the Los Angeles area, Dr. Raffy Karamanoukian provides comprehensive and expert treatment of spider veins and varicose veins using the most state of the art technology.  Our board certified vein surgeon is a diplomate of the American Board of Phlebology (vein surgery) and the American Board of Plastic and Reconstructive Surgery.  He provides expertise in medical and cosmetic vein treatment.  If you are having problems with your varicose veins and have bulging veins, unsightly spider veins, or just pain and discomfort associated with your veins in the legs and thighs, early treatment is recommended.  The following list of treatments are available at the Los Angeles Vein Clinic of Dr. Raffy Karamanoukian. 

Duplex ultrasound

An ultrasound examination is an important component in the medical diagnosis of varicose veins and venous insufficiency.  Years ago, the only treatment options available were vein stripping and vein ligation.  Two major surgeries that were performed to eliminate venous reflux in the greater saphenous vein.  Today’s technology allows physicians and vein experts to treat the specific root cause of varicose veins with a single outpatient procedure performed under local anesthesia.  Before recommending such a treatment, Dr. Karamanoukian will perform an ultrasound examination to carefully look at the function and blood flow through the veins in your legs.  By examining the dynamics of the veins with an ultrasound, Dr. Karamanoukian can evaluate whether advanced vein treatments for venous insufficiency are required, or if simple cosmetic spider vein treatments are preferable.  Ultrasound examination is useful for endovenous vein treatments including EVLT, VNUS, Venefit and ClariVein.  Most patients will be glad to know that ultrasound examination of the veins are covered by most medical insurance plans and are painless.

Vein mapping

Vein mapping is an important component of varicose vein treatment as it allows Dr. Karamanoukian to examine your veins and determine what the root cause of the veins is superficially as well as the peripheral branches of the vein network.  Most vein clusters have a predictable pattern composed of a main trunk leading to peripheral branches. By performing a vein mapping procedure, Dr. Karamanoukian can evaluate your legs and thighs and determine which veins are conducive to laser treatment and which are conducive to sclerotherapy and injection.  A vein mapping procedure is usually performed during your initial vein consultation in our Los Angeles Vein Clinic.


Sclerotherapy is a procedure in which a small needle is used to administer a medicine into an unwanted and unhealthy vein.  The medicine causes the vein to collapse within seconds and thereafter, the body will absorb the vein and eventually lead to its elimination. Sclerotherapy has many different options and Dr. Karamanoukian is familiar with foam sclerotherapy, ultrasound guided sclerotherapy, transdermal sclerotherapy and transilluminated sclerotherapy.

All of these options have a specific indication and Dr. Karamanoukian can evaluate which of the sclerotherapy options are preferable in your specific case.  Sclerotherapy is generally used for thread veins and small spider veins underneath the skin.  The patients will note that newer sclerotherapy options are a lot less painful and less uncomfortable than previous salt water solutions.

Endovenous laser treatment

A procedure known as EVLT or endovenous vein laser treatment is considered the goal standard for the treatment of venous insufficiency and venous reflux.  EVLT is a minimally invasive procedure that uses a small laser fiber to eradicate and eliminate the root cause of venous reflux in the thigh.  By performing the endovenous laser treatment at the greater saphenous vein, EVLT can remove and eliminate the root cause of venous reflux and venous insufficiency that leads to varicose veins.  Dr. Raffy Karamanoukian is an expert in EVLT and endovenous laser treatments.  He prefers the minimally invasive approach as opposed to old fashioned vein stripping and vein ligation surgery.  If you have questions about EVLT and endovenous laser, Dr. Karamanoukian can discuss these options and the types of anesthesia used to perform EVLT during your consultation.  EVLT is performed under local anesthesia with the patient awake.  Recovery is relatively quick with the patients resuming normal activity within hours after their procedure.

Endovenous RF vein treatment

An alternative to EVLT and endovenous laser treatment is a procedure that uses radiofrequency or sound energy as opposed to laser energy to close off the root cause of venous insufficiency.  The main procedure used in endovenous RF treatment includes Venefit and endovenous techniques.  These vein procedures are performed under local anesthesia much like the previously mentioned EVLT and endovenous laser treatments.  By addressing the root cause of varicose veins and venous insufficiency, unhealthy vein networks are eliminated and the patients are allowed to resume normal activities within hours after the procedure.  The major difference between endovenous laser treatment and endovenous RF treatment is the source of the energy.  EVLT uses laser energy as opposed VNUS and Venefit which use sound waves.

Transdermal laser
Smaller spider veins and thread like veins are commonly seen in the feet, ankles, legs, and thighs.  If your vein concern is poorly cosmetic then spider vein treatments using laser are optimal.  Laser spider vein therapy is also known as transdermal laser therapy and the treatment begins with the application of a targeted laser that can eliminate spider veins from the surface of the skin.  Spider veins, thread like veins and telangiectasia are commonly treated with this laser therapy.  Transdermal laser is preferential option for the patients who have pure cosmetic veins who have no underlying medical condition.  Dr. Karamanoukian uses the Candela pulsed dye laser system, the Palomar system, and the Candela gentle YAG system to eliminate spider veins.  Our center is a comprehensive vein clinic in the Los Angeles area and we have three lasers that can address your spider veins and thread veins.

Vein surgery
Vein surgery, although considered a traditional method for vein treatment, still has its application and is necessary for bulging varicose veins that can not be eliminated by injection or endovenous treatment.  Bulging varicose veins that are uncomfortable or painful can be eliminated using two techniques known as ambulatory microphlebectomy and vein perforator ligation and excision.  Bulging veins and perforator veins can thus be eliminated using the simple techniques that are performed on an outpatient basis with minimal anesthesia.  The patients are pleased to know that the bulging varicose veins can be easily eliminated with minimal recovery and minimal downtime.  Regardless of the type of the vein treatment that you wish to undergo, the first step in your treatment is to schedule a comprehensive vein consultation with Los Angeles vein surgeon Dr. Raffy Karamanoukian.  Our vein center performs medical and cosmetic vein treatments and serves the Greater Los Angeles areas including the Westside, Hollywood, Santa Monica, San Fernando Valley, Encino, Thousand Oaks, Marina Del Ray, Pasadena, and Glendale. 
Santa Monica Vein Center
Santa Monica, CA 90403

Go Top