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Venefit™ Endovenous Ablation (VNUS Closure)
Venefit™ Procedure (previously called VNUS Closure™)

There are many reasons to undergo treatment for venous insufficiency.  During your consultation for varicose vein problems, Dr. Karamanoukian will evaluate your legs with visual inspection, vein mapping with Vein Lite which transilluminates the veins AND use the Vein Viewer which uses infrared technology to visualize the veins - as such, Dr. Karamanoukian will map the varicose veins, reticular veins, feeder veins and spider veins in the legs. 


Next. Duplex scanning is peformed to determine whether there is venous insufficiency at the saphenofemoral and saphenopopliteal junctions, aslo known as truncal venous insufficiency. This determines whether you are a candidate for endovenous laser (VenaCure EVLT), Radiofrequency ablation with the Venefit Procedure (previously called VNUS Closure), or the ClariVein Procedure (mechanochemical ablation). 



We next determine which pattern of great saphenous vein (GSV) or small saphenous vein (SSV) reflux exists for classification and treatment:


  1. Segmental reflux - reflux source or origin from a tributary or perforating vein distal to the saphenous junction and reflux drainage through a tributary or perforating vein in the thigh, knee or calf.
  2. Distal reflux - reflux source or origin from a tributary or perforating vein distal to the saphenous junction and drainage through veins at the ankle.
  3. Proximal reflux - reflux source at the saphenous junction and drainage thorugh tributary or perforating vein at the thigh or calf, but proximal to the ankle.
  4. Multisegmental reflux - Two or more reflux segments with five basic types - proximal segmental, proxmal distal, segemental segmental, segmental distal and proximal segmental distal.
  5. Diffuse reflux - reflux source at the saphenous junction and drainage at the ankle and no discernable patern or from of the great sapehnous vein.
  6. Perijunction reflux -
  7. Normal pattern - absence of extension into the saphenous vein down to the ankle


This pattern utilized is from CA Engelhorn from Phlebology 2012; 27: 25-32.  






At the Vein Treatment Center, Dr. Karamanoukian also utilizes the newest and most advanced laser system to perform endovenous ablation procedures ! This happens to be the VenaCure endovenous laser therapy (EVLT) Never Touch system. Dr. Karamanoukian has been using the VenaCure EVLT Never Touch system since 2007 and to date has performed over 18,000 endovenous ablation procedures - combined Venefit Procedure (previously called VNUS CLosure, EVLT and EVLT Never Touch Procedures). We incorporated the VenaCure Never Touch procedure in our armamentarium of procedures since 2009 to treat venous insufficiency involving the great saphenous (GSV) and small saphenous (SSV) veins.


Although other surgeons were quick to adopt this second generation FAST catheter, Dr. Karamanoukian waited for the clinical results to be published in the scientific literature before adopting it and using it in his patients. Having published over 140 scientific articles, Dr. Karamanoukian believes that adopting new technology should await hard proven scientific data. However, Dr. karamanoukian is the first surgeon in the world to perform bilateral VNUS Closure procedures (Venefit Procedure) at the same office setting! This is very helpful in reducing the number of trips and allowing the patient to resume all activities as soon as possible, typically returning to work the same afternoon and certainly by next morning ! This work was started in 2006 and presented with 2 year follow-up at the 2009 American College of Phlebology Meeting in Palm Desert, California.


The benefit of having your treatment done at the Vein Treatment Center is that we have both EVLT laser and VNUS Closure FAST (Venefit Procedure) technology and Dr. Karamanoukian will determine which technology best suits the anatomy and pathophysiology of venous insufficiency in a particular patient. We are the only center in Western New York to have both of these technologies under one roof and with a large expertise in performing both of these procedures by our Board Certified Phlebologist, Dr Karamanoukian.  We have also been using a third technique, namely mechanochemical ablation with ClariVein technology. No other center in the U.S. or Canada utilizes all 3 different methods in treating venous insufficiency:


  1. Venefit Procedure - uses radiofrequency energy to obliterate saphenous veins or perforator veins
  2. VenaCure EVLT Never Touch - uses laser energy to obliterate saphenous veins or perforator veins
  3. ClariVein - uses mechanical and foam sclerotherapy to obliterate saphenous veins


The benefits of the VNUS or Venefit endovenous ablation system are as follows:

  1. Minimally-invasive procedure for varicose veins: Avoids prolonged surgery or extended downtime.
  2. Quick recovery when compared to traditional vein stripping procedures.
  3. Less pain and discomfort when compared with vein stripping procedures.
  4. Excellent clinical outcomes: see study below ... '5 year outcome study of Venefit Procedure" :



Covidien on December 20th, 2012 reported durability of the Venefit Procedure (previously called VNUS Closure) in a 5-year outcome study.




The ClosureFast Study was conducted at eight centers in Europe from April 2006 to June 2007. The Venefit procedure, using the ClosureFast radio frequency ablation catheter, was used to treat 295 lower limbs in 225 patients diagnosed with superficial venous reflux, the underlying cause of varicose veins and [chronic venous insufficiecy].




Dr. Proebstle of Germany reported that "full occlusion of the treated vein was observed in 92 percent of patients versus 98 percent at one year. Also, 95 percent of the patients were free of pathological venous reflux as against 99 percent at one year".




Dr. Karamanoukian of the Vein Treatment Center performs the VNUS Closure Procedure - now called Venefit Procedure (new name).




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.



Most of the procedures we do for venous insufficiency require 1 or 2 needle sticks and the rest of the procedures, such as vein stripping and ligation procedures, are relegated to the history books (for the most part) and are performed today by general surgeons.




The procedures we do today that follow EVLT laser or VNUS Closure use non surgical techniques with no cuts, no sutures and return to work IMMEDIATELY !  There is no down time.




That's right, you can have great legs at any age if you take preventive measures and walk every day, wear compression stockings, exercise your leg muscles to keep the 'calf muscle pump' strong and take some natural supplements which have been shown to help prevent venous insufficiency (read Dr. Karamanoukian's books about horse chestnut extract and bioflavonoids) - you can also visit my website to read and purchase Veinamin supplements.




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. 




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



  1. ClariVein procedure - one needle stick procedure for venous reflux
  2. VenaCure EVLT Never Touch
  3. VNUS Closure Fast, also known as Venefit Procedure
  4. VenaCure EVLT peroforator vein Procedure
  5. Foam Sclerotherapy
  6. Topical laser treatments
  7. Ultrasound guided sclerotherapy
  8. 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.


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