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EVLT for the legs los angeles

Featured on the NBC Nightly News with Brian Williams, the EVLT system is fast becoming one of the most coveted vein treatments in the world.  Using patented and FDA approved laser technology, EVLT endovenous vein procedures tackle difficult vein problems by addressing the root cause of venous reflux. Find out why patients all over the United States have chosen the EVLT system for effective elimination of problems associated with vein disease.  Our Los Angeles vein clinic specializes in non-invasive treatments for varicose veins and vein disease.  If you are having problems with your varicose veins, or if you are concerned about bulging varicose veins, schedule an appointment in our office. Varicose veins and venous reflux have also been associated with a condition known as Restless Leg Syndrome. 

EVLT in Los angeles

Patients may present to a doctor years after they began noticing spider and varicose veins on the legs and thighs.  Varicose veins and venous problems can arise purely as a cosmetic concern, or in combination with underlying medical problems with the circulation.  A condition known as venous insufficiency often is responsible for the development of varicose veins or abnormal vein problems in the legs and thighs.  A treatment known as endovenous laser therapy, or endovenous laser can be used to treat varicose veins and underlying venous insufficiency in healthy men and women.  Endovenous laser is a significant advancement from traditional vein stripping and vein surgery, and can reduce the amount of venous reflux in patients with incompetent or malfunctioning vein valves.  The benefit of EVLT or traditional vein stripping is the reduction in downtime and the need for significant surgery.


Dr. Raffy Karamanoukian is the only vein surgeon in the country who is a diplomat of the American Board of Plastic Surgery and the American Board of Phlebology (vein surgery).  He is a national expert in the management of complex vein disease and is an expert in both EVLT endovenous laser treatment and VNUS radiofrequency vein ablation.  Both treatments allow for nonsurgical and noninvasive closure of malfunctioning veins in the legs and thighs.  Dr. Karamanoukian uses the EVLT system to carefully reroute poor circulation in the lower extremities.  The patients who are in need of EVLT procedures often have symptoms associated with their vein including throbbing, leg pain, cramping, heaviness in the legs, swelling, itching, burning, restless legs, and unwanted cosmetic bulging varicose veins.  EVLT is performed using a ultrasound monitor and a tiny laser fiber that can internally destroy unwanted veins.  The process uses light energy in order to heat up and collapse the perpetrating vein in the thigh.

There are many benefits of the EVLT procedure of traditional vein stripping and traditional varicose vein surgery.  Our patients undergo the EVLT procedure under local anesthesia and are able to return to normal activities after the procedure.  The Venacure EVLT system has a long record of safety and efficacy in the treatment of venous insufficiency.  The following are the main reasons patients choose the EVLT procedure in our Los Angeles vein clinic:

  1. EVLT can be performed in an office setting without hospitalization
  2. Venacure EVLT has a 98% success rate.
  3. Early return to normal physical activities with minimal to absent downtime
  4. Does not require general anesthesia or preoperative laboratory testing
  5. Minimal to absent scarring with the EVLT catheter
  6. Typically covered by most insurance plans
  7. EVLT is CPT coded for reimbursement by private insurance and by Medicare




Varicose veins can lead to leg swelling and are often associated with a condition known as venous reflux and venous hypertension.  These two conditions can lead to chronic venous insufficiency which may lead to a gradual overload of the returned venous circuit back to the heart.  Some patients may notice the appearance of bulging varicose veins, whereas others may notice a gradual worsening of leg pain and leg swelling.  The appearance of varicose veins and leg swelling may be disconcerting for some men and women who have a history of varicose veins that have progressively worsened with time.  Varicose veins can gradually diminish the normal venous circulatory system and may ultimately cause other medical symptoms to occur.


Medical symptoms associated with varicose veins and chronic venous insufficiency include leg swelling, leg pain, discomfort, leg throbbing, cramping, leg tenderness, early muscle fatigue, and restless legs.  Leg swelling may be improved in the early phase using prescription compression stockings or an equivalent pressure support.  Treatments for venous insufficiency and chronic vein disease can be initiated by first scheduling a comprehensive consultation and evaluation by board certified vein surgeon Dr. Raffy Karamanoukian.  In our Los Angles vein clinic, Dr. Karamanoukian provides comprehensive treatment for varicose veins, leg swelling, and venous insufficiency with the most state of the art equipment.  Our office offers the endovenous treatment, EVLT, ClariVein, Venefit, VNUS, foam sclerotherapy, ultrasound guided sclerotherapy, and laser vein treatment.


During your consultation for varicose vein problems in Los Angeles, we will begin with a comprehensive medical examination and medical history followed by vein mapping and ultrasound diagnostic studies.  All of theses studies may help delineate the pattern of vein disease and the root cause of your varicose vein problems.  Once the examination and consultation is complete, Dr. Karamanoukian will offer a complete treatment plan which incorporates lasers, radiofrequency, ultrasound, sclerotherapy, microphlebectomy, and endovenous technique.  Schedule a comprehensive consultation today for vein treatment by calling 310-998-5533.

Male EVLT in men




  1. What are some symptoms associated with varicose veins and venous insufficiency? Venous insufficiency can be associated with many physical complaints including heaviness of the legs, aching, discoloration and browning of the skin around the ankles and lower legs, pain, discomfort, itching and burning, swelling of the legs, restless legs, and leg ulceration.  Not all of these occur in any given individual, but some patients with vein disease will have several of these complaints as a direct result of venous insufficiency. 
  2. What type of laser is used in the EVLT system when treating veins? The EVLT laser system treats venous insufficiency and utilizes the 1470 nm laser system to coagulate the greater saphenous vein near the saphenofemoral junction.  The laser works to safely coagulate the diseased vein and reduce venous reflux.
  3. Is general anesthesia necessary for EVLT endovenous laser therapy of varicose veins? Most, if not all, patients will undergo the EVLT endovenous laser treatment while awake under local anesthesia.  Treatments are well tolerated with minimal pain and discomfort.  Our Los Angeles vein clinic specializes in non-invasive and non-surgical vein treatments.  During your consultation, we will discuss all of your options, including EVLT and Venefit. 
  4. Is laser vein treatment painful? Treating varicose veins and spider veins does not have to be a painful or major procedure.  Using minimally invasive laser options, board certified vein surgeon Dr. Raffy Karamanoukian can identify the root cause of your varicose veins and destroy them at their source.  This technique for the treatment of venous reflux is known as endovenous laser ablation and has high utility in the treatment of painful and uncomfortable varicose veins.  At the santa Monica Vein Center, we advocate the use of minimally invasive and nonsurgical options for varicose veins and spider vein.  We emphasize high safety and low risk with every vein procedure performed at our office.  We have treated thousands of patients and have a high succuss rate that is unparalleled.  If you have questions about varicose vein consultation or second opinion for varicose veins and spider veins, please call Los Angeles Plastic Surgery office at 310-998-5535.
  5. What is my recovery with varicose vein removal? A decade ago, varicose vein removal required major surgery.  An advancement in minimally invasive varicose veins treatment led to a procedure known as endovenous laser ablation.  In this treatment known as EVLT, a tiny nick in the skin is used to direct a laser into a problematic vein in order to collapse it from the inside.  This simple technique avoids unnecessary pain and discomfort, and minimizes surgical downtime.  If you have questions about endovenous ablation, Dr. Karamanoukian at the Santa Monica Vein Center can help you with your vein problems.  This is especially true if you have a family history of vein problems and have a genetic predisposition to the development of unwanted varicose veins or bulging veins.  Recovery is relatively short, with most patients being able to return to normal activities immediately after the procedure.  Dr. Karamanoukian has extensive experience in endovenous laser ablation of varicose veins and has seen many patients return to work immediately after their procedure.  Call 310-998-5535 to schedule your appointment for vein removal.
  6. Are there scars associated with endovenous laser ablation? EVLT and VNUS procedures are superior to old fashioned vein stripping in that they minimize the surgical risk and scarring.  The majority of patients who have undergone laser vein treatment using EVLT have a single tiny scar on the inner thigh that is about 0.2 cm wide. This is about half the length of a pencil tip and is easily disguised within months after the procedure.  Varicose vein treatment and treatment of venous reflux has been revolutionized with these endovenous nonsurgical and minimally invasive procedures.  Surgical scarring is also minimized and the patients are able to recover quickly after the procedure.  If you have questions about varicose vein treatment and live in the Los Angeles area, simply call 310-998-5535 and schedule a consultation with Dr. Karamanoukian.  Our office is equipped with the latest technology for varicose veins and our surgical director is board certified by the American Board of Phlebology (vein surgery).  If you live in Los Angeles, call 310-998-5535 to schedule your appointment for vein treatment.
  7. Is arnica useful after sclerotherapy? Sclerotherapy is a specific injection treatment for small spider veins and thread like veins.  Some patients may also benefit by injection sclerotherapy for larger reticular veins and smaller varicose veins.  If you have significant vein problems and wish to undergo treatment with a spider vein injection or laser therapy, we would recommend that you use an arnica supplement after your procedure in order to minimize bruising and swelling associated with injections.  Endovenous laser patients may also benefit from arnica treatment after the procedure.  Our surgical director recommends Bruise Pak for the procedure.  Call 310-998-5535 to schedule a comprehensive consultation for vein treatment in Los Angeles or to purchase Bruise Pak arnica supplements before and after your procedure.
  8. Will my insurance cover varicose vein treatment in Los Angeles? The major insurance carriers in the Los Angeles area do provide for medically related varicose vein treatment.  The first step in considering insurance coverage for varicose vein treatment begins with a consultation with Dr. Karamanoukian in which he will evaluate your varicose veins and spider veins to determine whether they are most likely a medical problem or a cosmetic problem.  After extensive vein mapping and vein evaluation, Dr. Karamanoukian may also recommend a vein ultrasound in order to determine the extent of the medically related varicose veins.  Some patients may qualify for medical varicose vein treatment, while others may only have a cosmetic spider vein concern.  Consultations are often required and include a vein mapping in order to determine the extensive vein problems in your legs and thighs.  The patients who have varicose vein disease can seek a consultation with Dr. Karamanoukian, at which time he will dictate a consultation note to be sent to your insurance carrier.  A consultation note will specify reason for inclusion by your insurance carrier.  Call 310-998-5535 to schedule your consultation for varicose veins and to determine whether varicose veins are covered by your insurance.  Unfortunately, the insurance companies can not deny or accept claims for varicose veins without a comprehensive vein consultation.  Call 310-998-5535.
  9. What happens to the diseased vein once it has been treated with EVLT? The treated vein is no longer needed as the blood reroutes normally.  The vein becomes fibrosed and the body simply absorbs the redundant material and collagen.  Over time, the vein will eventually become a small area of collagen surrounded by the normal tissue.  Dr. Karamanoukian will evaluate you in intervals after your procedure to make sure that your vein treatment is healing as planned. 
  10. Is there an age limitation for EVLT treatment, Venefit treatment, or Clarivein treatment? Varicose veins and vein disease can affect men and women of all age groups. In fact, certain developmental problems can affect adolescents and teenagers with bulging varicose veins.  The EVLT, Clarivein, and Venefit procedures can be performed on healthy individuals of all age groups, provided there is documentation of venous reflux. These vein procedures offer the benefits of an outpatient procedure that is minimally invasive with little to no scarring.  Most of our patients will resume normal activities soon after their vein procedure. 
  11. Why is ultrasound necessary for the EVLT procedure? An ultrasound uses sound waves to look deeply into the tissues of the legs and thighs, thus allowing Dr. Raffy Karamanoukian to examine your legs to determine which veins are working properly and which veins are unhealthy.  Once this is identified, the EVLT or Venefit procedure is performed to collapse and destroy the diseased vein before it leads to further circulatory problems.   
  12. Can EVLT help with venous stasis ulcers in the legs and ankles? Venous stasis ulcers are chronic open wounds that occur on the inner ankle and leg.  They are often associated with chronic venous insufficiency and venous hypertension.  Venous ulcers can be particularly problematic as they never seem to close off on their own, necessitating chronic wound care. Our office performs ultrasound examination and duplex scanning for patients with venous stasis ulcers to determine if there is underlying venous reflux or an abnormal vein perforator.  If there is venous reflux, then the EVLT should help in the healing of the venous stasis ulcer.  In addition Unna Boot therapy can also help in the local exudate and control of venous stasis ulcers. 
  13. Will I be awake during the EVLT or VNUS procedure? Most, if not all of the endovenous laser or RF treatments performed in our Los Angeles vein clinic are performed while a patient is awake.  Awake procedures minimize anesthesia and allow for a quicker return to normal function.  If there are any reasons to undergo the procedure under anesthesia, please discuss these with Dr. Karamanoukian and our office will make arrangements to perform the procedure under anesthesia, if indicated.
  14. Is endovenous vein treatment as effective as vein stripping surgery? Our office utilizes the endovenous systems EVLT, Clarivein, and Venefit over traditional vein stripping surgery.  Most longterm studies have shown equivalent results between EVLT, Clarivein, and VNUS vs. vein stripping, with vein stripping having increased risks and morbidity.  During your vein consultation in Los Angeles, our office will review the guidelines for endovenous ablation and discuss your expected benefits and risks. 
  15. What is ambulatory phlebectomy? Some veins that are bulging can be difficult to treat with laser.  In these cases, a procedure known as ambulatory phlebectomy is performed to remove abnormal veins and sometimes tie them off at their root base.  Ambulatory phlebectomy is often a minor procedure with minimal downtime and patients should not be overly concerned about risks with this procedure, as it is generally considered a safe and effective minimally-invasive procedure.
  16. Are men at risk for varicose veins? Both men and women are at risk for developing varicose veins.  In our Los Angeles vein clinic, we see healthy adult men and women who have developed painful leg symptoms as a result of varicose veins and vein disease. Men are less likely to seek early treatment and this is an unfortunate cause of many leg vein ulcers and advanced vein symptoms we see in our clinic.  If you have a male family member with varicose veins, schedule a consultation for them in our office by caling (310) 998-5533. 
  17. Is sclerotherapy a good option for large varicose veins? Varicose veins are the bulging veins that pop out of the skin.  Bulging varicose veins are typically not treated with sclerotherapy in our Los Angeles vein clinic.  Rather, ambulatory phlebectomy with or without treatment of venous reflux is suggested.  The first three steps in varicose vein treatment include an examination, vein mapping, and ultrasound to assess the degree of venous reflux. 
  18. What is a Cockett's perforator? A Cockett's perforator is an abnormal perforator vein that communicates between the deep and superficial vein system. It is usually found on the medial distal one-half of the leg. Sometimes the Cockett's perforators can be seen as bulging vein or palpated as deep fascial defects.  Cockett's perforators may contribute to skin changes, bulging veins, and skin ulceration. 




The diagnosis of a venous stasis ulcer is one that no one wants to hear about.  The fact is that venous stasis ulcers are usually caused by longstanding chronic venous insufficiency.  This results from unhealthy veins that have begun to compromise the normal venous circuit of the body's circulation.  Most venous stasis ulcers occur on the inner ankle and leg, often associated with leg discoloration and skin changes.  The statistics for venous stasis ulcers are overwhelming, with over 2.5 million people being diagnosed with venous ulcers in the United States per year. All told, about seventy percent of venous stasis ulcers are likely to recur if proper treatment and follow-up is not maintained. The risk factors for venous stasis ulcers include the following:


  1. Advancing Age: Since chronic venous insufficiency increases with advancing age, our Los Angeles vein clinic sees venous stasis ulcers in patients who are older rather than active adolescents. 
  2. Genetics: Family history plays a large role in the development of chronic venous insufficiency, venous reflux, and varicose vein disease.  Thus, a family history of venous ulcers or varicose veins may increase your own personal risk for the development of complications from varicose veins. 
  3. Activity: A more aerobically active lifestyle may hold off the development of venous stasis ulcers in adults.  A sedentary lifestyle coupled with other medical problems like diabetes and obesity may together increase your risk of developing venous problems, and ultimately, venous stasis ulcers. 
  4. Post-phlebotic Syndrome:
  5. Congestive Heart Failure: Heart disease and poor circulation can put an increased work load on your circulatory system, causing the venous circuit to further deteriorate.  This may be responsible for the development of venous stasis ulcers. 
  6. Vein Valve Incompetence: Vein Valve incompetence may further worsen your venous reflux, which in turn may make the venous reflux worsen.  Venous stasis ulcers are often caused by poor and unhealthy veins in the legs. 
  7. Previous History of Venous Stasis Ulcers: Much like a family history of venous stasis ulcers, a previous personal history of ulcers may increase your risk of developing another venous ulcer. 


In order to prevent further deterioration or progression of a venous stasis ulcer, our Los Angeles vein clinic encourages patients to optimize their vein health by employing the following recommendations: 


  1. Vein Consultation: Schedule an appointment with our Los Angeles vein clinic so that we may better examine your legs and veins in order to determine whether local wound care or vein treatment is best for you.
  2. Leg elevation: Elevating the legs at the end of the day may improve venous return to the heart and decrease the pooling of blood in the veins. 
  3. Frequent Breaks: Take a break if you have been sitting or standing for long periods of time.  These breaks can reduce some of the workload on the veins and further improve your venous return. 
  4. Aerobic Activity: Increased aerobic activity is associated with a healthier lifestyle and a more efficient circulatory system.  Aerobic activity, particularly with active flexion and extension of your ankles, can minimize the affects of venous insufficiency. 
  5. Avoid prolonged periods of sitting or standing. 


In our Los Angeles vein clinic, the goal of therapy for venous stasis ulcers is twofold, namely to treat the existing venous ulcer and to monitor and prevent recurrence in the future.  If your venous stasis ulcer is associated with venous reflux, an important objective is to treat the underlying venous reflux in order to minimize the effects of venous reflux on venous stasis ulcer recurrence. 


The Santa Monica Vein Center and Dr. Raffy Karamanoukian are pleased to offer the most state of the art varicose vein and spider vein treatments in Los Angeles.  Our office offers FDA approved sclerotherapy, endovenous ablation, and laser therapy options for vein problems.  We also offer expertise in the surgical treatment of leg vein ulcers, vein disease, and bulging varicose veins. If you have questions about varicose veins and spider veins, Dr. Karamanoukian has extensive experience in the management of vein problems.  He has been features on KTLA, Good Day LA, The Doctors, and has multiple publications and presentations regarding his unique approach to vein therapy.  Please call our office at 310-998-5533.

  1. What are some common sclerotherapy agents used in vein treatment? Some common types of sclerotherapy agents used include Sodium Tetradecyl Sulfate, Polidocanol, Asclera, and Hypertonic Saline.  Dr. Raffy Karamanoukian is a double board certified vein surgeon and can discuss which sclerotherapy or laser vein treatments are optimal in your care. These options can be discussed during your vein consultation in our Los Angeles vein clinic. 

Learn more about Varicose Vein Disease: Click Here


  1. Symptomatic varicose veins
  2. Venous reflux and venous insufficiency
  3. Venous ulcers
  4. Recovery after venous phlebectomy procedures or vein surgery
  5. Recovery after sclerotherapy
  6. Thrombophlebitis
  7. Pregnancy and varicose veins


  1. The EVLT procedure is a safe and effective minimally-invasive procedure for venous reflux and varicose veins.  Avoid all blood thinners prior to treatment, including Aspirin, Ibuprofen, Coumadin, or Warfarin.  If you are taking these procedures in the one week before surgery and inform us of your dosage before the EVLT.  If you have been taking them up until the morning of the procedure, our office may elect to reschedule your procedure if clinically-indicated. 
  2. There is no need to shave or wax your legs prior to EVLT.
  3. Do not apply moisturizing creams or depilatory creams prior to EVLT.
  4. Wear comfortable clothes, and loose shoes.  It may be appropriate for you to bring an extra set of undergarments the day of EVLT. 


  1. Most patients are able to drive home themselves and resume normal activities after the EVLT procedure.  The goal of post-treatement activity is to remain active, but refrain from overly strenuous activity.  Avoid heavy lifting, strenuous exercise, pilates, yoga, or hiking.  Aerobic exercise is often encouraged, as long as you take it slow.
  2. Walk around for 15 to 30 minutes after the EVLT procedure.  This will stimulate blood flow to your legs and thighs after EVLT and minimize the risk of blood clots or thrombus in the normal veins. 
  3. Compression stockings can be used after your EVLT procedure, but are not necessary in all patients.  Ask our office staff about your specific needs and whether or not you need compression stockings after surgery. 
  4. Resume normal activities for the one week after your EVLT procedure.  You will be scheduled for a follow-up ultrasound and examination once you complete the EVLT treatment.
  5. Our office recommends Bruise-Pak or equivalent therapy after your EVLT.
  6. Avoid long flights or travel for at least 3 to 5 days after EVLT. If you must travel, speak to our Los Angeles vein clinic to discuss your situation so that we may offer you some suggestions for safe travel. 
  7. Dr. Raffy Karamanoukian will apply a small steristrip or bandage after your procedure. Steristrips should be left in place, whereas the bandage can be removed within 24 hours after EVLT. 
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