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MEET THE DOCTOR

MERAB BOTER

M.D., Ph.D
Vein Specialist

Experienceover 40 years

" Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter "

MERAB BOTER

Vein Specialist

Experienceover 40 years

" Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter Quote from Dr. Boter "
About Dr. Boter

Dr. Merab Boter has been practicing General Surgery since 1970. He has developed successful practices in many fields of General Surgery such as gastro-intestinal, hernia, gallbladder, trauma, general vascular and others. He is a board-certified general surgeon and is a diplomat of The American Board of Surgery.
About MVLC

In 2005 Dr. Boter opened the Modern Vein & Laser Center in Brooklyn, New York. Since then thousands of procedures have been performed under local anesthesia there. The patients are ecstatic to have these minimally invasive non-surgical procedures at the office.
History

In 1992, Dr. Boter performed his first minimally invasive varicose vein surgery, “stab-phlebectomy” and “PIN stripping” of the saphenous vein, which were done in the hospital. Operating room and hospital staff members, who had never seen or heard anything like this before, were surprised to see the patient was left scar less and painless.

Dr. Merab Boter has been practicing General Surgery since 1970. He has developed successful practices in many fields of General Surgery such as gastro-intestinal, hernia, gallbladder, trauma, general vascular and others. He is a board-certified general surgeon and is a diplomat of The American Board of Surgery.

In 2005 Dr. Boter opened the Modern Vein & Laser Center in Brooklyn, New York. Since then thousands of procedures have been performed under local anesthesia there. The patients are ecstatic to have these minimally invasive non-surgical procedures at the office.

In 1992, Dr. Boter performed his first minimally invasive varicose vein surgery, “stab-phlebectomy” and “PIN stripping” of the saphenous vein, which were done in the hospital. Operating room and hospital staff members, who had never seen or heard anything like this before, were surprised to see the patient was left scar less and painless.

Varicose vein stripping is a surgical procedure that removes varicose veins from the legs or thighs. Varicose veins are the puffy and twisted veins that you can see under the skin. They usually have a red or bluish-purple color. Varicose veins most often appear in the legs, but they may also develop in other parts of the body. Varicose veins form in the legs when the valves in the veins aren’t functioning correctly.Veins normally have one-way valves that prevent your blood from flowing back up toward the heart. When these valves don’t work properly, blood begins to collect in the vein rather than continuing to the heart.This makes the vein fill with blood, resulting in painful, swollen veins. Varicose vein stripping treats varicose veins and helps prevent them from coming back. The procedure is also known as vein stripping with ligation, avulsion, or ablation.

Treatments

SUPERFICIAL VENOUS REFLUX

Superficial venous reflux is progressive and if left untreated may worsen over time. Symptoms and stages of Varicose vein disease. LEG PAIN, ACHING OR CRAMPING. LEG HEAVINESS AND FATIGUE. BURNING AND ITCHING OF LEG SKIN. RESTLESS LEGS. BLOOD CLOTS IN THE LEGS VEINS. BLOOD CLOTS IN THE LUNGS. SPIDER VEINS. VARICOSE VEINS. LEG OR ANKLE SWELLING. LEG SKIN BROWN DISCOLORATION. LEG SKIN BROWN DISCOLORATION AND SKIN THICKENING. LEG ULCERS

TREATMENT OF VARICOSE VEINS

Varicose veins are not normal veins. They are weakened, distorted and disfigured veins that may only cause harm, sooner or later. Their walls and valves are weak, causing abnormal venous blood circulation.Diagram of abnormal valves are presented below. They show bidirectional i.e. abnormal blood flow in the affected veins.Varicose veins are harmful for the body. Some of varicose veins are visible under the leg skin; some are deeper than the skin and are not visible. They all need to be removed or excluded from blood circulation to achieve cure.In the recent past major surgery was the only treatment for varicose veins (their removal through major skin incisions, in the hospital, under general anesthesia). It was painful, lengthy surgery, associated with severe post-operative pain and significant temporary disability. In many countries the old type of surgery still remains as main treatment modality.In the USA and in some other countries new types of minimally invasive (and virtually painless) procedures have been developed and introduced into medical practice since 1990’s:For visible varicose veins:MicrophlebectomyFoam sclerotherapyFor not visible varicose veins:Endovenous laser ablation;Endovenous radiofrequency ablation;ClariVein procedure;Varithena procedure;VenaSeal Procedure.All of these procedures are performed under local anesthesia. Additional intravenous sedation is optional. After the above procedures the patients leave the doctor’s office almost immediately, going home or to work.

MICROPHLEBECTOMY

In the recent past major surgery was the only treatment for large varicose veins (removal through major skin incisions, followed by suturing, in the hospital, under general anesthesia). It was painful, lengthy surgery, associated with severe post-operative pain and significant temporary disability. In many countries old type of surgery still remains main treatment modality.The best contemporary treatment of varicose veins is microphlebectomy i.e. removal of them via 1-2 mm wide skin punctures, not requiring suturing. Special microsurgical instruments are used.Microphlebectomy was adopted in the USA in the1990’s. These procedures have been performed in some office based venous centers under local anesthesia only. The patients return to home or work immediately after the procedures.At Modern Vein & Laser Center, accredited facility, during microphlebectomy we also offer intravenous sedation if patients so desire. In such cases the patients leave for home in about an hour after recovery from sedation. Dr. M. Boter has over twenty five years of experience with microphlebectomy.After microphlebectomy most patients do not have pain, some have only minimal discomfort. Since there are no incisions - there are no scars. Small temporary skin puncture traces may be visible temporarily, which fade away in a few weeks. Post-procedure bruises will disappear in 2-3 weeks.

ANESTHESIA FOR VARICOSE VEIN TREATMENT

Several modern procedures are available for the treatment of large varicose veins (Microphlebectomy, Endovenous Laser Ablation, EndovenousRadiofrequency ablation, ClariVein, Varithena, VenaSeal).What do they have in common? They are all minimally invasive, can be done under local anesthesia at the office after which the patients return to home or work immediately.No hospital, no general anesthesia, no major incisions, no pain, no scars.What is local anesthesia? Most people are familiar with it because dentists use it. Most frequently 1-2 cc of Lidocaine is used to numb up the area for dental or other minor surgery.Up until late 1990’s large surgical areas (such as leg varicose veins) could not be performed under local anesthesia because Lidocaine daily dosage could not exceed 25 cc. Due to that particular reason all venous surgeries used to be done through major incisions under general anesthesia in the hospitals.Research by the prominent dermatologist from California showed that Lidocaine in diluted form with some other medications, injected certain way, would allow 10-20 times that dose of Lidocaine to be used safely. It is called – Local Tumescent Anesthesia.This was a revolution in surgical practice. Many surgeries have been performed at the office setting since the introduction of Local Tumescent Anesthesia in the United States.In our Modern Vein & Vein Center we use Local Tumescent anesthesia for all of the above mentioned procedures. In addition, as per the patients’ request we can arrange for intravenous sedation given by the anesthesiologist.

ENDOVENOUS LASER THERAPY

Since the beginning of the 21st century endovenous lasers were developed, which made the treatment of that vein easy.As seen in the diagram, the vein is not removed. It is rather being closed with the laser heat under local anesthesia. Through only one needle stick into the vein the laser fiber is advanced in the vein from below up to the groin. The laser machine is turned on and the laser fiber is withdrawn slowly downwards closing the vein lumen thereby eliminating wrong blood flow in that weak vein.Patient is awake. After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

ENDOVENOUS RADIO FREQUENCY ABLATION

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy.The long diseased vein is not removed. It is rather being closed (sealed) by the heat generated by the RF machine under local anesthesia, similar to laser ablation presented in the previous posting. Through only one needle stick into the vein the RF catheter (see photo) is advanced in the vein from below up to the groin. The RF machine is turned on and the RF catheter is withdrawn slowly downwards closing the vein lumen thereby eliminating wrong blood flow in that weak vein.Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.Lasers and RF ablations achieve the same goal: to close the lumen of the diseased vein. Some centers use the lasers, others use RF machines. We use both. RF machine works better with the large diameter veins and causes less or no pot-procedure discomfort.In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

CLARIVEIN PROCEDURE

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy. We already discussed Endovenous laser or Radiofrequency ablation of the invisible weak leg veins earlier.In 2009 ClariVein Procedure for vein closure was introduced in the US. ClariVein is a specialty catheter for the infusion of physician specified fluids (sclerosing solution) with a unique rotating dispersion tip. Use of the ClariVein does not require local anesthesia. It is a slim, thin catheter (tube) that is inserted into the vein through a pin-sized entrance point. The catheter is withdrawn slowly downwards, closing the vein lumen, thereby eliminating wrong blood flow in that weak vein. The procedure typically takes very little time and creates minimal discomfort.Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.ClariVein procedure, lasers and RF ablations achieve the same goal: to close the lumen of the diseased vein. Some centers use the lasers, others use RF machinesIn our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

VARITHENA PROCEDURE

Radiofrequency ablation, ClariVein procedure of the invisible weak leg veins earlier.In 2014 Varithena Procedure for vein closure was introduced in the US. Varithena is foam made of a sclerosing liquid medicine in a special canister. This foam may be introduced into the diseased veins through the small needle under ultrasound guidance for their closure. Use of the Varithena does not require local anesthesia. The procedure typically takes very little time and creates no discomfort. This foam can be used for strait or tortuous veins; for visible or invisible varicose veins.Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.Varithena procedure, lasers and RF ablations, ClariVein procedure achieve the same goal: closure of the lumen of the diseased vein, which will stop wrong blood flow in the veins. Some centers use the lasers, others use RF machines or ClariVein or Varithena.In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

VENASEAL PROCEDURE

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy. We already discussed Endovenous laser or Radiofrequency ablation, ClariVein procedure, Varithena procedure of the invisible weak leg veins earlier.In 2018 VenaSeal Procedure for vein closure was introduced in the US. VenaSeal is medical grade glue in a special canister. This glue may be introduced into the diseased veins through the small needle under ultrasound guidance for vein closure. Use of the VenaSeal does not require local anesthesia. The procedure typically takes very little time and creates no discomfort. This foam can be used for strait or tortuous veins.Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.VenaSeal , lasers, RF ablations, ClariVein, Varithena procedure achieve the same goal: closure of the lumen of the diseased vein, which will stop wrong blood flow in them. Some centers use the lasers, others use RF machines or ClariVein or Varithena.In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

SUPERFICIAL VENOUS REFLUX

Superficial venous reflux is progressive and if left untreated may worsen over time. Symptoms and stages of Varicose vein disease.

  • LEG PAIN, ACHING OR CRAMPING.
  • LEG HEAVINESS AND FATIGUE.
  • BURNING AND ITCHING OF LEG SKIN.
  • RESTLESS LEGS.
  • BLOOD CLOTS IN THE LEGS VEINS.
  • BLOOD CLOTS IN THE LUNGS.
  • SPIDER VEINS.
  • VARICOSE VEINS.
  • LEG OR ANKLE SWELLING.
  • LEG SKIN BROWN DISCOLORATION.
  • LEG SKIN BROWN DISCOLORATION AND SKIN THICKENING.
  • LEG ULCERS

TREATMENT OF VARICOSE VEINS

Varicose veins are not normal veins. They are weakened, distorted and disfigured veins that may only cause harm, sooner or later. Their walls and valves are weak, causing abnormal venous blood circulation.

Diagram of abnormal valves are presented below. They show bidirectional i.e. abnormal blood flow in the affected veins.

Varicose veins are harmful for the body. Some of varicose veins are visible under the leg skin; some are deeper than the skin and are not visible. They all need to be removed or excluded from blood circulation to achieve cure.

In the recent past major surgery was the only treatment for varicose veins (their removal through major skin incisions, in the hospital, under general anesthesia). It was painful, lengthy surgery, associated with severe post-operative pain and significant temporary disability. In many countries the old type of surgery still remains as main treatment modality.

In the USA and in some other countries new types of minimally invasive (and virtually painless) procedures have been developed and introduced into medical practice since 1990’s:
For visible varicose veins:
Microphlebectomy
Foam sclerotherapy

For not visible varicose veins:
Endovenous laser ablation;
Endovenous radiofrequency ablation;
ClariVein procedure;
Varithena procedure;
VenaSeal Procedure.

All of these procedures are performed under local anesthesia. Additional intravenous sedation is optional. After the above procedures the patients leave the doctor’s office almost immediately, going home or to work.

MICROPHLEBECTOMY

In the recent past major surgery was the only treatment for large varicose veins (removal through major skin incisions, followed by suturing, in the hospital, under general anesthesia). It was painful, lengthy surgery, associated with severe post-operative pain and significant temporary disability. In many countries old type of surgery still remains main treatment modality.

The best contemporary treatment of varicose veins is microphlebectomy i.e. removal of them via 1-2 mm wide skin punctures, not requiring suturing. Special microsurgical instruments are used.

Microphlebectomy was adopted in the USA in the1990’s. These procedures have been performed in some office based venous centers under local anesthesia only. The patients return to home or work immediately after the procedures.

At Modern Vein & Laser Center, accredited facility, during microphlebectomy we also offer intravenous sedation if patients so desire. In such cases the patients leave for home in about an hour after recovery from sedation. Dr. M. Boter has over twenty five years of experience with microphlebectomy.

After microphlebectomy most patients do not have pain, some have only minimal discomfort. Since there are no incisions - there are no scars. Small temporary skin puncture traces may be visible temporarily, which fade away in a few weeks. Post-procedure bruises will disappear in 2-3 weeks.

ANESTHESIA FOR VARICOSE VEIN TREATMENT

Several modern procedures are available for the treatment of large varicose veins (Microphlebectomy, Endovenous Laser Ablation, EndovenousRadiofrequency ablation, ClariVein, Varithena, VenaSeal).

What do they have in common? They are all minimally invasive, can be done under local anesthesia at the office after which the patients return to home or work immediately.

No hospital, no general anesthesia, no major incisions, no pain, no scars.

What is local anesthesia? Most people are familiar with it because dentists use it. Most frequently 1-2 cc of Lidocaine is used to numb up the area for dental or other minor surgery.

Up until late 1990’s large surgical areas (such as leg varicose veins) could not be performed under local anesthesia because Lidocaine daily dosage could not exceed 25 cc. Due to that particular reason all venous surgeries used to be done through major incisions under general anesthesia in the hospitals.

Research by the prominent dermatologist from California showed that Lidocaine in diluted form with some other medications, injected certain way, would allow 10-20 times that dose of Lidocaine to be used safely. It is called – Local Tumescent Anesthesia.

This was a revolution in surgical practice. Many surgeries have been performed at the office setting since the introduction of Local Tumescent Anesthesia in the United States.

In our Modern Vein & Vein Center we use Local Tumescent anesthesia for all of the above mentioned procedures. In addition, as per the patients’ request we can arrange for intravenous sedation given by the anesthesiologist.

ENDOVENOUS LASER THERAPY

Since the beginning of the 21st century endovenous lasers were developed, which made the treatment of that vein easy.

As seen in the diagram, the vein is not removed. It is rather being closed with the laser heat under local anesthesia. Through only one needle stick into the vein the laser fiber is advanced in the vein from below up to the groin. The laser machine is turned on and the laser fiber is withdrawn slowly downwards closing the vein lumen thereby eliminating wrong blood flow in that weak vein.

Patient is awake. After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

ENDOVENOUS RADIO FREQUENCY ABLATION

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy.

The long diseased vein is not removed. It is rather being closed (sealed) by the heat generated by the RF machine under local anesthesia, similar to laser ablation presented in the previous posting. Through only one needle stick into the vein the RF catheter (see photo) is advanced in the vein from below up to the groin. The RF machine is turned on and the RF catheter is withdrawn slowly downwards closing the vein lumen thereby eliminating wrong blood flow in that weak vein.

Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

Lasers and RF ablations achieve the same goal: to close the lumen of the diseased vein. Some centers use the lasers, others use RF machines. We use both. RF machine works better with the large diameter veins and causes less or no pot-procedure discomfort.

In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

CLARIVEIN PROCEDURE

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy. We already discussed Endovenous laser or Radiofrequency ablation of the invisible weak leg veins earlier.

In 2009 ClariVein Procedure for vein closure was introduced in the US. ClariVein is a specialty catheter for the infusion of physician specified fluids (sclerosing solution) with a unique rotating dispersion tip. Use of the ClariVein does not require local anesthesia. It is a slim, thin catheter (tube) that is inserted into the vein through a pin-sized entrance point. The catheter is withdrawn slowly downwards, closing the vein lumen, thereby eliminating wrong blood flow in that weak vein. The procedure typically takes very little time and creates minimal discomfort.

Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

ClariVein procedure, lasers and RF ablations achieve the same goal: to close the lumen of the diseased vein. Some centers use the lasers, others use RF machines

In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

VARITHENA PROCEDURE

Radiofrequency ablation, ClariVein procedure of the invisible weak leg veins earlier.

In 2014 Varithena Procedure for vein closure was introduced in the US. Varithena is foam made of a sclerosing liquid medicine in a special canister. This foam may be introduced into the diseased veins through the small needle under ultrasound guidance for their closure. Use of the Varithena does not require local anesthesia. The procedure typically takes very little time and creates no discomfort. This foam can be used for strait or tortuous veins; for visible or invisible varicose veins.

Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

Varithena procedure, lasers and RF ablations, ClariVein procedure achieve the same goal: closure of the lumen of the diseased vein, which will stop wrong blood flow in the veins. Some centers use the lasers, others use RF machines or ClariVein or Varithena.

In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

VENASEAL PROCEDURE

Since the beginning of the 21st century endovenous radio-frequency generators were developed, which made the treatment of that vein easy. We already discussed Endovenous laser or Radiofrequency ablation, ClariVein procedure, Varithena procedure of the invisible weak leg veins earlier.

In 2018 VenaSeal Procedure for vein closure was introduced in the US. VenaSeal is medical grade glue in a special canister. This glue may be introduced into the diseased veins through the small needle under ultrasound guidance for vein closure. Use of the VenaSeal does not require local anesthesia. The procedure typically takes very little time and creates no discomfort. This foam can be used for strait or tortuous veins.

Patient is awake (or sedated if so desired by him or her). After the procedure the patient walks out of the office and returns to home or work immediately. Post-procedure pain is minimal or absent. The procedure is done under the ultrasound guidance.

VenaSeal , lasers, RF ablations, ClariVein, Varithena procedure achieve the same goal: closure of the lumen of the diseased vein, which will stop wrong blood flow in them. Some centers use the lasers, others use RF machines or ClariVein or Varithena.

In our center we use all the modern technologies approved in the US, which allows us to utilize advantages of each of them in various situations to achieve better results.

Testimonials

Ia Jikia
Patient 12/26/2019

I have been wearing compression stockings for the past 3 years but they would not help me. I made the decision to do endovenous laser ablation and now I am so happy because I am free from my pain, free from my compression stockings.

Valerie Shilko
Patient February 27, 2017

I have only good things to say. First, with Dr Boter, he is an amazing doctor, very knowledgeable, respectful and has a great bed-side manner. The staff is amazing too, what a great group of women, very professional. They care!!!! I am a very happy patient, and would recommend Modern Vein and Laser center to anyone!!!!

Bibi Kvachi
Patient August 23, 2018

Professional staff. Thank You All so very much. Dr. Boter gave me confidence to go to the beach again. I am going to be forever thankful

FREQUENTLY ASKED QUESTIONS

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Why Choose Us?

  • The Center is dedicated to vein care only – both large varicose veins and spider veins All of the modalities, available for large varicose vein treatments in the USA, are utilized at our Center including: Endovenous Laser Therapy – Endovenous RadiofrequencyTherapy – Microphlebectomy – ClariVein – Varithena. All of the modalities available for the spider veins treatments in the USA are utilized at our Center: Liquid Sclerotherapy – Foam Sclerotherapy – Transcutaneous Laser Therapy – Intense Pulsed Light Therapy – Radiofrequency Therapy – Microsurgical Therapy

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