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Cardiac Center of Texas
Vein Clinic of Texas

4201 Medical Center Drive
Suite 380
McKinney, TX 75069

1600 Coit Road
Suite 209
Plano, TX 75075

(p) 972-529-6939
(f) 972-529-6935

Office Hours

Mon - Fri 8:00 a.m. - 5 p.m. CST

Memberships & Accreditation

Meet Dr. Khan

Recurrence of Varicose Veins after Endovenous Ablation

Venous Insufficiency is the most common cardiovascular disorder in the human species. It also is unique to human beings as animals do not get varicose veins.  Why? Because it is directly related to the erect posture of humans and is a direct influence of gravity.  This is why veins below the heart build up pressure and eventually get dilated and start refluxing.

Incidence of some variation of varicose veins is around 20% in the general population but the incidence of venous insufficiency is 40%.  For example, 50% of venous insufficiencies are hidden until you check for this with ultrasound.  Over time, varicose veins get bigger with increased pressure and damage to venous valves and this blood starts pooling into the lower extremities causing swelling, discomfort, edema, restless leg syndrome, and chronic skin changes.  If untreated up to this stage, it can lead to venous ulcers and infection.

Several years ago, varicose vein treatment was a nightmare.  For example, vein stripping was more of a brutal procedure with a high recurrence rate.  Then came endovascular techniques using laser and radiofrequency ablation.  Since then routine varicose vein surgery has proliferated and changed the venous disease dynamics.

Even with new endovascular techniques recurrence of varicose veins is still a significant problem in 15-18% within a year and especially in women.

The most common reason for recurrence is treating the wrong vein or treating only one source of the reflux.  It is common to have more than one area of venous reflux and identification of those areas is a pre-requisite to good success.

The most commonly ignored area is the pelvic veins. This is poorly understood and a difficult territory to visualize.  Some physicians take the easy way with the large saphenous vein and assumes everything will be okay.  But the source of the reflux is up higher in the pelvis and recurrence is common.  It is especially common in females.  Females with multiple births see 20% of the source of their reflux coming from pelvic veins.  There are two types of veins responsible for pelvic reflux.  Ovarian vein 7% and internal iliac vein 93%.

Significant reflux leads to lower abdominal pain, excessive menstrual bleeding, pain during intercourse, bladder and lower GI irritability, and lower extremity edema.  This is called Pelvic Congestion Syndrome.

Conventional superficial ultrasound does not identify pelvic congestion syndrome.  Some selected centers to have CT Venography or MRA to rule out venous reflux but it is not common practice and you can still miss the diagnosis.

Most useful diagnostic test in transvaginal ultrasound to identify dilated and refluxing pelvic veins. But most of the vein centers do not have this option available. That is why you see frustrated women having recurrences of varicosities after successful operations.

The clue to pelvic reflux is one of the symptoms discussed above and the examination where you can visualize vulvular varicosities and the thigh vein extending into medial aspect and going to the pelvis or entering posteriorly via buttock area.  That gives you a good clue to assess pelvic veins before fixing greater saphenous vein.  So we see at least 20% of women with surgery come back with some problem since new physicians do not recognize it and do not have the means to diagnose it.  Make sure you tell them any pelvic symptoms you have and ask them if they are capable of doing a transvaginal venous ultrasound.  Good Luck!

Cardiac Center of Texas and Medical Center of Plano offering one of the nation’s first FDA-approved drug-coated balloon for peripheral arterial disease

The Cardiac Center of Texas and Medical Center of Plano are one of the first in the area to offer a new treatment option for people suffering with peripheral arterial disease or PAD.

PAD is a life-threatening condition where plaque builds up in the blood vessels that carry blood from the heart to the arms and legs, hardening and narrowing those arteries and causing poor circulation.

The new drug-coated balloon (DCB) catheter, IN.PACT Admiral by Medtronic, is similar to a standard balloon catheter used to open arteries, but it also releases a drug from the balloon surface to the treated area that helps reduce future narrowing and improve blood flow. It is one of the first DCBs approved by the US Food and Drug Administration (FDA) for the treatment of PAD in the femoropopliteal artery.

“We are thrilled to be among the first hospitals in the nation offering this new treatment option, reinforcing our commitment to bring the latest innovations to our patients,” says interventional cardiologist M. Akram Khan, MD, President of Cardiac Center of Texas and Director for PVD Intervention and Limb Preservation at Medical Center of Plano.

PAD in the femoropopliteal artery, a large artery in the thigh, affects millions of Americans and, according to the National Institutes of Health, puts those patients at high risk for lower-extremity amputation, particularly in people over the age of 50.

The successful treatment of PAD requires improved blood flow (patency) for longer periods of time. Minimally-invasive endovascular procedures such as angioplasty balloons and stents, medications and vascular bypass surgery are some of the accepted ways to treat PAD, but a major limitation of these options is re-blockage of the vessels.

According to Dr. Khan, the IN.PACT Admiral DCB delivers the drug and inhibits the regrowth of the plaque.

“The drug coated balloon is a significant step toward a more reliable and longer lasting option for blockages in the legs and arteries, a critical factor since PAD is a progressive and debilitating disease.”

For more information about the IN.PACT Admiral DCB and other PAD treatment options, please call Cardiac Center of Texas, 972-529-6939.


FDA Approves Drug Eluting Stent with Bioabsorbable Polymer (Synergy)

MARLBOROUGH, MA — American interventional cardiologists will soon have access to a very different type of drug-eluting stent (DES) now that the US Food and Drug Administration has approved an everolimus-eluting stent with a bioabsorbable-polymer (Synergy, Boston Scientific).

Unlike traditional DES with a polymer that remains, Synergy’s bioabsorbable polymer breaks down and is fully absorbed after the drug is released. Unlike other stents with bioabsorbable polymers, which in general are fully absorbed within 8 to 9 months, the Synergy polymer is fully absorbed after 3 months, leaving leaving behind a bare platinum-chromium stent.

Synergy is the first and only commercially available DES with a bioabsorbable polymer in the US. The stent received CE Mark approval in Europe in 2012.

At 1 year, the rate of target lesion failure (TLF), a composite end point that included cardiac death, MI, or ischemia-driven revascularization, occurred in 6.5% of the Promus-treated patients and 6.7% of the Synergy patients, a nonsignificant difference (EVOLVE II was designed as a noninferiority trial).

Importantly, there was no difference in revascularization or stent-thrombosis rates at 12 months. With Promus, there were two definite/three probable cases of stent thrombosis, while there were two definite/one probable cases of stent thrombosis with Synergy. Long-term data from the EVOLVE study also showed very low rates of stent thrombosis and target lesion revascularization, according to Boston Scientific.

Speaking with the media at the AHA, Dr Dean Kereiakes (Christ Heart and Vascular Center, Cincinnati, OH) said the Synergy stent differs from other DES with bioabsorbable polymers in that the stent struts are thinner and that absorption of the polymer is much more rapid.

The rationale for the absorbable or bioresorbable polymer is that long-term exposure to the stent polymer can cause inflammation, which delays healing and has been linked with complications, including stent thrombosis. In eliminating the polymer, which modulates drug release, the hope is that stents with absorbable polymers will promote speedier healing and reduce the risk of vascular complications.

Kereiakes reports honoraria for consulting with Boston Scientific, Abbott Vascular, and Reva Medical, Harvard Clinical Research Institute, and Ablative Solutions.


courtesy of

FDA Approves New Drug for Varicose Veins

Role of Diosmin in Chronic Venous Disease

Leg cramps, swelling, bulging veins or unsightly veins are issues commonly found in many middle aged women and often men as well.  These swollen blood vessels called Varicose Veins not only make your legs look unattractive, but they also indicate a serious circulatory problem leading to a disease called Chronic Venous Insufficiency or CVI.  At our clinic, Vein Clinic of Texas, our main focus is screening and early detection of varicose veins.  We have a full spectrum of treatment options for advanced disease as well.  More information can be found on our website at

Although CVI is not a major life threatening issue, it can have a severe impact on both an individual’s life and the healthcare system.  It is estimated that more than 50 percent of women in America develop varicose veins by the age of 50.  Along with pain and disfiguration, CVI adds to the expense of the medical system.  The cost of treating CVI has been estimated to be $750 million to $1 billion per year. The average cost of treatment for a single patient can exceed $40000.  Estimates of 2 million work days are lost due to medical conditions and around $3 million are lost in health care costs.

The treatment methods currently available include compression stockings or bandages, sclerotherapy, laser or radiofrequency ablation and surgical intervention.  However, these methods are cumbersome and come with financial and biological issues.  Surgical remedies are expensive and comprehensive bandages are time consuming as well as difficult to apply.  We reserve surgical intervention for advanced disease.  The least invasive and least painful treatment is radiofrequency ablation, RFA, for varicose veins which is offered at our clinic and done within the office setting.  Please see for more details.

Phlebotonics are drugs or nutrients functioned to improve vein health.  Out of various phlebotonics, Diosmin has been labelled as especially useful in countering CVI.

Diosmin is a naturally occurring hesperidin bioflavonoid, first identified in 1925.  It is prescribed as a standard pharmaceutical intervention in Europe for CVI and hemorrhoids.  Many women in the US have been using this European drug available without prescription, as a food supplement.  Micronized Diosmin has been clinically proven to produce healthier looking legs by healing swollen ankles, spider and varicose veins and leg ulcers.

Before getting into detail about Diosmin, First we must know what chronic venous disease is and how it affects an individual’s life.

What is CVI?

CVI occurs when veins in the legs don’t allow blood to travel back to the heart due to incompetent venous valves.  This leads to venous hypertension and improper circulation of blood in the leg.  CVI is a common cause of leg pain and swelling, associated with varicose veins.

Normally, each pump in the heart pushes blood around the body.  This pump works well for outgoing blood coursing around the arteries.  By the time blood hits and returns through the veins, much of the propulsion generated by the heart is gone.  In addition to this challenge, returning blood travelling from the legs has to fight against gravity.

Our body has a complicated system set up to perform this operation.  This system includes venous muscle pump, a series of flap valve and perforating veins to allow communication of the superficial and deep venous system.  Dysfunction of any of the normal structures, specifically the venous valve may lead to venous hypertension and development of CVI.

Venous valves are a series of one-way valves that prevent blood from returning to the feet.  As these valves become incompetent they allow retrograded flow of blood towards the feet and build up pressure in lower veins.  This pressure in turn weakens the valve further down.  Engorged with blood, the vein walls weaken, turning them into varicose and spider veins.  This vicious cycle develops blood that seeps through weakened vein walls and pools in the calves of the legs.  The buildup of lymph fluid and blood causes swelling and discoloration which can get worse with the development of painful and stubborn ulcers.

Even though CVI is not life threatening, it can affect quality of life if left untreated.  CVI can lead to serious medical conditions including phlebitis and DVT.  Risk factors of CVI include work environments that involve standing or sitting for a long period, women over the age of 50, tall height, pregnancy, physical activity, smoking, obesity and family history of varicose veins.

What is Diosmin?

Diosmin is a naturally occurring hesperidin bioflavonoid extracted from the rind of sweet oranges.

The most clinically effective Diosmin is micronized, which means it has undergone a scientifically controlled process to reduce the size of standard particles in order to increase its bio-availability and rapid relief of symptoms that accelerate healing.

How does it work?

Diosmin reduces the sensation of pain, swelling, tension and heaviness in the legs associated with chronic venous disease.  Micronized Diosmin prolongs the vasoconstrictor effect of noradrenaline on the vein wall and by doing so, increases venous tone, and thereby reduces pooling that can lead to swollen veins.  It has anti-inflammatory effects on vessel walls as well.

Clinical Data

In a study of 245 patients with varicose vein disease who underwent surgical removal of an affected vein, those given micronized Diosmin pre- and post-operative therapy (two weeks before and for 30 consecutive days after surgery) achieved a measurable reduction in postoperative hematoma, pain severity and limb heaviness, as well as ease of exercise and improved quality of life.

Diosmin’s clinical efficacy has been tested in more than 40 clinical trials comprising of more than 15,000 patients.  The largest published clinical trial for CVI was a two year trial which enrolled 5,052 patients in 23 countries.  After six months, there were significant reductions in edema and improved quality of life (QOL).  Objective endpoints like decrease in venous reflux, increase in venous flow and reduction in venous pressure was also statistically significant in the Diosmin treated group.

Studies showed that micronized Diosmin protects the one way venous valves from leukocyte induced inflammation and destruction.  Micronized Diosmin also increases venous tone and reduces venous stretching and blood pooling.  This increases blood flow towards the heart and reduces venous high blood pressure present in suffering from chronic venous disease.

Other Benefits

Venous Leg Ulcers. Unhealed leg ulcers are a major consequence of chronic venous disease and major health issues.

Studies show that micronized Diosmin helps heal leg ulcerations by inhibiting the synthesis of inflammatory prostaglandin and free radicals.  Micronized Diosmin also decreases microvascular leakage and inhibits white blood cell trapping and migration.  One study found that treatment with micronized Diosmin led to complete healing of infected leg ulcers.

A multicenter, randomized, controlled trial tested micronized Diosmin in addition to standard compression stocking therapy versus placebo for two months in patients with leg ulcers.  A complete healing of leg ulcers is seen in patients who use Diosmin and compression stockings.

Lymphedema. Lymphedema is an abnormal swelling due to blockage of the lymphatic system.

Micronized Diosmin has been shown to improve lyphatic drainage by promoting lymphatic contraction by increasing the number of functional lymphatic capillaries and by decreasing the diameter of lymphatic capillaries and the intralymphatic pressure.

One study analyzed micronized Diosmin as a treatment of upper limb lymphedema secondary to conventional therapy for breast cancer.  Results showed improvement of the lymphedema but no significant reduction of arm swelling and no effect on cancer.

Diosmin may also bring relief to people suffering from secondary restless leg syndrome.

Micronized Diosmin alleviates acute and chronic pain and swelling of hemorrhoids.


There are multiple ways to treat chronic venous insufficiency including compression bandages, sclerotherapy and surgery but nothing has come closer to the inexpensive and effective treatment with micronized Diosmin.

Micronized Diosmin is the only oral treatment shown to be effective with the earliest symptoms of chronic venous insufficiency up to the most severe stage.

Because of unique and clinically proven mode of action which deals with all the clinical aspects of venous disease it should be used as a first line treatment for edema and symptoms of CVI at any stage of the disease along with other conservative therapy.

Micronized Diosmin enjoys an outstanding safety record unrivaled by any other drug used to treat venous disorders.  The majority of published studies, including the ones involving pregnancy, show that Diosmin is generally nontoxic at recommended doses.  However, those who are pregnant or take any prescription medications should check with a physician before taking micronized Diosmin.

Now a prescription formulation is also available in the US known as Vasculera (Diosmiplex).  It consists of a proprietary blend of micronized and highly purified Diosmin glycotides in combination with alkaline granules, alka4 complex.  It is the only FDA approved formulation in the US.

For further information and to schedule a free vein screening please contact our office at 972-529-6939.  Our physicians, Dr. M. Akram Khan and Dr. Ambreen Ashfaque have many years of experience in varicose vein care and are both certified by the American Board of Venous and Lymphatic Medicine.  Visit our website for more information at