Carotid stenosis refers to a narrowing of the internal carotid artery, as a result of atherosclerosis. The atherosclerotic debris, being washed by the blood passing through, can be thrown into the brain, where it can produce a so-called embolic stroke. The narrower the artery, the thicker the layer of atherosclerosis, the more likely and more severe is the stroke.

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    Coronary artery disease refers to a narrowing of the blood vessels supplying the heart with fresh blood. Just like in the case with peripheral arterial disease or carotid stenosis, coronary artery disease is another type of arterial atherosclerosis and, therefore, a consequence of the combined effects of the specific risk factors. These factors include one non-modifiable, genetic predisposition, and six modifiable ones: hypercholesterolemia, hypertension, diabetes, sedentary life style, tobacco abuse and obesity. In other words: high cholesterol, high blood pressure, high blood sugar, increased weight, high nicotine level and low level of physical activity.

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    Dissection of the thoracic aorta is a lethal condition with the following mechanism of formation. The thoracic aorta, being the closest to the heart artery in the body, receives the highest mechanical stress during cardiac contractions. In presence of certain predisposing factors, such mechanical stress can produce microscopic tears of the inner wall of the aorta. The blood under high pressure goes through these tears in between the layers of the aortic wall forcing them apart and eventually causing rupture and internal bleeding.

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    Abdominal aortic aneurysm, or AAA, is a widening of the abdominal aorta by 50% or more from its normal diameter, which in majority of individuals is approximately 2 cm. Usually, AAA involves a segment of the abdominal aorta from just below the renal arteries, in the place where the aorta divides into the two common iliac arteries. Rarely accompanied by symptoms, except for occasional abdominal pain, the aneurysms tend to grow and eventually rupture causing significant and immediate blood loss and death. The risk of rupture is considerable when the diameter exceeds 5.5 cm. What causes the formation of an aneurysm is unclear, but the common known risk factors include genetic predisposition and smoking; while only known risk factor for aneurismal rupture is hypertension.

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    An aneurysm, or widening of the iliac arteries rarely exist by themselves and develop usually as continuation of an abdominal aortic aneurysm, and, therefore, are normally being treated together with it. Isolated iliac aneurysms can be caused by local trauma, surgery and other mechanical factors or infections.

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    Peripheral arterial disease is a narrowing of the arteries of the lower extremities due to atherosclerosis. There are seven known risk factors for arterial atherosclerosis. They include: hypercholesterolemia, hypertension, diabetes, sedentary life style, tobacco abuse, obesity and genetic predisposition. The progression of atherosclerosis in the arteries of the lower extremities, just like in the heart or carotid arteries, goes through three stages. The first stage, called claudication, takes place when an insufficient amount of blood is being delivered only at instances of physical exertion. Typically, the pain is located in the calf muscles and increases as a person walks, to a degree when it is necessary to stop in order to decrease the demand for oxygen. If left untreated, the disease progresses to the second stage, when not only during exertion, but even at rest, lower extremities do not receive enough blood. It usually happens at night time, when the feet being furthest away from the heart, become painful, pale and cold. It is called rest pain. Finally, during the third stage, tissues do not receive enough blood even for normal metabolism, which leads to the formation of the ischemic ulcers or development of gangrene.

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    Popliteal artery aneurysm is a relatively rare disease and refers to dilation of the popliteal artery above its usual diameter, which is about 1cm to 1.5 cm. It is unknown why people develop popliteal aneurysms. The main complication of a popliteal aneurysm, as opposed to almost any other type of arterial aneurysm, is the formation of a local blood clot called thrombosis, and its resultant migration towards the foot - also called an embolization. The above process leads to foot ischemia and can cause gangrene.

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    The term “Lymphedema” is composed of two words: “lymph” and “edema”. “Edema” stands for diffuse accumulation of any type of fluid in the soft tissue, more specifically: in between cells of this tissue. In case of localized accumulation of fluid, it is usually referred to depending on the type of fluid it is: “seroma”, “hematoma” or “biloma” for serous fluid, and blood or bile correspondingly. The word “lymph” indicates the type of fluid composing the above edema. Lymphedema usually develops as a consequence to the disruption of the lymph nodes draining this particular area of the body. The most common cause of lymphedema in the world is damage of the nodes by filaria, a parasite endemic to subtropical areas of Africa, Asia, Central and South America. In the developed countries, however, the most common cause of lymphedema includes surgical resection of affected lymph nodes during diagnostic or therapeutic excisional biopsy in the patients with malignant lesions. Rarely lymphedema can be caused by congenital dysfunction of a specific lymphatic group. In the prevailing majority of cases, it affects only one extremity and is obvious early in life. Lymphedema overall is being over-diagnosed: non-lymphatic edema is being incorrectly diagnosed as lymphedema.

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    Deep vein thrombosis, or DVT, is defined as the formation of a blood clot in the vein belonging to the deep venous system. It most often happens in the veins of lower extremities, but can occur in the upper extremities as well. DVT is an independent disease often mistaken with thrombophlebitis, which is a complication of superficial venous insufficiency. Mechanisms of developing DVT belong to one of three of the following factors. The first one includes abnormalities of the blood flow, such as decreased flow following prolonged periods of immobility during long plane flights or during hospitalization. The second factor is damage to the inside wall of the vein, such as can be caused by a trauma or surgery. Finally, the third factor comprises different states of hypercoagulability, condition when the blood is too thick. Such disorders can be acquired and temporary, such as during dehydration, or hereditary and permanent, such as in several so-called congenital hypercoagulable diseases.

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    Superficial venous insufficiency refers to a condition when superficial veins of lower extremities (greater and lesser saphenous veins) do not bring blood upstream toward the heart, but rather allow it to drain down. It takes place because the veins become too wide and their valves do not reach each other allowing, therefore, the blood to leak in between. Such reversal of blood flow is the main difference between superficial venous insufficiency and all other diseases causing swelling of lower extremities. The risk factors for this disease include genetic predisposition in addition to states significantly increasing endovenous pressure for prolonged time, such as lifting heavy weights, prolonged standing, multiple pregnancies, obesity, sedentary life style, pelvic tumors and many others.

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Visiting Dr. Khitin was a refreshing experience. I've visited multiple physicians and it looks like most of them treated me like a number. Dr. Khitin has an amazing ability to patiently explain all of the intricacies of the disease. Treatment went smooth. I feel 15 years younger! Thanks doc! –Anastasia L., Manhattan NY

I usually don't write reviews, but I feel that Dr. Lev literally saved my leg. I am 35 and not the typical patient for this kind of stuff, but I had an open ulcer on my leg for 3 years!!! Compression, creams, special diet - nothing helped. After Dr. K's treatment, the ulcer slowly began disappearing and it was gone in 6 weeks. If you ever had an ulcer, you know exactly how I felt! Thank You! Thank You! Thank You! – Mike B., Fair Lawn NJ

I was referred to Dr. Khitin by my primary after suffering for many years from restless leg syndrome and varicose veins. Dr. Khitin is the best! Knowledgeable, experienced, but most importantly, he cares! Relief came shortly after the very first treatment. Definitely recommend this doctor. –Samantha K., Manhattan NY

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Thank you so much for all your terrific work. I have spent over a decade trying to find the right doctor, while my legs have been getting worse and worse. Dr. Khitin has changed my life and returned my freedom: finally, I can walk independently! –Donna W., Manhattan NY

The most outstanding treatment I have received! All questions answered, tests done, procedures performed and I feel like a new person in no time! Thank you so very much! –Peter R., Philadelphia PA

I have suffered from trophic ulcers for 28 years until I got to Dr. Khitin’s office! He has literally saved my legs! If you have problems with your legs and do not want to get an amputation, do not see any other physician: do see Dr. Khitin right away! –Bob from UPS,  NY

I have traveled thousands of miles to see Dr. Khitin, who literally returned me my health back! Thank you and all your staff for the most wonderful experience! –Dominique S., Montreal, Canada

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