Dr. Nirman Tulsyan

Varicose Vein Doctor located in Manhattan (Midtown East), NYC

About Dr. Nirman Tulsyan

Dr. Nirman Tulsyan is Board Certified vascular surgeon with 15+ years of experience.

He has been a practicing Attending Vascular Surgeon since 2007. He has vast experience in complex aortic reconstruction, carotid artery disease, lower extremity arterial and venous pathology, and management of dialysis access for patients with end-stage renal disease. He is also prolific writer, having authored over 20 research articles published in peer-reviewed journals, as well as 2 book chapters on Vascular Surgery. Among his many service awards include “Patient’s Choice”, “Compassionate Doctor”, and “On-Time Doctor”.

Dr. Aziz' practice accepts most major insurance plans, and he speaks English, French, Spanish and Arabic.

Varicose Veins: Symptoms, Causes, and Diagnosis

Varicose veins also know as varicoses or varicosities, are enlarged veins often on the thighs, the backs and fronts of the calves, or the inside of the legs near the ankles and feet. Varicose Veins affect approximately 25% of adults, affecting women more than men. During pregnancy, varicose veins can happen around the inner thigh, lower pelvic area, and buttocks.

If you are symptomatic, your legs may feel heavy or ache. Your symptoms may get worse after sitting or standing for long periods of time and can improve after resting and elevating your legs. Larger varicose veins may cause aching, throbbing, and discomfort. Varicose veins can also be responsible for ulcers that form on the skin near varicose veins.

Varicose Veins Symptoms

The following factors increase your risk of developing varicose veins:

  • Veins that are blue or purple in color
  • Veins that appear raised, twisted or enlarged
  • An achy or heavy feeling
  • Burning, muscle cramping, swelling and throbbing
  • Increased pain after sitting or standing for a long time
  • Itching around one or more of your veins
  • Skin discoloration
  • Restless Leg Syndrome
  • In severe cases, there can be significant bleeding and ulcers.


Changing hormone levels may affect your symptoms. Because of this, you may notice more symptoms during certain times in your menstrual cycle or during pregnancy or menopause.

Muscle contractions in your lower legs help blood return to your heart. Tiny valves in your veins open as blood flows up towards your heart, then close to stop blood from flowing back down. If these valves are weak or damaged, blood can flow backward and pool in the vein, causing the veins to stretch or twist. Over time, more blood gets stuck in the vein, building pressure that weakens the walls of the vein, which causes the vein to grow larger.


Risk factors

The following factors increase your risk of developing varicose veins:

  • Standing or sitting for long periods of time. If your leg muscles aren't contracting, they aren't assisting in the flow of blood up towards your heart.
  • Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow some blood to flow back into your veins where it collects instead of flowing up to your heart.
  • Family history. If other family members have or have had varicose veins, its more likely you will too.
  • Sex. Women are more likely to develop this condition. Hormonal changes during pregnancy or menopause or hormone treatments such as birth control pills, may be a contributing factor as female hormones tend to relax vein walls.
  • Obesity. Additional body weight puts more pressure on your veins, which can be a contributing factor.
  • Pregnancy. During pregnancy, the volume of blood in your body increases. This change supports the growing baby, but also can contribute to enlarged veins in your legs.


Ask your self the following questions: more YES answers indicate a greater likelihood of Varicose Veins.

  1. Do your legs and/or feet ever feel numb?
  2. Are your legs and/or feet warm to the touch?
  3. Have you ever had burning pain and/or severe cramping in your legs?
  4. Do you have spider veins and/or varicose veins?
  5. Do you have persistent lower back and/or leg pain?
  6. Have you developed any discoloration or color changes in your legs?
  7. Have you had any previous vein treatments in the past that failed?
  8. Have you ever had an open sore or non-healing wound on your feet/ankles?
  9. Has your doctor ever diagnosed you with venous disease or insufficiency?
  10. Do you feel weak all over and exhausted most of the time?
  11. Do your legs hurt or feel constant heaviness when you stand or walk?
  12. Do you lose sensitivity in your legs when you stand for a long time?
  13. Is the skin on your legs so dry that it tends to crack?
  14. Have you ever worn compression stockings?
  15. Do your symptoms improve when wearing compression stockings?
  16. Have you taken any medication for leg pain?
  17. Do your daily activities require prolonged periods of standing?
  18. Do you have difficulty completing your work or daily activities due to leg pain/swelling/heaviness?
  19. Have you recently had heart surgery?
  20. Have you ever been diagnosed with Peripheral Arterial Disease (PAD)?
  21. Have you ever been diagnosed with a blood clot or DVT in one or both of your legs?
  22. Have you or a family member ever been diagnosed with a clotting disorder?
  23. If female, are you currently pregnant?
  24. Are you on any blood thinners other than aspirin or Plavix (clopidogrel)?



Initially we conduct a visual examination where we look at your legs while you're standing or sitting with your legs dangling and ask about any symptoms you might be experiencing or any pain.

Next we often use ultrasound to check blood flow in your veins and to look for blood clots. This noninvasive test uses high-frequency sound waves, which allows us to see the flow of blood through your veins. During this test, a handheld device will be placed on your body and passed back and forth over the affected area. The device sends and receives sound waves. A computer converts the sound waves into an image of the blood flow in your arteries and veins. A venogram which is an X-ray is performed using a special dye, which allows us to see the flow of blood in your veins, may also be used in your diagnosis.

Tests such as ultrasounds or venograms help ensure that another disorder like a blood clot or a blockage isn’t causing the pain and swelling in your legs.


Words from our patients

“Dr Tulsyan is a very nice person and treats the elderly very well. My mom who is 89 thinks the world of him. He speaks to the patient and does procedures only if absolutely needed. I recommend him highly. I think he has a great attitude and most of all he listens to the patients needs.”

~ Thanks, Margaret M.

“Very caring, great bedside manner.”

~ John C.

Dr. Nirman Tulsyan
509 Madison Avenue, Suite 1111
Midtown East

New York, NY 10022
Phone: 212-906-9111
Fax: 212-906-9100
Office Hours

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