Month: October 2019

MILLIONS WITH LEG PAIN HAVE PERIPHERAL ARTERIAL DISEASE

Posted on by Angelica Rodezno

A NY Times Health Care blog published in April of 2016 screamed out with the title “Millions With Leg Pain Have Peripheral Arterial Disease”.”More than eight million older Americans have a condition that can cause leg pain when they walk even short distances. Yet half of those who have the condition don’t know it and consequently don’t get treated for it, putting themselves at risk for a heart attack, stroke or worse.The condition, called peripheral artery disease, or P.A.D., is marked by diseased or blocked arteries in the legs. More than half of those with such circulatory problems in the extremities also have coronary or cerebral artery disease, noted Dr. Iftikhar J. Kullo, a cardiovascular specialist at the Mayo Clinic, in The New England Journal of Medicine in March. Failure to diagnose and treat blocked arteries elsewhere in the body can result in more serious, or even fatal, problems if they affect the heart or brain.It may seem odd that people who have serious difficulty walking normal distances would not know something is wrong and get checked out. Yet, as Dr. Kullo noted, P.A.D. is both underdiagnosed and undertreated. And the number of cases of P.A.D. is only likely to rise as the population ages, he said.”The article in its entirety can be read by clicking on the link below

https://well.blogs.nytimes.com/2016/04/11/millions-with-leg-pain-have-peripheral-artery-disease/

San Jose’s South Bay Vascular Center surgeons specialize in the care and treatment of patients suffering from PAD. Recognized as one of California’s leading Vascular Surgeons, Dr Kokinos has a special interest in peripheral re-vascularization procedures. Essential to her success in treating PAD is her ability to perform these re-vascularization procedures in her nationally accredited, custom built, state of the art peripheral arterial disease (PAD) treatment center. This facility, located in Campbell, CA., was specifically designed as a PAD treatment facility and is where South Bay Vascular Center physicians leverage advanced imaging systems (Ziehm C-Arms with Flat Panel Detectors and Phillips Intra Vascular Ultrasound imaging systems) to provide the most advanced surgical techniques available in this area. This advanced technology, together with a vast inventory of specialized medical devices not found in traditional operating rooms allows our surgeons to perform advanced, minimally invasive surgical procedures in their efforts to provide the best possible outcomes in the most difficult circumstances.Diagnosis
Many types of health care providers can diagnose and treat PAD. Family physicians, internists, physician assistants, nurse practitioners and vascular specialists can all diagnose PAD by examining a patient’s medical and family history, performing a physical exam, and conducting diagnostic tests. PAD can be diagnosed through a variety of diagnostic procedures including:

  • Ankle-brachial index (ABI):A common test used to measures the difference between blood pressure at the arm and at the ankle. A difference in the two areas indicates restricted blood flow.
  • Ultrasound
  • CT and MR angiograms
  • Angiography
  • Blood tests

Treatment
Over the past 15 years the interventional treatment of peripheral arterial disease (PAD) has changed significantly. Endovascular techniques have replaced many traditional open surgically invasive procedures as the dominant intervention. More recently, pedal access techniques, accessing the blocked area from the toe versus a traditional access point in the patients groin, has shown, in certain instances, to be significantly more successful that earlier methods of revascularizing the impacted area. Dr. Kokinos has performed more pedal access approach procedures that anyone in Northern California and because of this she able to provide patients with more options for treating their disease than many other surgeons.There are multiple options for treatment of PAD, ranging from medical interventions, surgical revascularization, and endovascular therapy. Vascular Surgeons are uniquely qualified and trained to treat patients diagnosed with PAD. Approaches to treatment include:

  • Minimally invasive endovascular procedures
  • Medical management
  • Exercise and lifestyle modifications
  • Surgical bypass Amputation

Early detection and treatment are important to control the disease and to allow patients a full selection of treatment options. If you suffer from non-healing leg wounds and or have difficulty walking short distances, ask your physician if you can have a vascular ultrasound study to evaluate your risk of PAD.

South Bay Vascular Center and Vein Institute is the recognized as the regional treatment center for the treatment and care of patients suffering from Peripheral Arterial Disease. Dr.’s Kokinos’ specialized training and state of the art interventional facility offers patients a unique alternative to a hospital setting and provides the highest level of care for the treatment of PAD as an alternative to limb amputation.

If you or a loved ones suffers from PAD, call our office today at 408-376-3626 to schedule a visit.

We offer hope when others say there is none.

www.southbayvascular.com

WHEN HIP PAIN MAY BE MORE THAN JUST ARTHRITIS

Posted on by Angelica Rodezno

Do your legs hurt when you walk? Can you only walk a block or two before you start experiencing cramping in your hip or buttock? Often times, patients are told this is just a normal part of getting older and probably due to arthritis. But sometimes it isn’t. If your pain only happens when you walk a certain distance and stops when you stop walking, it may be a circulation issue known as claudication. Claudication is a vascular condition that occurs when your leg muscles do not get enough blood flow while they are being used. This is generally caused by a build-up of plaque in the arteries–known as atherosclerosis–in your abdomen or legs. This build-up of plaque on the inside of the arteries, which carry oxygen and nutrients to your organs and muscles, restricts how much blood and therefore oxygen can get to the muscles. When you walk, you use energy, and your muscle requires more oxygen and nutrients to work. If the muscle does not get this needed oxygen, it begins to cramp up. This causes pain, and ultimately causes you to stop walking. Those at risk for this happening are people over the age of 60, those who smoke or were smokers in the past, those with high cholesterol or high blood pressure, and those who have heart disease or have had an ischemic stroke.

This problem can occur in one or multiple arteries from your belly button to your knee. It can be easily diagnosed on exam by simply feeling pulses in the patient’s groin, behind their knees, and at their ankles to check for blood flow. We can also listen for an abnormal sound called a “bruit” in the abdomen or the groin with a stethoscope. Where the pain is in your leg gives a clue as to where the problem is in your arteries. If there is a problem in the arteries in your abdomen or pelvis (the aorta and iliac arteries), it will cause buttock or hip pain with walking. This is often confused as hip arthritis or bursitis by medical doctors and patients. At SBVC, we have seen many patients who have had multiple injections into their backs or hip joints with no relief. On exam, we find they do not have pulses in their groin. An ultrasound done by specialized vascular technologists checking blood flow in the arteries will confirm this exam finding and can help plan treatment. Most treatments today are directed at opening the blood vessels up with surgery or a stent procedure. These are very safe and can immediately provide relief from pain and allow the patient to walk much longer distances than before. If you believe you are suffering from claudication, please talk to your doctor about your options. You may benefit from seeing a vascular surgeon for ultrasound and possible treatment.

BLOOD CLOTS AND SURGERY

Posted on by Angelica Rodezno

Most hospital surgeries require patients be put under general or epidural anaesthesia. Anaesthesia allows the patient to “sleep” through their procedures helping patients avoid both the physical and emotional stress of the operation. Anesthesia is also very important because it keeps the patient from moving during surgery. This “stillness” allows the surgeon to undertake their procedure without jeopardizing patient safety due to unwanted movement.

This same lack of movement, however might also cause other problems for the patient. The most concerning of these problems is the formation of a blood clot developing in the legs, or deep venous thrombosis (DVT) while the patient lies motionless on the table. In fact, in some surgical procedures (typically those lasting more than 3 hours, those involving bones or the back, or those done to treat a cancer) the risk of developing a blood clot can be as high as 80%. For that reason, national guidelines recommend that patients undergoing these long and complex surgeries (as well as some minor surgeries) are treated prophylactically- in advance- of a problem. This treatment can include the use of blood thinners before and after surgery, the use of compression pumps, and the use of early mobilization after surgery.

Blood clots that develop after a knee or hip surgery are also very common; unfortunately, these clots can be quite difficult to diagnose. One expects the affected joint to be painful and swollen after a procedure. Unfortunately, what could be a life threatening condition is often overlooked or misdiagnosed.

How can one know if post operative swelling is a part of the normal recovery or something more concerning? Only by getting a vascular ultrasound study can a definitive determination be made as to the presence or absence of a clot.

It is important to ask your surgeon to order an ultrasound if:

  • You feel tenderness and swelling in your calf or thigh after a surgical procedure.

  • These symptoms last longer than what your doctor told you to expect.

  • These symptoms prevent you from performing the activities for recovery you expected to do.

A special note of caution: ultrasound studies can be done at the hospital or at a nearby vascular surgeon’s office where the technologists are specialists in examining the veins and arteries of patient’s legs for clots

At SBVC, we perform dozens of exams for DVT monthly; mostly for orthopedic surgeons, podiatrists, and primary care doctors who want fast and accurate results. We also help these doctors immediately start treatment should a DVT be diagnosed because we can evaluate their patients immediately and if necessary we can beginning them on blood thinners in the office. As vascular surgeons we are able to begin care immediately saving patients from an expensive, frustrating, and time-consuming visit to the emergency room. We are aware how difficult this unsuspected surgical complication can be, especially when you are still in pain and recovering, but, we do our best to help you through this unfortunate occurrence.

If you experience any of the post surgical complications outlined above and suspect that it may be a blood clot, contact your surgeons office immediately to schedule an appointment.

BLOOD CLOTS AND AIRLINE TRAVEL

Posted on by Angelica Rodezno

People are more mobile today….everyday traveling to more and more places by plane, train, and automobile. Now, more than ever, vast numbers of business people and pleasure seekers cross the globe on a daily basis for work, opportunity and adventure.

As difficult (and as exciting as travel can be) extended periods of immobility during these long trips carries a hidden risk…a sometime fatal risk…especially if one is squished into the middle seat in the back of the plane for hours on end making it difficult to get up and move: the risk of developing a DVT (more commonly known as a blood clot) in the deep veins of their legs.

Veins are a network of blood vessels that work to return blood TO the heart (as compared to arteries which are blood vessels that transfer blood AWAY from the heart) Veins work by using a series of very small valves to keep blood flowing in a single direction and, generally, prevent blood from going back towards the ground even though gravity exerts a constant force to pull the blood down.

One’s calf muscles play a critical role in the venous system. These muscles, when activated, act like a “pump” to help squeeze blood back up through the veins and back up to their heart. When immobile,especially common during long periods of travel, the muscles cannot help the veins do their job, and the blood just sits in your legs. Blood naturally has proteins in it that helps it clot so that you don’t bleed to death after a cut or injury. When these clots develop, the leg can become swollen and painful. Many people develop leg swelling during long plane or car travel. However, one big differentiating factor between that kind of swelling and a DVT is that a DVT usually only happens on one leg. Often, the swelling persists for more than a little while after you get moving again. In addition, the leg, especially in the area of the calf muscle, is often tender when squeezed.

In the event that you experience the kind of symptoms explained above it is vitally important to go to the doctor or emergency room immediately. The most feared complication of a DVT is when the clot in the leg travels to the lung causing a PE—a pulmonary embolus. This can cause shortness of breath, chest pain, and even death. In fact, PE is the third most common cause of death in the United States, and few regular people know about it. If you do think you have a blood clot, it is important to get an ultrasound to diagnose it and to be started on blood thinners. It is also very important to see a doctor who specializes in blood clots, often a vascular surgeon, to evaluate whether or not there is another reason in addition to travel that this may have happened. Occasionally, having a DVT is a sign of a more serious underlying issue, and the travel just precipitated its occurrence.

At SBVC, our physicians and surgeons aggressively work up patients who present with the symptoms of a DVT to make sure there is no other contributing factor. We work closely with your primary care doctor, and occasionally call in hematologists (specialists in blood problems) to consult as well. If you or anyone you know suffers from non resolving swollen calf’s or legs following a long flight please call our office at 408-376-3626 to schedule an immediate visit to determine the extent of and appropriate treatment for DVT.

To learn more about blood clots and flying click on the attached link to visit a more detailed article on healthline.com

https://www.healthline.com/health/dvt-and-flying