Month: January 2022

BLOOD CLOTS

Posted on by Michael Kokinos

Today, I want to give insight into one of the more common questions I receive as a vascular surgeon: How do I know if I have a blood clot?

Why is this important? Here are a few facts directly from the US Center for Disease Control and Prevention (CDC).

  • Anyone can develop a blood clot.
  • In the United States, as many as 900,000 people are affected by DVT’s each year and
  • About 100,000 people die of PE annually.

Many factors can put you at risk for a blood clot. These include:

  1. Major trauma
  2. Cancer
  3. Being 55 and older
  4. Having a personal or family history of blood clots
  5. Immobility (such as being on bed rest or difficulty with walking)
  6. Pregnancy, or using estrogen containing medications such as birth
    control pills, patches, and hormone replacement therapy
  7. Obesity
  8. Smoking

Almost half of all blood clots occur either during or soon after discharge from a hospital stay or following surgery. The more risk factors you have, the greater your risk of developing a blood clot will be.

The medical term for blood clot is Deep Vein Thrombosis. (DVT) Veins at their most fundamental level are blood vessels that return blood from the body (e.g. feet, hands, intestines, kidney, etc.) back to the heart.  In the legs, there are two main sets of veins: superficial and deep.  Deep veins are very close to the muscle and bones.  Superficial veins are very close to the skin, hence the name superficial.  The word thrombosis derives from the Greek word of the same spelling, thrombosis, which means curdling.  In contemporary medicine thrombosis refers to the blood’s transition from liquid to solid.  With all these words explained, we can see that a deep vein thrombosis refers to blood clots that are in the deep system of veins in the legs.  Though superficial veins can become clotted as well, the symptoms that result are usually not as severe as a deep vein thrombosis.

Once the deep veins of the legs are blocked, blood becomes trapped in the veins below and the blood pressure in the veins increases.  Consequently, the leg and foot will become swollen, blue, and tender.  Patients often complain of a “tension” or “pulling” sensation in the groin, thigh, and behind the knee.  These feelings of tension and pulling are often also considered as very painful.  Because of the swelling there may be severe difficulty with tasks as simple as walking to the bathroom or a few feet.

PE’s: A Silent Killer

Sometimes, a piece of clot can break off from the legs and travel to the lungs.  This is called pulmonary embolism or PE.  Pulmonary refers to lungs and embolism refers to something that breaks off from one place and travels to another.  When patients have a blood clot associated with a pulmonary embolism, they will experience:

  • Shortness of breath
  • Palpitations/fast heart rate, and
  • In very severe cases, dizziness associated with fainting.

Recognize The Signs and Symptoms of a Blood Clot

DVT (Arm or Leg) – if you experience any of these, call your doctor as soon as possible.

  • Swelling of your leg or arm
  • Pain or tenderness not caused by an injury
  • Skin that is warm to the touch, with swelling or pain
  • Redness of the skin, with swelling or pain

PE (Lung) – if you experience any of these, seek medical attention immediately.

  • Difficulty breathing
  • Chest pain that worsens with a deep breath
  • Coughing up blood
  • Faster than normal or irregular heartbeat

Blood Clots Can Be Prevented

  • Know your risks and recognize signs and symptoms.
  • Tell your doctor if you have risk factors for blood clots.
  • Before any surgery, talk with your doctor about blood clots.
  • See your doctor as soon as you can if you do have any symptoms.

    I hope this blog post can shed some light on blood clots.  If you or someone you know are experiencing these types of symptoms, please do not hesitate to visit our website at www.southbayvascular.com to call our office at 408 376 3626 to schedule an appointment today!

    FOOT PAIN AT NIGHT?

    Posted on by Michael Kokinos

    As vascular surgeons, many of the consultations and questions we receive revolve around one issue: foot pain!  As people age there can be many sources of foot and leg pain and I want to shine some light onto a few of the most common causes that I see.  They include peripheral vascular disease, chronic venous insufficiency, diabetic foot disease, and sciatica.

    Peripheral Vascular Disease:

    In all people there are two main kinds of blood vessels, arteries, and veins.  Arteries bring blood from the heart to the feet.  Veins bring blood back from the feet to the heart.  In individuals who have a history of

    • High blood pressure,
    • High cholesterol,
    • Diabetes,
    • Obesity,
    • Smoking

    The arteries that lead to the feet can develop blockages, otherwise known as Peripheral Vascular Disease.  When too many blockages develop, the feet do not receive the amount of blood they need to stay alive, and they become very painful.  When this happens, patients tend to hang their feet in dependent positions off the side of the bed at night to allow gravity to help the blood travel through the blockages to the feet.  The pain tends to concentrate on the forefoot and toes where the blood vessels are the smallest.

    Chronic Venous Insufficiency

    With vein disease, patients tend to have swelling in the legs below the knee including the ankle and feet.  Normally, there are structures in the veins called valves that allow blood to go to the heart but not to go back down towards the feet.  In patients with vein disease, these valves leak and cause blood to pool in in the legs below the knees.  After patients are standing or sitting upright for extended periods of time, the pressure in the veins of the legs builds resulting in an aching pain as well as also causing varicose veins, dark discoloration of the skin, and, in the worst cases, ulcers on the leg.

    Diabetic foot disease

    Diabetic foot disease is one of the most common problems I see as a vascular surgeon.  These patients describe numbness much more often than pain.  This numbness is a result of the inflammatory damage that high sugar levels in the blood can inflict on the nerves of the foot.  Sometimes, even when these patients develop ulcers, they do not feel any pain because the nerve damage is so severe.  As such, patients with diabetic foot ulcers, though they can experience pain, often experience numbness as well.

    Sciatica

    Lastly, sciatica can also be a cause of leg and foot pain.  The nerves that detect sensation from the legs and foot originate from the spinal cord in the back of the pelvis and abdomen.  As such, when these nerves are pinched they tend to cause the patient to feel a pain radiating from the lower back or buttock down the leg and sometimes even to the foot.  This radiating pain can be easily distinguished from the pain of peripheral vascular disease and venous insufficiency which is concentrated in the legs and feet.

     

    If you or anyone you know suffers from leg pain at night and if any of these stories seem to fit the pain or discomfort that you may be having in your legs, please call one of our South Bay Vascular Offices in either Campbell or Gilroy CA at 408 376 3626 today to schedule an appointment! We Can Help!

    ARTERIES AND VEINS….WHAT’S THE DIFFERENCE?…AND HOW DO THEY WORK?

    Posted on by Michael Kokinos

    As a vascular surgeon, one of the more common questions I receive from patients and from friends and family alike is what do I actually do?  I find the question interesting because before I went to medical school, I did not even know that the field of vascular surgery existed!  Vascular surgeons operate on the blood vessels all around the body including the chest, arms, neck, abdomen, and legs. One key thing to remember is that Vascular surgeons do NOT work on a person’s heart. Heart doctors are more commonly known as cardiologists and cardiac surgeons.

    There are two different types of blood vessels: arteries and veins.  Arteries are the tubes that bring blood from the heart to the rest of the body including arms, legs, head, abdomen, and legs.  Arteries allow blood to travel at high speed with the pressure provided by the contraction of the heart.  Common health problems like high blood pressure, high cholesterol, smoking, and diabetes can result in blockages of the arteries that lead to the foot.  Once the blockages are severe enough, a patient can have pain in the calves and feet as well as ulcers or gangrene of the toes and feet that do not heal.  In addition to the effects on the legs, patients can also develop narrowing in the carotid arteries that supply the brain, the arteries that lead to the arm, and the arteries that lead to organs in the abdomen.

    On the other hand, veins are the tubes that bring blood back to the heart from the body.  After dropping off oxygen and nutrients to the tissue, the blood returns to a low-pressure state and thus moves at a low speed in the veins back to the heart.  Because of the low pressure, specialized structures called valves exist in the veins to make sure that after blood goes back to the heart, the blood does not reflux back into the vein.  When reflux occurs, the venous pressure can increase and cause ulcers, swelling, and varicose veins in the legs.

    If you have ulcers on your feet that have not healed or varicose veins or swelling in your legs that are limiting your life, do not hesitate to call our office at 408-376-3626 to schedule a consultation. We can help!

    Visit our website at www.southbayvascular.com to learn more about who we are, what we can do, and how we can help restore your circulatory health.

    South Bay Vascular Center and Vein Institute

     25 years of compassionate vascular care for South Bay communities

     

    YOU HAVE A BLOOD CLOT. NOW WHAT?

    Posted on by Michael Kokinos

    One of the most common consultations that we as vascular surgeons receive is for deep vein thrombosis, otherwise known as blood clots.  Deep veins refer to the location of the vein that has the problem.  In the legs we have two main sets of veins: Deep and superficial.  Deep veins are within the muscle and close to the bones whereas superficial veins are close to the skin; hence their names!

    Thrombosis refers to the process of the blood turning from a liquid into a solid form.  Normally, thrombosis occurs in response to an injury to stop bleeding from a wound.  However, when thrombosis occurs in the deep veins, it stops blood from being transported from the foot back to the heart.  The obstruction of flow results in swelling and pain below where the thrombus, or clot, has formed.

    There are many causes of blood clots, but the most common causes include:

    • Traveling for extended periods of time in a sitting or resting position.
    • Trauma, including accidents which cause broken bones or bruises.
    • Narrowing of the veins of the pelvis, and
    • Specific genetic mutations that increase the likelihood of the blood forming clots. 
    • In older patients, another potential cause of blood clots without any other cause is cancer.  Cancer, unfortunately, can result in the release of chemicals and hormones within the body that make clotting more likely.

    For patients who develop a blood clot in the context of traveling, narrowed pelvic veins, or having a traumatic injury to the affected leg, treatment involves a 3-month course of blood thinning medication followed by ultrasound tests to determine the stability of the clot.  If the symptoms improve and the clot remains stable, then the medication to thin the blood can be stopped at 3 months.

    For travelers who are forced to sit for extended periods without being able to move, making an effort to walk around intermittently throughout the traveling can be helpful.  For example, on the plane, every 30 minutes stand up and walk up and down the aisle 3-4 times.  For patients who have a traumatic injury to their leg, the best choice would be to avoid, if possible, situations that led to the particular accident.  Finally, in patients with narrowed pelvic veins, I as a vascular surgeon can help relieve the narrowing with a special minimally invasive procedure called a venogram.  In the procedure, I place a self-expanding tube called a stent into the compressed vein via a small 2 mm puncture site in the groin to make sure the compressed vein remains open.

    For those patients who did not have a traumatic accident, narrowed pelvic veins, recent travel, or a high suspicion of cancer, referral to a hematologist, or a doctor who specializes in disorders of the blood, can be helpful.  The hematologist can help order special genetic tests to determine if there is a genetic predisposition to forming clots.  In patients who do end up having genetic mutations, long-term placement on blood thinning medications can help prevent further events.

    If you are anyone that you know is suffering from a blood clot, please do not hesitate to call our office on 408-376-3626 to schedule an appointment!  The expertise that vascular surgeons have in this area of medicine is critical to ensure a good outcome!