Michael Kokinos, Author at South Bay Vascular Center and Vein Institute

BLOOD THINNING MEDICATION’S PART 3: STATINS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on May 19, 2022 by Michael Kokinos

Over the past two weeks, I have described the blood thinning medications that vascular surgeons use to treat patients: Anticoagulant and Antiplatelet medications. This week, I want to spend time talking about another important medication that primary care physicians and vascular surgeons both agree helps to improve patient outcomes: Statins.

Statins refer to a general class of drugs that inhibit a special enzyme involved in the production of cholesterol within the body: 3-hydroxy-3-methylglutaryl-Coenzyme A, otherwise known as HMG-CoA. HMG-CoA catalyzes the first reaction in a series of almost 30 individual reactions to create molecules of cholesterol! As a vascular surgeon I sometimes prescribe Statins to my patients with high cholesterol to help my patients manage their cholesterol levels.

Cholesterol:

A high cholesterol level is one of the most common medical problems that patients I see have. As a vascular surgeon it is important for me to understand when a patient has high cholesterol because of the following fact:

A high cholesterol level in the blood may result in a narrowing within the blood vessels of the heart, legs, and neck. When these narrowing’s form they can cause heart attacks, ulcers and pain in the feet, and strokes, respectively.

In numerous clinical trials, the administration of statins has been shown to decrease the rate of death, heart attack, and stroke in patients at elevated risk of these medical problems due to high blood pressure, history of smoking, and diabetes. The general group of statins includes medications like atorvastatin, simvastatin, and rosuvastatin.

At every office visit, I check my patients’ medical history to make sure that their cholesterol levels are being properly managed to ensure the best possible outcomes. Typically, when a patient presents in my office with a history of the following medical conditions, I will often prescribe statins as part of a larger approach to managing their cardiovascular disease:

History of heart attack, peripheral vascular disease, or stroke
History of diabetes mellitus over the age of 45

Vascular disease is both complex and difficult to manage. At South Bay Vascular Center and Vein Institute our physicians have been specially trained to understand “WHY” a problem exists so that our patients have real solutions to living a healthy life. Proper medical and surgical management of our patient involves a deep understanding of our patient’s medical history of which statins may play an important part. If you are currently on a statin or your referring physician believes a statin may be part of a larger approach to your circulatory health, please feel free to schedule an appointment with our office so that we can help you to evaluate this important decision with the context of your overall vascular health. Moreover, if you have a history of ulcers or pain in your feet or stroke, please do not hesitate to call my office today to schedule a consultation to determine if statins can be prescribed as part of your overall care and treatment!

Dr. Ignatius H. Lau: Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

To see what our patients are saying about us, follow the link below to read our reviews.

https://www.google.com/search?q=south+bay+vasculr&rlz=1C1CHBD_enUS878US878&oq=&aqs=chrome.0.69i59i450l8.2997409j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice. Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

BLOOD THINNING MEDICATIONS PART 2: ANTIPLATELETS: PLAVIX AND ASPIRIN. WHAT ARE THEY AND HOW ARE THEY USED?

Posted on May 11, 2022May 12, 2022 by Michael Kokinos

Last week I began a description of the medications that vascular surgeons use with a blog post on drugs used for anticoagulation. This week, I want to describe a group of medications that also thin the blood, albeit through a different mechanism. As discussed last week, the coagulation cascade works to turn the blood from a liquid to a solid. A special group of cells in the blood mixed with red blood cells called platelets works simultaneously with the coagulation cascade to serve as the glue so to speak between clumps of red blood cells. This bond that platelets facilitate with clotted blood helps clot to attach and build upon other collections of clot, thereby facilitating the control of bleeding that the clotting system was designed for.

Obviously, in the case of vascular surgery we often times want to prevent blood clotting from occurring. The main agents we use are aspirin and plavix (clopidogrel). In the early 2000s literature from interventional cardiology for minimally invasive heart procedures found that placing patients on aspirin and plavix together reduced the incidence of recurrent heart attacks as well as death. This literature from cardiology has been extrapolated to the lower extremity circulation and allows the interventions we perform in the lower extremities to fix blood flow to stay open for a long period of time. In addition to the use of aspirin and plavix for lower extremity arterial blockages, we also use it in patients who have had a stroke in order to help prevent them from having another stroke.

Aspirin is a low strength blood thinner that patients can take orally as an 81 mg tablet once a day. In the body aspirin blocks a specific enzyme called cyclooxygenase. When cyclooxygenase is inhibited, the enzyme cannot help to produce chemicals in the blood called prostaglandins. Prostaglandins are normally responsible for creating an environment that stimulates the clotting of blood via complex but mild mechanisms. Studies have shown generally that patients with cardiovascular disease have a lower incidence of death, stroke, and heart attack over time than patients who do not take aspirin. In general, I tend to make sure that all my patients who have peripheral vascular disease take aspirin as a general preventative measure.

Plavix is a much higher strength blood thinner that binds directly to platelets and completely inhibits their function. When used in concert with aspirin, the blood becomes thin enough to prevent the recurrent blockage of vessels that we have opened up.

Overall the large majority of my patients who receive procedures to fix blood flow to the foot are placed on aspirin and plavix. If you think you might benefit from these medications or are in need of a procedure to fix the blood flow to your feet or brain, please do not hesitate to call my office to schedule an appointment!

CLICK ON THE LINK BELOW TO READ HOW OUR PATIENTS DESCRIBE THEIR EXPERIENCE AT SOUTH BAY VASCULAR.

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BLOOD THINNING MEDICATIONS PART 1: ANTICOAGULANTS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on May 2, 2022May 11, 2022 by Michael Kokinos

Over the next few weeks, I want to discuss the medications that vascular surgeons may prescribe. These medications include anticoagulants, antiplatelets, statins, and other miscellaneous agents. This week I will discuss anticoagulants!

Anticoagulation refers to agents that STOP the clotting of blood. The clotting of blood starts with what is known as the coagulation cascade. The cascade refers to a series of consecutive events each involving special proteins that are needed to occur for blood to form a clot. Different anticoagulants block specific parts of the cascade. The main reason we usually see patients with anticoagulants are for hypercoagulable states, certain heart arrhythmias like atrial fibrillation, and deep vein thromboses otherwise known as blood clots. Hypercoagulable states are specific genetically inherited disorders that result in the blood being more likely to clot. Atrial fibrillation and other arrhythmias can cause blood clots to form in the heart.

Anticoagulant agents are given to prevent the formation of clots in the heart that can then break off and go to the brain, hands, feet, kidneys, or any other part of the body and cause problems.

Deep vein thrombosis or blood clots mandate the prescription of anticoagulant therapy to ensure that more blood clot does not form.

Anticoagulants can be broken up by many different classification schemes. For the purposes of this blog, I will limit our discussion here to agents that are appropriate for the OUTPATIENT (Outside of the hospital) setting. Please speak with you private physician to answer any additional questions you may have regarding Anticoagulation medication of feel free to reach out to me directions for more information on how anticoagulation is used. Anticoagulation agents that are used during hospitalization or in the IN-PATIENT setting in patients are outside the scope of this article.

Up until the 2010’s the mainstay of anticoagulation therapy was with a drug called warfarin (Trade name: Coumadin). Warfarin, though effective, requires the weekly or biweekly measurement of a specific lab for the blood called the prothrombin time. The active monitoring of the prothrombin time facilitates modulation of dosing to always allow for safe levels of effective therapeutic anticoagulation. Since the beginning of the 21st century new agents have come to market that require only taking one or two pills a day. They include Xarelto or Rivaroxaban and Eliquis or apixaban.

If you have a question about how your medications may be affecting your vascular disease, please do not hesitate to call and schedule an appointment today!

PART 4: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? DIABETIC FOOT DISEASE

Posted on April 19, 2022May 2, 2022 by Michael Kokinos

Over the past month, I have discussed why venous and arterial disease as well as Raynaud’s Syndrome may cause pain in the feet and toes at night. Today, I want to discuss another one of the most common causes I see in my clinic for pain in the feet at night: Diabetic foot disease.

Interestingly, diabetes mellitus has Greek etiology and literally means sweet (mellitus) urine (diabetes). Diabetes is a condition in which the body loses its ability to limit the amount of sugar in the blood. The high concentrations of sugar result in the formation of harmful chemicals that can hurt the eyes, kidneys, and nerves all around the body, especially in the feet. Once the sugar levels become high enough, they overload the kidneys—the organ that creates urine—and sugar overflows into the urine, hence the Greek etiology of diabetes mellitus.

Diabetes causes pain in the feet via two main pathways: Neuropathic pain and pain from ulcers.

Neuropathic Pain:

For neuropathic pain, the high blood sugar levels damage the small nerves in the feet responsible for sensation. As a result, patients often complain of burning, cramping, tingling, and at the very worst end of the spectrum, numbness. Sometimes only the toes have these symptoms, but often times the symptoms can encompass the entire foot!

Ulcerative Pain:

The way diabetes results in the formation of ulcers is multifactorial.

First, the damage to the nerves can result in numbness or lack of sensation. Thus, when a person injures their foot, that person does not feel it and protects it from further injury.
Second, in addition to damaging the nerves responsible for sensation, diabetes also damages the nerves that innervate muscles responsible for moving. The damage to the muscle nerves occurs in such a way that irregular contractions of muscles within the foot push the bones of the foot outward creating pressure points that ulcerate easily. Once the ulcer is formed, infection of the ulcer or exposure of the raw tissues beneath the skin can cause pain. In patients who otherwise have numb feet, an infection can spread to an area that does have sensation and cause pain there.

Given that diabetes is so common, patient education is vitally important to those impacted by this disease. If you or anyone you love suffers from diabetes, my hope is that this blog will help you to better understand some of the underlying factors that may be contributing to your foot pain at night. As a rule of thumb, always remember to share with your primary care physicians all symptoms of pain that you experience during your regularly scheduled appointments and if you think your condition may be getting worse, please do not hesitate to call my office to schedule an appointment for a second opinion! We can help.

408-376-3626

Dr. Ignatius H. Lau

Vascular Surgeon

To see what our patients are saying about us, follow the link below to read our reviews.

https://www.google.com/search?q=south+bay+vasculr&rlz=1C1CHBD_enUS878US878&oq=&aqs=chrome.0.69i59i450l8.2997409j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

PART 3: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? PERIPHERAL ARTERIAL DISEASE

Posted on April 8, 2022May 2, 2022 by Michael Kokinos

In part one- and two of our four-part series on “Why do my feet hurt at night”, I discussed Venous disease and Raynaud’s Syndrome. In today’s discussion I want to focus on an even more common reason for why patients may suffer from leg pain at night: Peripheral arterial disease (otherwise known as PAD.)

As we’ve discussed in our earlier blogs, there are two kinds of blood vessels: Arteries and veins.

Arteries bring blood from the heart to the foot and toes under high pressure while
Veins bring the blood back from the foot to the heart under low pressure.

Over the course of anyone’s lifetime, blockages may build up in the arteries between the heart and the feet, especially in the pelvis and the legs. Risk factors that increase the risk of formation of these blockages include:

Obesity
High blood pressure
High cholesterol
Diabetes
History of smoking tobacco.

As you may imagine, the tissue within the foot needs a certain amount of blood to supply the nutrients and oxygen necessary to keep the cells within the foot living. Though a single, short segment blockage of the arteries in the leg may not result in any problems, multiple blockages from the pelvis to the foot may can make it difficult or even impossible for the cells within the foot to survive this lack of nutrients and oxygen.

What Does PAD Feel Like?

Typically, patients notice a gradual onset of pain in the forefoot and toes over the course of a few weeks to months. As their blockages worsen, their pain becomes more severe. Pain from PAD occurs in the forefoot and toes because those parts of the body are the furthest away from the heart and thus any blockage along the way from the heart to the toes can contribute to the lack of blood flow. One classic symptom of PAD pain is a burning, tingling, or numb sensation that can be partially relieved by hanging your foot off the bed or a chair. In this position with the foot hanging down, gravity assists the flow of blood to the foot and toes and relieves the pain. Typically, patients complain that when they lay flat at night, the pain in the forefoot and toes or just the foot in general will wake them up. I always specifically ask patients if they are woken up at night by the pain. If they are woken up by the pain, then I know the PAD must be very severe.

In some patients, the lack of blood flow is so diminished that there is also the development of ulcers, or defects in the skin with exposure of underlying fatty tissue, bone, and muscle or gangrene, the death of the tissue itself.

Even though PAD is a very severe and life limiting disease, specially trained vascular surgeons have many tools to combat it! We can do a minimally invasive procedure called an angiogram that I described in an earlier blog post that you can access here! Essentially, I access the diseased blood vessel with a needle and through that needle use contrast and x-ray to see where the blockages are. Then, using balloons, stents, or self-expanding metal tubes, it is possible to re-open the blockages to re-establish blood flow to the impacted area. For severe blockages, I also use a device called atherectomy that allows me to cut through and to remove the plaque responsible for blocking this vessel. The procedure on average takes 1.5 to 2.5 hours and most patients can go home the same day.

Does foot pain wake you up at night? If you are experiencing pain in your foot or toes, please do not hesitate to contact my office at 408-376-3626 to schedule a clinic appointment today!

We Can Help!

Dr. Ignatius H. Lau

Vascular Surgeon

PART 2: WHY DO MY TOES, ANKLES, AND FEET HURT AT NIGHT? RAYNAUD’S SYNDROME

Posted on April 1, 2022May 2, 2022 by Michael Kokinos

Last week I wrote the first part of a four-part series about foot pain at night. Specifically, I talked about venous disease as a cause of foot pain.

Today, I want to talk about another common cause of foot pain at night: Raynaud’s Syndrome.

As a quick review, last week we talked about the two main types of blood vessels in our bodies: arteries and veins. Arteries bring blood from the heart to the feet under high pressure. Veins bring blood back from the foot to the heart under low pressure.

Raynaud’s Syndrome is a disease of the arteries, particularly the small arteries, in the feet.

(Though Raynaud’s can also affect the hands as well).

Before we dive into Raynaud’s Syndrome though, I need to briefly review another anatomical system in our bodies that is involved in Raynaud’s Syndrome: The nervous system.

In general, we have two broad types of nerves.

There are nerves that are responsible for sensation and for moving muscle and
There are nerves that are responsible for regulation of bodily function.

Diving a little bit deeper into the kinds of nerves that regulate bodily function, there are the

Sympathetic nervous system: The sympathetic nervous system, amongst other things, is responsible for opening blood vessels in the legs and arms and increasing blood flow when exercise is necessary
Parasympathetic nervous system: The parasympathetic nervous system in similar fashion opens the blood vessels leading to the intestines to allow for the digestion of food.

In patients with Raynaud’s Syndrome, sometimes their sympathetic nervous system does not function properly resulting in the constriction of blood vessels that lead to the hands, fingers, feet, and toes. When it happens, blood vessels in the fingers and toes typically first turn blue because of the lack of oxygen; then white because of the lack of blood flow; and finally red, once the constriction ends and the blood flow returns to the fingers and toes. During this constriction of the blood vessels, patients can have significant pain, numbness, tingling, and, in very severe cases, ulcers (defects in the skin with exposure of underlying fat and muscle) and gangrene (black and dead tissue).

Interestingly, environmental and social triggers play a significant role in Raynaud’s Syndrome episodes of vessel constriction. Factors including stress, caffeine, alcohol or other drugs, and cold temperature can all induce a painful episode with lack of blood flow to the hands and feet.

Not much is known about the cause of Raynaud’s Syndrome or specifically why it happens. Sometimes, Raynaud’s Syndrome can occur on its own without any other related disease. In other cases, the patient has another inflammatory disorder like lupus or Sjogren’s Syndrome that is known to be highly associated with Raynaud’s Syndrome.

Though we do not fully understand the causes of Raynaud’s Syndrome there are many treatment strategies that can help. Starting with behavioral modifications and certain blood pressure medications that can reduce spasm to specific procedures aimed to reduce the spasm of the vessels induced by the sympathetic nervous system, there is so much that I as a vascular surgeon can do to help patients with Raynaud’s Syndrome. If you think that you might suffer from Raynaud’s Syndrome, please do not hesitate to call our office on 408-376-3626 to schedule an appointment. We Can Help!

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York, he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

Posted on March 30, 2022May 2, 2022 by Michael Kokinos

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night? Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists. Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night. Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

Veins are blood vessels that bring blood BACK from the feet to the heart.
Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet. As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes. The increase in venous pressure at the ankle typically results in

Varicose veins,
Swelling,
Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting. Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles. When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles. When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause! Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon. Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes. Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

Dr. Ignatius H. Lau

Vascular Surgeon

FIXING BLOCKED ARTERIES

Posted on March 9, 2022 by Michael Kokinos

The most common disease that I treat as a vascular surgeon is a medical problem called peripheral vascular disease. Specifically, peripheral refers to the legs, and vascular disease refers to blockages of the arteries.

Because peripheral vascular disease is the most common disease that I treat, I want to talk today about what I can do as a vascular surgeon to fix these kinds of blockages in the arteries!

First though, let me explain why blockages to the arteries of the legs are bad. When not enough blood flow reaches the legs, patients can have pain in their calves or buttocks that limits their ability to walk longer than a city block. When the blockages are very severe, they can also have pain in their feet and toes even when they are not moving or develop non-healing ulcers and gangrene. When I open blockages in patients’ legs, I allow them to walk again, or I give them the ability to heal their ulcers and gangrene pain free. The improvement in patient lives is the most exciting aspect of my job!

There are two main approaches to performing what we call revascularization. Revascularization refers to the opening of old passageways or creation of new passageways to bring blood directly from the heart to the foot without any obstruction.

Open Surgery: In the early decades of vascular surgery, namely the 1980s and 1990s the primary way to treat peripheral vascular disease was to perform an open surgical bypass. If there was a blockage in the thigh, I would surgically expose above and below the blockage and take a synthetic tube or the patient’s own vein and then sew it above and below the blockage. This would allow the flow of blood to bypass the blocked segment, hence, the reason we call this surgery a bypass! Though this procedure does produce robust flow, it necessitates large surgical incisions that cause significant pain and are susceptible to poor wound healing and/or infection.

Endovascular Surgery: In the 2000s, an innovative approach called endovascular surgery started to become more widely used and is now actually standard of care today. Indeed, I prefer to treat patients with peripheral vascular disease with endovascular surgery whenever possible. We access the arterial system of the leg with a needle in the groin. Through that needle we put in a strong wire and over that wire we can then advance several different instruments over catheters. In general, there are three different techniques I can employ in my efforts to re-establish blood flow to an area that is no longer receiving blood due to some type of arterial blockage.
- Balloons: The most basic instrument is a balloon that expands and breaks up the narrowing or blockage.
- Stents: If the balloon does not work, we can use a self-expanding tube called a stent.
- Atherectomy: If the stent does not work, we can use a special device called atherectomy. Atherectomy involves the use of a device that can literally cut the plaque out of the artery and aspirate all the debris.

These three technologies allow the reopening of arteries from the toes to the pelvis and only necessitate a 2 mm puncture site in the skin of the groin to be used. There is little to no risk of infection and the procedure can be performed several times over the course of the patient’s life. On the other hand, surgical bypass can only be performed twice—three times—during the patient’s life due to the development of dense scar tissue after each operation.

If you have trouble walking because of pain in your buttocks or calves or have pain in your feet and toes or ulcers that will not heal, please do not hesitate to call my office today at 408-376-3626 to schedule an appointment. The chances are that I will be able to help take your pain and ulcers away! We Can Help

www.southbayvascular.com

ANEURYSMS: WHAT ARE THEY AND WHY IS IT IMPORTANT TO KNOW IF YOU HAVE ONE?

Posted on March 1, 2022 by Michael Kokinos

Of the many reasons that a patient can be referred to a vascular surgeon, one is that their referring physicians believes that their patient may have developed an aneurysm. Aneurysms, typically speaking, form in arteries which are the specialized vessels that carry blood from the heart to the rest of the body under high pressure. When the wall of an artery weakens, it can develop into a balloon-like dilation called an aneurysm. (See below). This most commonly occurs in the main blood vessel in your abdomen, which is called the abdominal aorta. When the blood vessels dilate to 50% greater than their normal diameter, the vessel has become an aneurysm.

Interestingly, the reason why aneurysms form is actually poorly understood. We know that smoking cigarettes and a family history of aneurysms increases the risk that a patient will develop an aneurysm, but no direct cause-effect relationship has been established. Diabetes mellitus, however, appears to have a protective effect. That is, the presence of diabetes appears to help prevent aneurysms! The other health risks of diabetes including neuropathy and infection, of course, make diabetes an undesirable health problem to have.

Aneurysms have two main catastrophic problems: Rupture and thromboembolization. (to learn more about aneurysms visit our website at https://www.southbayvascular.com/aneurysms/ Rupture refers to a tear in the wall of the blood vessel resulting in a leakage of blood. When aneurysms in the abdomen rupture, the amount of blood loss into abdomen can be life threatening and result in death within seconds. Thromboembolization refers to the formation of blood clot within the aneurysm that then breaks off and goes somewhere else. When aneurysm and associated blood clot form in the abdomen, these blood clots can break off and travel to the leg resulting in a lack of blood flow to the legs. Such a sudden cessation of flow to the legs can result in the death of the foot and/or legs within hours.

As you can see arterial aneurysms can be very troublesome. Luckily, vascular surgeons have many tools and instruments that we can use to treat these aneurysms in a minimally invasive way. In my blog next week, I will go over the different options for treating aneurysms in the abdomen. If you or someone you love have been told that you may have an aneurysm, please call our office immediately to schedule an appointment for a full vascular work-up. 408-376-3626

We Can Help!

WHAT IS “ENDOVASCULAR” SURGERY?

Posted on February 25, 2022February 25, 2022 by Michael Kokinos

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

Open surgery is just as you might think! It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures. Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
Endovascular surgery is a recent development that only began in the 1990s. Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel. Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel. Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot. For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage. If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open. There is also a technology called atherectomy which literally means cutting out plaque. The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric. We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed. Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm! As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients. If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!