Tag: blood clot

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!

HOW CAN A SWOLLEN LEG BE RELATED TO CANCER?

Posted on by Angelica Rodezno

How Can A Swollen Leg Be Related To Cancer? Many people know that leg swelling is a normal part of pregnancy. Or that if your heart or kidneys are not working properly, then fluid can “back up “ into your legs and cause swelling. Unfortunately, one problem that most people do not associate with leg swelling is cancer. This is unfortunate, because many people have leg swelling, most specifically an unprovoked deep venous thrombosis causing that swelling, as the first sign of their cancer. What does that mean?

Deep venous thrombosis (DVT), or a blood clot in one of the deep veins in the leg, is very common in the United States. This usually presents as unilateral leg (when only one leg swells) swelling, especially of the calf and ankle. As many as 900,000 people a year are diagnosed with a DVT and about 100,000 of them DIE of either the DVT or a pulmonary embolus (PE). A pulmonary embolus is when the blood clot travels to the lung and causes the death of a part of the lung. Most of the time, a DVT is provoked, or has a cause. Common reasons for a DVT include long car or plane rides, having orthopedic or other surgery, being on bedrest or being very sedentary, being on birth control pills, or having unusual proteins in the blood that cause one to clot more easily.

Sometimes, however, a patient develops a blood clot without having a history of one of these things. When that happens, it is VERY important to be worked up for the possibility of a hidden cancer. This is because studies have shown that if someone develops a DVT with none of the “normal” risk factors, the chance of diagnosing cancer in that patient is one in ten in the first year after the DVT.

It is therefore very important that if you are told you have a DVT, that you be screened for cancer. This can be done simply with a thorough history and physical, some lab work, and possibly some Xrays, depending on your history. It is important NOT to just go to the urgent care, be told you have a blood clot, and just take your blood thinners. Please go see a vascular surgeon who can both manage the medication for you blood clot, follow it up with ultrasounds, and do the proper work-up to ensure that it is not the sign of something bad.
South Bay Vascular Center and Vein Center specializes in the treatment of DVT and Swollen Legs. If you or anyone you know suffers from blood clots (DVT’s) or swollen legs, please call our office to schedule a consultation at 408-376-3626

TREATING SWOLLEN, ACHING LEGS

Posted on by Angelica Rodezno

Leg swelling is a difficult symptom to diagnose. There is a long list of underlying causes for leg swelling and it is important to note two things:

1. Is the leg swelling unilateral (in one leg) or is it in both?

If it is in both, it is more likely to be a “systemic” issue, that is a problem with one’s general health. This can be something as simple as too much time in a chair, to something as serious as congestive heart failure. Many medications can also contribute to bilateral leg swelling as can liver disease, kidney problems, and obesity.

2. What part of the leg is swollen?

If the swelling extends into the foot, it is more likely to be lymphedema than a venous problem.

If it goes all the way up into the thigh it may be ​ Iliac Vein Compression ​or, if the onset of swelling is rapid, it may be the result of an ​ileofemoral blood clot​ (DVT).

It is important not to ignore leg swelling, especially if it comes on abruptly as it may be a sign of a serious and potentially life threatening issue.

Iliac vein compression syndrome occurs because of the anatomic compression of the left iliac vein between the lumbar spine and the right iliac artery. Although originally thought to be a rare syndrome, it is now believed that about 30% of all people have significant compression of their iliac vein. In most people, this is asymptomatic and will never cause a problem. However, it is being recognized that in more people who have chronic leg swelling, especially of the left side, continued aching despite treatment of superficial venous disease, recurrent left leg blood clots, and /or nonhealing ulcerations at the ankle or shin that this compression prevents the adequate drainage of blood from the leg. Although about 80% of the compressions are of the left iliac vein, we do sometimes find them on the right, especially as a result of scarring from pelvic or back surgery. This is the most common cause of ileofemoral DVT and should be worked up aggressively.

This is a special area of interest of ours, and we are active in doing clinical research to find better ways to diagnose and to treat iliac vein compression. Unfortunately, many physicians are unaware of these latest treatment options and tell their patients that not much can be done to treat this condition. Consequently, we find that way too many patients live with this painful and difficult condition of leg swelling and the non-healing wounds that often accompany it. There is hope.

We can help.

The physicians at South Bay Vascular Center and Vein Institute are board certified vascular surgeons and not “phlebologists” or “vein specialists”. As such we can do significantly more to treat generalized leg swelling and the leg swelling that often accompanies failed cosmetic vein procedures. Our surgeons are at the forefront of diagnosing iliac vein compression and leg swelling secondary to cosmetic procedures using regular vascular ultrasound. Most importantly, we can treat this painful condition with the newest endovascular techniques using IVUS (intravascular ultrasound) and stents in an outpatient office setting. To date, we have successfully treated over 75 patients in our outpatient angio suite here in Campbell, CA. If you suffer from leg swelling, especially left leg swelling there is hope. Please give us a call at South Bay Vascular Center and Vein Institute to schedule an appointment to discuss your treatment options. 408-376-3626

IS VEIN DISEASE COVERED BY INSURANCE

Posted on by Angelica Rodezno

One of the questions I am most often asked when doing screenings for vein disease is “Is treatment covered by insurance?” As usual, most medical questions are not easily answered and so the answer is yes, and no. All insurance companies consider varicose vein disease treatments medically necessary, and will therefore cover it, if there are complications such as bleeding or ulceration. Most consider treatment medically necessary if there are symptoms and reflux can be demonstrated on a Doppler exam. Of course some of the newer treatments are considered “experimental” and therefore not covered. Spider vein treatments are considered cosmetic and no longer covered by any insurance plans of which we are aware. Lastly, not only does each insurance company have its own requirements but each individual policy can vary within the general guidelines of the company. Sounds confusing and it is. The best way to find out if your particular situation meets the requirements necessary for insurance coverage is to come in for an evaluation. Call us at 408-376-3626 to schedule an appointment to discuss your options.