Tag: Dr. Polyxene Kokinos

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

Posted on 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.

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

Posted on 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

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,,,

 

TRANSCAROTID ARTERY REVASCULARIZATION: THE FUTURE OF CAROTID SURGERY

Posted on by Michael Kokinos

One of the most gratifying problems we help treat for patients is carotid artery disease.  The carotid arteries supply the brain with blood.  In patients with high blood pressure, high cholesterol, diabetes, and a history of smoking, the carotid arteries can become narrowed and form blood clots that then go into the brain and cause strokes.  Traditionally, vascular surgeons have fixed this carotid artery narrowing’s with a surgery called a carotid endarterectomy.  The carotid artery is dissected out and cut open.  The plaque is then removed, and the carotid artery is sewn back together.

Over the past five years, however, I have had the opportunity to perform a new technique involving carotid stenting called trans carotid artery revascularization or TCAR.  Stents are self-expanding metal tubes that we can use in the carotid artery to stop clots from forming in narrowed areas.  TCAR uses a suction machine to reverse flow in the carotid artery during the placement of a stent to minimize the risk of inadvertent stroke during the procedure itself.  After having performed over 20 of these procedures in the past two years, I can say with confidence that the flow reversal and stenting that TCAR provides is a highly safe and successful way to treat carotid artery disease.  Furthermore, the length of the incision, postoperative pain, and risk of nerve damage and bleeding are all much less with TCAR than with CEA.

I am so happy to be able to offer this revolutionary, safe, and effective therapy to all my patients at South Bay Vascular Center.  Should you or anyone you know have any problems with your carotid arteries or a stroke, please do not hesitate to call us today at 408-376-3626 to schedule a consultation.

https://youtu.be/O32nDoovMPY]

ONE PATIENT, ONE DOCTOR, ONE NURSE; SOUTH BAY VASCULAR CENTER’S COMMITMENT TO PERSONALIZED CARE

Posted on by Michael Kokinos

Unlike so many big box medical centers (Kaiser, Sutter, PAMF, Stanford) where patients are often “overwhelmed” as soon as they get to the parking lot, South Bay Vascular Center and Vein Institute offers world class, cutting edge vascular surgical care in a kinder, gentler environment.  Individualized patient care, although talked about and marketed heavily by these corporate health systems, more often than not falls far short of patient expectations as higher order operational efficiencies and profitability concerns impact the kind of care patients actually experience in these larger health care systems.

ONE PATIENT; ONE DOCTOR; ONE NURSE. 

Putting patients at the center of everything that a physician does is a philosophy that sounds obvious…but is that always the case? At South Bay Vascular Center we are honored by the chance to earn your trust and to serve as your physicians; BUT, we also know that we must EARN the trust of every patient that we see.  That’s why our CREDENTIALS are NOT Enough…That’s why our REPUTATION is NOT enough. That’s why unmatched patient care is at the center of everything that we do. That’s why when patients come to our facility for a procedure each patient has their own nurse from start to finish to ensure the greatest patient care experience from start to finish. 

We know patients have options for their vascular care and that’s why we work hard to ensure that any patient referred to us by another doctor or that comes to us on their own has the confidence to know they’ve made the right choice of doctor to help them with their vascular related illnesses. ONE PATIENT; ONE DOCTOR; ONE NURSE is just one of the many ways that South Bay Vascular Center demonstrates our commitment to our patients in our efforts to provide the most advanced vascular care options offered anywhere in the world.

OUR TEAM

Together with her full time, highly skilled team of critical care and surgical nurses, radiological technicians, RVT certified Ultrasound Technologists and scrub assistants, Dr Kokinos provides unmatched peripheral vascular surgical care in her Nationally Accredited Surgical Facility. As diverse as Silicon Valley is, our staff reflects this same diversity as we have native speaking staff fluent in over 10 different languages. Be it Vietnamese, Mandarin, Korean, Russian, Tagalog, Hindi, Spanish, French, Greek or English, we have staff to make our patients comfortable in their native tongue.

OUR FACILITY

The South Bay Vascular Ambulatory Surgery facility is one dedicated entirely to the practice of Vascular Surgery and houses a specialized inventory of vascular medical devices and imaging equipment that surpasses the number of vascular medical devices and imaging equipment at Good Samaritan and O’Connor Hospitals combined. Together with her highly trained and specialized team, Dr Kokinos brings over 30 years of surgical experience and 7 years of specialized surgical experience operating in a specially built vascular surgery outpatient facility to her patients.  Other physicians may claim to have the kind of training and experience that Dr Kokinos has in the outpatient environment, but NO other Vascular Surgeon in Silicon Valley comes anywhere close to having the kind of experience and outcomes Dr Kokinos does when it comes to providing care to the patients who come to her for the treatments and care of their vascular disease.

Put another way, for 25 years Dr Kokinos and her team at South Bay Vascular Center and Vein Institute have provided unmatched, compassionate and individualized vascular surgical care to South Bay communities. It is why more independent physicians refer their vascular patients to Dr Kokinos than to all the other Silicon Valley vascular surgeons combined. When it comes to your health, we know that it’s not just our credentials and our experience that count.  It’s not about just having an accredited facility or a staff of travelling specialists to help when needed…   It’s about the RIGHT KIND OF EXPERIENCE EVERY TIME YOU NEED IT.

RESULTS matter when it comes to your health because sometimes you don’t get a second chance.

South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say there Is None.

Call us at 408-376-3626. We Can Help

VARICOSE VEIN DOCTORS

Posted on by Michael Kokinos

Type “Varicose Vein Doctor” into your Google search and in seconds, you’re overwhelmed by results.

Each link points to a different website.  Each site claims their “Vein Doctor” is the “best” and every practitioner claims to have the “bona-fides” to back-up these claims. Credentials span the continuum from Academic Institution Affiliations, (claiming to be X, Y or Z University Affiliated); to Chair-Personships (they “chaired’ this or that medical departments in the “Big Box” health care systems they came from (i.e. Kaiser, PAMF, or Sutter) to Medical Journal Publications…all this in an apparent attempt to equate administrative responsibilities with clinical excellence. Some of the bolder in the group even claim they trained at the best medical schools hoping to convince potential patients that by attending a great medical school they are the best physician for the procedure.

 

AN ESPECIALLY CONCERNING TREND IS A PHYSICIAN’S USE OF GOOGLE ADWORDS TO ADVANCE THEIR MESSAGE

 

If a vein doctor’s website shows up in your Google Search and you see that the listing starts with the word “AD” …be careful. It means that the owner of this practice is paying Google a special Advertising fee to get their name to the top of the search results. This is an attempt by this physician to “BUY LEGITIMACY”.  Businesses PAYING google to display their ads above the practitioners who have EARNED this privilege is a great way for Google to make money. Unfortunately, it can be deceiving to people who think that because a doctor’s website pops up at the top of the search results that they must be the best. (On a separate note…If a physician’s website DOES show up at the top of the search results and DOES NOT have the word “AD” in front of it, IT IS a sign that this physician has many website visitors and that they have been around for a long time…Especially if this listing is followed by a large number of Google Reviews.)  It also means that this physician has EARNED their reputation, and NOT purchased their website ranking. A word of warning to patients searching for an experienced vein care professionals. Anyone can pay to elevate their search rankings on Google; regardless of their experience.

 

IGNORE websites with paid “AD’s”, especially if they don’t have any verified Google reviews. 

 

To make things even more difficult, it can be very confusing just trying to figure out what kind of doctor actually does varicose vein procedures. Some doctors call themselves “Vein Specialists”. Others call themselves “Vein Experts”. You’ll also see the labels “Phlebologist” and “Vascular Expert”. Finally, there is the “Vascular Surgeon”. You ask yourself, do all of these physicians fix varicose veins? If so, what’s the difference? (Learn more by clicking on the following link). https://www.southbayvascular.com/blog/vascular-surgeon-vs-phlebologist-vs-vein-specialist/ Every one of these “Vein Doctors” promises to rid you of your ugly, painful veins, leg swelling and non-healing ulcers. Every one of them posts photos showing off their work to prove their point.

Let’s face it, it’s confusing. All you really want is to get your veins “fixed” so that next time you get invited to a pool party you can wear shorts or a skirt again without being “mortified” by how bad your legs look. So, what’s next?

Lost in this hype, finding the right doctor to treat your varicose veins might seem impossible. Choosing the best doctor for your specific vein condition is a difficult decision and not one that you should take lightly.  Only after serious consideration of the available options should this decision be made and in the best of all worlds, it should be made in consultation with your primary care physician…and this is the probably the most important message in this post.

LISTEN TO YOUR PRIMARY CARE DOCTOR

They’ve been in this community a long time and they know who is good and who is not. Their referral should be your number one reason to make an appointment with a Varicose Vein Doctor.

In the best of scenarios, patients should visit as many doctors as they can; interview them and question them about everything relating to their condition and their ability to help you…but remember, your primary care doctor has been doing this for a long time. They’ve got the benefit of having seen the results from different doctors and on the strength of their recommendation, you should have the confidence to know that you are making the right choice.

Here are a few things varicose vein patients should keep in mind:

  1. Remember, these are your legs. You deserve the best and you deserve to “Love Your Legs Again”.
  2. Don’t be frightened to ask your doctor tough questions.
    • Don’t just ask your vein doctor how long they have been in practice, ask them how long they have been doing these specific kinds of vein procedures. Ask them how many of these procedures they’ve done.
    • If your doctor is in private practice, ask them how long they have owned their own practice. This is important because getting things done right in a private practice is significantly more difficult than getting work done in a University Hospital or Big Box Medical System.
    • How many of these procedures have you done RECENTLY….if they do less than 25-30/ month, you might want to seriously consider finding another option
    • What kind of complications might you expect…every person is different and if your doctor says your legs will look as good as they did when you were 20, you might want to consider seeing someone else.
    • Who does your ultrasounds…are your ultrasound techs RVT’s (Registered Vascular Technologists?) Are they done “in-house” by full time Vascular ultrasonographers or are they done by “travelling” ultrasonographers who just work in their office a few times a week and who are not full time employees of the medical office.
    • Most importantly, is your Vascular lab IAC Accredited? This is especially important as your doctor will make their diagnosis on the basis of your ultrasound report and an IAC accreditation guarantees the best of the best studies are being done at that particular lab.
    • Who reads the ultrasounds….is it an RPVI registered physician, not simply a radiologist… as the two physicians will look for vastly different signs relating to vascular disease and health. Keep in mind if the study isn’t read correctly, the procedure can go poorly.
  3. Finally, ask your “Vein Specialist” about what happens if you have a complication Ask your provider if they have “Admitting privileges” at the local hospital in the event something goes wrong during the procedure and what their plan is if their procedure fails.

 

EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH!

 

South Bay Vascular Center and Vein Institute brings 24 years and 20,000 vein procedures to you as our patients. As the leading independent Vascular Surgery practice in the San Francisco Bay Area, more local independent physicians refer their vein patients to Dr Kokinos than to any other vascular surgeon in the greater Silicon Valley Region.

WE OFFER HOPE WHEN OTHER SAYS THERE IS NONE!

Call us today at 408-376-3626 to schedule your vein consultation

DR. KOKINOS SELECTED TO PRESENT AT THE AMERICAN VENOUS FORUM

Posted on by Angelica Rodezno

Dr. Kokinos will be presenting an abstract on her clinical research regarding iliac vein compression at the national American Venous Forum in New Orleans early next year. This meeting is the largest venous meeting of the year, and is sponsored by the Society for Vascular Surgery.

Dr. Kokinos has been recognized nationally as an expert on May-Thurner’s Syndrome, or iliac vein compession. This problem can cause symptoms of (predominantly) left leg swelling, heaviness, aching, deep venous clots, and non-healing ankle or leg wounds. She has performed more intravascular ultrasound exams and stents of the deep venous system than any other doctor on the West Coast in the last year. She will be presenting her clinical research on using regular ultrasound, done by the specially trained registered vascular technologists in the ICAVL accredited Institute for Vascular Testing to diagnose this fairly common but widely underdiagnosed issue. Previously, patients needed to get CT scans which used significant amounts of radiation and contrast for the diagnosis. This problem is not only seen because of a common anatomic situation, but also often as a result of an undiagnosed blood clot (DVT) in the iliac or femoral vein after orthopedic, back, or gynecologic surgery.

If you have one leg that is more swollen or painful than then other, or have had a leg blood clot in the past, please call us at 408-376-3626 or visit us at www.southbayvascular.com.

SAN JOSE DIALYSIS ACCESS CENTER STAFFED BY FULL TIME VASCULAR SURGEONS

Posted on by Angelica Rodezno

South Bay Vascular Center and Vein Institute is proud to announce the opening of the only dialysis access center in Santa Clara County and the South Bay region with full time vascular surgery coverage. The new center provides experienced care in a state of the art facility conveniently located in Campbell, CA.

Trusted local physicians provide compassionate care in a personalized setting. Full time vascular surgery coverage by board certified surgeons enables immediate access to care unlike any other facility in the region. From the most complicated dialysis access problems to the most basic access issues our full time vascular surgeons provides an entirely different level of care and treatment than found in other facilities staffed by interventional nephrologists. Full time Vascular Surgery coverage ensures the best results in the least amount of time; no more waiting in the cold corridors of a traditional hospital; no more secondary referrals; and equally important, a lower cost alternative to the current model of patient care. Most importantly, when you have a problem, we are here to help.

South Bay Vascular’s new facility is staffed by local physicians and surgeons who have been dedicated to treating South Bay patients for over 60 years. We are local physicians and not a large corporation staffed by out of town physicians. We are dedicated professionals passionate about patient care and who have long track record of success in the Santa Clara Valley. Our new center is a welcome alternative to the traditional hospital setting and provides un-matched access to board certified vascular surgeons trained to address any vascular access complication.

Call us Today Toll Free at 1-855-WE-D-CLOT

TEN MISCONCEPTIONS ABOUT VARICOSE VEINS

Posted on by Angelica Rodezno

Last weekend, during my daughter’s water polo game, I noticed the coach for the opposing team was limping and had a very swollen left leg. With a closer look I realized he had the hyperpigmentation (skin darkening) of chronic venous disease and ugly bulging varicose veins easily the size of my thumb all over the inside of his calves. I decided to go ask him about them, as they looked awful, the man was clearly in pain, and I was concerned. After a brief conversation with the coach, where he told me various “old wives’ tales” it dawned on me that he probably wasn’t alone thinking the way he did so I thought I should post this blog in an attempt to clear up these ten common misconceptions about varicose veins. Here goes:

“Varicose veins are simply a cosmetic problem”

About half of the patients we see in our practice for varicose veins complain about the pain they experience because of their veins. Because these patients are experiencing pain and suffering, many times varicose veins are categorized as a Medical condition and not just a cosmetic issue. This is especially true if they are accompanied by leg aching, throbbing, swelling, or discoloration. Venous disease affects about 40 million people in the United States and about 1 million end up with ulcers that are painful and difficult to heal. As a medical condition, depending on the severity of a patients condition, insurance often covers for the procedure to be done. That way, patients are not forced to pay out of pocket to rid themselves of their painful and ugly veins.

“Varicose veins can cause strokes, heart attacks, or gangrene”

Although varicose veins are a circulatory problem, the blood vessels causing strokes, heart attacks, and gangrene are arteries not veins. The patient profile of patients suffering from vein issues (women, multiple pregnancies, family history, standing occupation) is very different from those that get arterial problems (smokers, diabetics, patients with high blood pressure or cholesterol). Because of this, patients suffering from varicose veins should consult with their physicians to determine if this problem is accompanied by any underlying,and potentially more serious, circulatory issues

“Only women get varicose veins”

Although venous disease is more common in women, about 40% of our patients are men. Unfortunately, men tend to present with more advanced disease or longer standing symptoms.

“I have had my veins just like this for twenty years”

Venous disease does progress if not treated and currently there are several outpatient office procedures that can be done with excellent results and low risks

“It is not worth treating varicose veins because they just come back”

The treatment of venous insufficiency is one of the more successful treatments in medicine, as long as the underlying cause is treated- ie. the underlying veins that have the leaky valves. In the old days, patients were treated simply with removal of the bulgy veins. Because the underlying saphenous veins that had leaky valves were not treated, the bulgy veins come back. Now that we do ultrasound to “map out” the diseased veins, the recurrence rate should only be about 10% at 10 years.

“Insurance will not cover any varicose vein treatment”

Although insurance companies have absolutely made the criteria for coverage for venous disease much more difficult over the last ten years, most patients who do have leaky valves in their underlying valves are covered. Sclerotherapy for spider veins and the simple removal of bulgy veins for appearance are almost never covered today.

“Varicose veins are “surplus parts” that I might need someday”

They are abnormal blood vessels that develop usually because there is an underlying medical problem- vein valve failure or “leakiness”. The underlying greater saphenous vein, that usually is the one that has the leaky valves, is sometimes used in open-heart surgery or arterial vascular bypass surgery. However, today, it is not commonly used as those operations have been replaced to a large extent by less invasive procedures using balloons and stents.

“ Varicose veins are just part of getting old as is my leg pain”

Although it is true that there is an increase in the incidence of varicose veins as one gets older (one study found that 75% of women over the age of 65 had venous issues), it is NOT a normal part of aging to feel heaviness, aching, or throbbing in the legs. It is important to go have those symptoms evaluated by a vascular surgeon as often it can be easily treated.

“Treatment of my varicose veins will lay me up for weeks”

Until about 15 years ago, the main treatment for varicose veins was a difficult procedure called vein stripping. This was generally done under general anesthesia, in a hospital where one was admitted, with two moderate sized incisions in the groin and at the ankle. It generally took patients several weeks to recover. The field was revolutionized by the introduction of endovenous ablation, which currently is an office procedure, done under local anesthesia where the patient usually has NO post-operative pain. Most patients return to all of their normal activities with 24-48 hours.

“You have to have bulging veins to have a vein problem”

Many patients who present with heavy, aching or swollen legs actually do not have bulging varicose veins but are found to have a problem on evaluation. In order to diagnose venous disease, it is important to have a VENOUS REFLUX ULTRASOUND. This is not the same as a vein ultrasound to look for blood clots that primary care doctors often order at hospitals. It is critical to have this test done at an ICAVL accredited laboratory as it is extremely technologist dependent. A good exam will take about 30 minutes per leg and will examine veins with the patient in a standing or head slanted up position from the groin to the ankle.

BLOOD CLOTS (DEEP VENOUS THROMBOSIS‐DVT) A SILENT KILLER

Posted on by Angelica Rodezno

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. DVT is a very feared complication of venous disease because it can lead to a pulmonary embolus, a clot in the lung that can be deadly.

There are several symptoms to DVT but the most common are the sudden onset of pain and swelling in your leg. This does not happen in your foot, but happens, most commonly in the back of your calf or your entire thigh. Usually, the painful part of your leg is also swollen. This comes on abruptly and generally does not go away even after a few days. It is very important to go to your regular doctor and get an ultrasound of your leg. If this is “normal” but the swelling or pain persists, then you should go see a vascular surgeon as more testing (such as CT scan or specialized ultrasound) may need to be done. This is quite important to do quickly as some treatments only work if they are done within a week of the development of symptoms.

If you are diagnosed with a DVT, you should be treated with blood thinners immediately. The role of blood thinners is not to actually “dissolve” the clot in your leg, but rather to prevent it from travelling to your lung and causing a Pulmonary Embolus. The blood thinners also work to prevent the clot from becoming more extensive. If this is your first blood clot, you should be treated for 6 weeks to 3 months with blood thinners depending on why the blood clot occurred. The risk factors for developing blood clots include long plane or car rides, immobility (after an operation or injury), obesity, being very sedentary, pregnancy, having had an orthopedic or gynecologic procedure, some genetic factors (hypercoagulable syndromes), dehydration, and cancer. It is important if there if there is not a clear reason for the blood clot, that a search for a hidden cause be done.

Dr. Kokinos and the staff at South Bay Vascular Center and Vein Institute are experts in the identification of and treatment of blood clots. If you or anyone you know suffers from the rapid onset of pain and or swelling following a medical procedure and or long trip (most common on long airplane flights) please contact your primary physician immediately or call us at 408-376-3626 to discuss your treatment options.