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

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.

TREATING SWOLLEN, ACHING LEGS

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

HOW ARE VARICOSE VEINS TREATED?

Both invasive and non-invasive (i.e surgical and non-surgical) methods are available to treat varicose veins. Non-invasive methods include wearing compression stockings, exercising, leg elevation, losing weight, not wearing tight clothes, avoiding long periods of standing or sitting and not crossing your legs while seated. Invasive treatments include endovenous therapy, ligation, and phlebectomy.

Endovenous therapy is treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls and cause the vein to close and then be reabsorbed by the body. Ligation is tying off a vein to cause it to shrink. Phlebectomy is removal of varicose veins. Only after your physician evaluates a patients vascular ultrasound study are they in a position to discuss the best treatment option for their patients. The vascular surgeons of South Bay Vascular Center and Vein Institute have successfully treated tens of thousands of varicose vein patients in their 20 year history of serving the silicon valley community. With offices in Campbell and Morgan Hill, Dr. Kokinos and her staff are honored to meet with you to discuss any questions you may have regarding varicose veins or any other circulatory related medical condition. Please call our office today to schedule an appointment to help us evaluate your treatment options. 408-376-3626

IS VEIN DISEASE COVERED BY INSURANCE

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.

FREE ILIAC VEIN SCREENING

During the months of May and June, in order to help our patients who have been suffering with left leg swelling for a long period of time, we are offering a free iliac vein ultrasound screening. This ultrasound will be offered on a limited basis to our current patients or someone who has a history of a DVT (deep venous thrombosis). These screenings need to be done in the early morning in fasting patients, and cannot be done on those who weigh more than 250 pounds. Please call our office at 408-376-3626 to inquire about availability of the free limited openings.

SWOLLEN LEG?

It is amazing to me how many patients we see who have suffered with leg swelling or wounds for months or years. They believe that it will just go away, or that the wound will just heal. Sometimes, they have even gone to their doctor, who usually does not even look at their leg. Although mild ankle swelling can sometimes occur just because the weather has been hot, or you have been sitting for a long time, or you had a lot of salt in your diet, the vast majority of the time, there is actually an underlying reason for the leg swelling. This can include such “big” problems such as a heart or kidney problem, a blood clot that has not been diagnosed (especially after an orthopedic procedure or a long car or plane trip), a tumor that is compressing your abdominal or pelvic vessels, or leaky valves in your veins. It is truly important to seek expert help from a vascular surgeon if your leg swelling extends up into your calf, or if it lasts more than a couple of days. This is especially true if it is painful. That is most commonly the sign of a deep venous thrombosis (DVT) and those must be treated immediately to prevent the blood clot from going to your lung and potentially killing you. Pulmonary embolus, when the clot travels to your lung and blocks a main artery there, is the number three cause of death in the United States that nobody talks about.

The work-up for leg swelling almost always will involve a leg ultrasound. This is a painless, quick, and inexpensive test that is diagnostic both for blood clots and leaky valves in the veins. Sometimes, if the problem is in the abdomen or pelvis, an ultrasound or CT scan there may be necessary. If the problems relates to a kidney or heart issue, blood work may be in order. In any case, sometimes, the treatment of the underlying problems that cause leg swelling need to be begun within a few days of its occuring so that one can have the best outcome possible.

If you have a swollen leg, whether it is for a few days or several months, come see the experts at South Bay Vascular Center to help diagnose and treat its cause.

SOUTH BAY VASCULAR CENTER LAUNCHES NEW WEBSITE

South Bay Vascular Center and Vein Institute is pleased to announce the launch of their new website. The new site is designed to offer patients an easy to read, customer friendly option for interacting with our practice. Our goal with the new site is:

  • To provide our patients and prospective patients a more complete understanding of our practice; who we are and what we do.
  • To help educate our patients on the available options for the diagnosis and treatment of their vascular medical issues.
  • To improve our customer service for patients by giving them the ability to submit their insurance information on line, in advance of their visit, in an effort to both streamline their visit and to verify coverage.
  • To provide a portal through which patients can download all of their check-in and registration documents, as well as their pre-operative and post-operative medical instructions directly from the website.

South Bay Vascular Center and Vein Institute is proud to celebrate its 20th year serving the patients of Silicon Valley, South County and beyond. With the opening of our new angiography suite in Campbell, CA. our practice continues to be on the cutting edge of Vascular medicine. Advancements in medical imaging and devices have enabled our surgeons and interventional radiology partners to treat circulatory issues in our new state of the art center in ways that were never before possible, greatly enhancing our ability to serve the vascular surgery needs of our patients.

Dr. Kokinos, a nationally recognized ABMS Board Certified General and Vascular Surgeon, and her staff are pleased to meet and to discuss treatment options for all your vascular related issues. If you suffer from leg swelling, non-healing ulcers and wounds, experience complications following cosmetic vascular procedures (varicose and spider veins etc) have been diagnosed with a Blood Clot or DVT, we are here to help.

Don’t continue to suffer alone…we can provide guidance and help when you feel like there are no answers to your medical condition. Give us a call to discuss your treatment options and we can help you “Get your life back.”