Tag: May-Thurner’s Syndrome

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.

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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

FOOT PAIN AT NIGHT: IT MIGHT BE MORE SERIOUS THAN YOU THINK

Posted on by Michael Kokinos

Many patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol wake up at night with pain in their foot or toes. Some believe this is arthritis or gout; others think it is the result of just spending too much time on their feet during the day.  Patients often self-adapt to this problem, as it usually develops slowly over time, but when questioned about their sleep habits, they will sometimes tell you that they sleep in a recliner or they sleep with their leg hanging over the side of the bed to make their pain go away.

It is very common for elderly patients to get up at night to go to the bathroom. Sometimes, however, it’s actually foot pain that wakes them up.  Once up, they get out of bed because that makes their feet feel better (again due to gravity) and after walking to the bathroom they can go back to sleep, pain -free for a couple of hours.  Even that small amount of walking helps to get their blood flowing again and makes it easier for them to go back to sleep.

Sometimes, foot pain at night is the sign of a more serious condition.

  • Foot pain at night may be related to having poor circulation in the foot. The name for this in medical terms is “rest pain”. This is not “pain at rest” but rather pain that happens because the circulation cannot support the tissues even when they are at rest.

Foot pain at night may be an early warning sign of critical limb ischemia.

  • Chronic Limb Ischemia is another term for lack of blood flow;  if you experience this rest pain at night and it goes away after hanging your foot over the side of the bed or chair you are sleeping in, immediately call and speak with your doctor to set up an appointment for them to evaluate your symptoms. Although it may come on slowly, the arteries in your feet may be so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes need to keep them nourished. Left untreated, this blockage can lead to a more serious problem, amputation or even death.

What’s important for the patient to realize is that chronic limb ischemia causes the foot and leg to get swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem

If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor OR schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you may need immediate help. This truly is a sign that your foot is starving for oxygen and blood and that if left untreated, might lead to an unnecessary amputation. Help is possible, however and if treated early enough, those suffering from these symptoms can be helped significantly.

If you suffer from painful feet in the middle of the night, WE CAN HELP

contact us today  at 408-376-3626 to learn more about PAD and how Dr. Kokinos can help, click here.

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

 

 

THE “RIGHT” EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH

Posted on by Michael Kokinos

The “RIGHT” Experience Counts When It Comes to Your Health! South Bay Vascular Center and Vein Institute is the Bay Area’s Most Trusted Varicose Vein Clinic and Treatment Center.

Having performed over 20,000 vein procedures in the past 24 years, more independent doctors refer their vein patients to Dr. Polyxene (Polly) Kokinos than to any other vascular surgeon in the greater Silicon Valley region. Recognized as San Jose’s most experienced Vascular Surgeon and Varicose Vein Expert, Dr Kokinos offers cutting edge care to patients suffering from all forms of both arterial and venous disease.

Here’s why more local doctors refer to South Bay Vascular than to any other Vascular Surgery Center in the Valley:

  • The “RIGHT” Experience Counts When it Comes to your Health: South Bay Vascular center has been treating vein patients in a private practice setting for over 24 years.
  • Cutting edge vascular care in a fully accredited, state of the art, and private out-patient surgery center dedicated entirely to the practice of vascular surgery.
  • Access to the most Advanced Imaging and Device technologies found anywhere in the world.
  • On-site fully staffed IAC accredited Vascular Ultrasound Clinic that is operated full time by Registered Vascular Technologists (RVT).
  • Vascular Studies ready by RPVI certified Vascular Surgeons.
  • Same day availability for Hemodialysis Access de-clots.
  • “One-Doctor, One Patient, One Nurse” practice philosophy means we put the patients first.
  • Full time access to practice physicians
  • Easy access to care: No admissions departments.
  • RESULTS:   We are MORE than just a colorful website and a Google Adwords campaign. Remember, all that glitters is NOT Gold!  https://www.southbayvascular.com/blog/varicose-vein-doctors/

 Trust the doctor your physician does.

 Remember, Its Not Just Experience That Counts.

When It Comes to Your Health, It’s The “RIGHT” Experience that Matters!

Dr Polyxene Kokinos, Silicon Valley’s Vascular Surgeon.

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

Click here to learn more about Dr Kokinos  NOT JUST VASCULAR CARE, EXCEPTIONAL VASCULAR CARE

LEG SWELLING: BEFORE AND AFTER PHOTOS FOLLOWING THE PLACEMENT OF AN ILIAC VEIN STENT

Posted on by Angelica Rodezno

Photos of patient who had suffered with right leg swelling for three months before coming to see us. The patient was found to have a problem with their right iliac vein (in the pelvis) that we easily treated with a 45 minute outpatient procedure placing a stent in the vein through a small puncture in their groin. Five days later, his swelling was almost completely gone.

If you have had painful or annoying one-sided leg swelling we may be able to help. Call us today for a consultation at 408-376-3626. South Bay Vascular Center and Vein Institute is the regional leader in treating leg swelling due to iliac vein compression.

LEG SWELLING CAN BE MORE THAN JUST VARICOSE VEINS

Posted on by Angelica Rodezno

Time and again, patients come to our office following a vein procedure by local Vein “Experts”, Vein “Specialists” and Phelebologists complaining that their legs continue to hurt and to swell even after their varicose vein procedures. Disappointed and scared, many of these patients have spent thousands of dollars, have undergone multiple procedures and have endured months of pain, only to find that they have been treated for the wrong condition and have been told that there is nothing else that their doctor can do to help them. Not knowing where else to turn, patients walk into our office knowing that something is just not right and hoping that we we can help.

The question is, why is this happening?

For the past 23 years the physicians and surgeons at South Bay Vascular Center and Vein Institute have dedicated their entire practice to treating patients with the full range of venous issues–from cosmetic spider veins to non-healing venous ulcers. Since 2005 alone, we have performed over 10,000 endovenous closure procedures in our office, and have done thousands more phlebectomies and sclerotherapy sessions in an effort to help our patients return to a normal life. At South Bay Vascular, we are not just a varicose vein treatment center or vein clinic; we are a group of board certified vascular surgeons, clinically trained to treat patients with problems in any part of their circulatory system. Treating varicose veins is not something we have learned at a weekend course or seminar as a way to augment our primary practice…veins are our primary practice and that is what we have been clinically trained to do.

Unfortunately, this isn’t always the case. And that is why so many patients come to our office looking for help.

Many of our patients, having been previously treated for varicose veins by cardiologists, internists, dermatologists and phlebologists positioning themselves as Vein “Specialists” and Vein “Experts”, but have conditions far more complicated than “leaky valves” that show up as varicose veins. In most of the complications we see, patients have been treated by doctors thinking the problem could be easily fixed using a VNUS, EVLT or Sclerotherapy procedure. Unfortunately for the patient many times this simple procedure does not work because their underlying medical condition is a much more complex and difficult problem to treat. When a patients problems persists, these same doctors end up referring these patients to an emergency room or to a vascular surgeon hoping their complications can be undone. Worse yet, sometimes these same doctors simply tell their patients that there is nothing else that can be done for them.

In our years of treating patients with venous disease we have achieved a technical success rate using our endovenous VNUS and laser procedures of nearly 100%. But NEARLY 100% is a far cry from 100%. Some patients don’t feel better. Some patients, continue to have legs that ache, legs that remain swollen, and wounds that do not heal. Some of our patients were just not getting better.

Up until about two years ago, all we could do for those patients whose legs did not heal was to repeat the ultrasound and hope to find some other vein issue that we could treat. Sometimes this worked; but many times it didn’t. In the instances when we did find a secondary vein or discovered that a vein treated earlier just did not close entirely, we would proceed to treat this vein a second time; but even then, many of our patients simply did not get better. Our question continued to be Why?

After 20 years and tens of thousands of patients, we discovered that in certain patients, there was in fact, another mechanism in the venous system that was keeping our patients from getting better. It was called May-Thurners Syndrome.

What we have discovered is that in many of the cases where our patients did not heal, the problem wasn’t with the the Greater Saphenous Vein (the main vein treated in the vast majority of varicose vein procedures) but with the iliac veins; the vein between the belly button and the groin. What we discovered was that problems in the iliac vein could cause many of the same types of symptoms and problems that we saw when there were leaky valves in the leg veins. What we learned was that the problems with the iliac vein were usually the result of a compression or a scarring. What we discovered was that iliac vein compression (first identified in the early 50’s by Dr’s May and Thurner) happened because of the way the iliac vein is anatomically positioned between a beating artery and a hard pelvic bone and that often times this presented as varicose veins and swollen left legs.

Iliac Vein Compressions not only causes elevated pressure in the left leg resulting in aching, swelling, and non-healing wounds, but predisposes the left side to a much higher risk of blood clots after orthopedic surgery, long flights or drives, cancer, periods of immobility or bed rest.

Very few doctors, it turns out, are able to treat iliac vein compression, because one has to be a vascular surgeon and or an interventional radiologist to do so. Many of the so-called phlebologists, and “vein doctors”, who decided to abandon their field of training to treat varicose veins and other cosmetic issues, are not people who were trained in their residencies or fellowships to perform this type of procedure. Nor were they trained in ultrasound or in understanding the flow dynamics of the vascular system. Because of this lack of clinic training, they are unable to treat iliac vein compression, and so they ignore it, keeping many patients from options that could help improve their daily lives, relieve their leg swelling, and heal their leg wounds.

At South Bay Vascular, we have trained and have performed thousands of venus procedures and have treated hundreds of cases of iliac vein compression. We are experts in all aspects of vascular surgery, including conditions like iliac vein compression. Unlike phlebologists, we can offer all approved treatment options to patients for the treatment of their leg aching, swelling, and discoloration. Most importantly, it is our state of the art accredited vascular lab and registered ultrasound technologists who make so much of what we do at south bay vascular possible. Our advanced vein mapping and screening protocols, together with our national accreditation gives us the ability to do cutting edge surgical procedures; this is what sets us apart from nearly every other vein clinic and treatment center in the whole of Northern California.

Because of the advances in medical imaging and device technology, a large number of our procedures can be done on an outpatient basis in our office. Dr. Kokinos is a recognized leader in the area of deep venous disease and has treated more patients in northern California using Intravascular Ultrasound than any other physician in the region. As a result of her cutting edge treatment protocols and surgical techniques, Dr. Kokinos has been recognized as an international expert and has been an invited speaker at national vascular and interventional meetings in San Francisco, Miami, and Colorado over the last 6 months to discuss her findings and her treatment for patients presenting with these types of problems. Most recently she has been asked to speak at the main venous meeting in the United States, the American Venous Forum, where she will be presenting her clinical research on the use of non-invasive and minimally invasive techniques to diagnose and treat iliac vein compression.

Currently, Dr. Kokinos serves as the Medical Director of the Wound Care Centers at O’Connor and St. Louise Hospitals, and is the Chairperson of the Cardiovascular department at San Jose’s Good Samaritan Hospital. She and her partner, Dr. Carlos E. Pineda, are dedicated to offering patients suffering from both arterial and venous wounds the most cutting-edge and effective treatments available to save their legs, stop their pain, and improve their lives.

If you or anyone you know suffers from varicose veins, diabetic infections, non-healing leg wounds and or are facing an amputation, please call our office to understand your options.

We offer hope when others say there is none.

408-376-3626

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.

FREE ILIAC VEIN SCREENING

Posted on by Angelica Rodezno

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 LEGS? YOU MAY HAVE ILIAC VEIN COMPRESSION

Posted on by Angelica Rodezno

Do you Suffer From Iliac Vein Compression?

To answer that question, take a few seconds to consider the following:

▪ Are your legs swollen? Is your left leg larger than your right?
▪ Is it harder to slip one shoe on in the morning than the other?
▪ Have you had any kind of cosmetic or other surgical procedure done on your leg and not gotten the outcome you wanted?
▪ Are you a cancer patient undergoing treatment or procedures?
▪ Have you ever suffered from a blood clot or (DVT) in your leg
▪ Do you visit a wound care clinic with little to no success?

If you’ve answered yes to any of these questions, you MAY be suffering from a known, but previously difficult to diagnose problem called May-Thurner’s Syndrome.

May Thurner’s Syndrome, also known as iliac Vein Compression, is a condition where the main artery supplying blood to the leg pushes down or compresses the main vein taking blood back to your heart. Previously undiagnosed, major advances in medical imaging technology have given vascular surgeons the tools needed to demonstrate that May Thurner’s syndrome is directly responsible for the slowing of blood going back to ones heart resulting in the swelling and or edema of the leg. These same studies have shown that in a full 30% of all people, the left iliac vein can be significantly compressed by the right iliac artery resulting in some kind of leg symptom….aching, heaviness, and most commonly, swelling or non-healing of wounds in the leg veins.

The Physicians and Surgeons at South Bay Vascular Center and Vein Institute are now able to diagnose and successfully treat iliac vein compression using state of the art ultrasonic imaging technology. If a patient is found to have iliac vein compression, and is symptomatic for this condition, we then recommend IVUS–intravascular ultrasound and iliac vein stenting. All of these procedures can be performed in our state-of-art angiography suite right at our office meaning that you can avoid going to the hospital to get this done. To date, Dr. Kokinos has successfully performed over 100 of these iliac vein stent procedures in her out-patient angiography suite and will be the featured speaker at a national convention in April 2016 to share her success stories helping patients reduce leg swelling and to increase the rate of wound healing.

During the months of April and May, Dr. Kokinos is offering a FREE, limited number of iliac vein screenings to patients with a history of venous reflux or DVT (blood clots) to screen for this possible compression problem. If you are currently experiencing a swollen leg, have a non healing leg, foot,or ankle wounds or have ever suffered a blood clot (DVT) please contact our office at 408-376-3626 to schedule an appointment.

Don’t suffer from swollen legs or non-healing leg ulcers any longer. We can help!
408-376-3626

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