Tag: Varicose Vein Specialist in San Jose

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.

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

Posted on 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!

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

Posted on 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

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 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

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.

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. POLYXENE KOKINOS; 25 YEARS AND COUNTING AS SAN JOSE’S PREMIERE VARICOSE VEIN EXPERT; VEIN CARE DOCTOR; VEIN SPECIALIST AND VASCULAR SURGEON

Posted on by admin

Dr. Polyxene (Polly) Kokinos is a ABMS Board Certified General And Vascular Surgeon with extensive training in the diagnosis and the treatment of vascular disease. Celebrating 25 years of service in San Jose as an independent community Doctor, Dr. Kokinos has spent her entire career DEDICATED to serving the South Bay Community as a Board Certified General and Vascular surgeon.

Her award winning South Bay Vascular Center and Vein Institute is the South Bay’s largest Vascular Surgery practice specializing in the treatment of vascular disease, including Peripheral Arterial Disease (PAD) Leg Swelling, the Treatment of Blood Clots (DVT’s), Varicose Veins and amputation prevention. Dr. Kokinos and her staff have performed over 20,000 Varicose Vein patients in the past 25 year while serving the South Bay Community and has worked at San Jose Hospital, Good Samaritan Hospital, O’Connor Hospital, Regional Hospital and Saint Louise Hospital. Dedicated to the community, Dr. Kokinos’ South Bay Vascular Center doesn’t just treat the symptoms of a problem: they find the “Why” so you have real solutions to living a healthy life.

If you or anyone you know suffers from any of the conditions listed above, or have had complications with cosmetic vein procedures, Dr. Kokinos is happy to discuss your treatment options. Call today to schedule an appointment at 408-376-3626 or visit us at our website at www.southbayvascular.com

SAN JOSE’S BEST VARICOSE VEIN DOCTOR

Posted on by Angelica Rodezno

San Jose’s most advanced vein treatment center, South Bay Vascular Center and Vein Institute invites you to

Love Your Legs Again

If you suffer from painful and unsightly varicose veins WE CAN HELP! Silicon Valley’s most trusted varicose vein clinic and treatment center.

CALL US AT 408-376-3626 TO LEARN HOW WE CAN HELP YOU GET BACK YOUR LIFE.

Actual patients from our practice.

Before After

Before After

Before After

Before After

SOUTH BAY VASCULAR CENTER: SIMPLY THE BEST VARICOSE VEIN TREATMENT CENTER IN SAN JOSE

Posted on by Angelica Rodezno

Millions of Americans suffer from varicose veins. In adult western populations it is estimated that visible varicose veins are present in 20 to 25% of women and 10 to 15% of men.

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 a treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls causing 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, NOT the closing of a vein. Only after your physician evaluates a patients vascular ultrasound study are they in a position to discuss the best treatment option for their patients.

Recognized by her peers as one of the pre-eminent vascular surgeons in the region, Dr. Kokinos serves as Chair of the Cardiovascular department at Good Samaritan Hospital in San Jose, CA. and was recently appointed as the Medical Director of both the O’Connor and St. Louise wound care centers. Dr. Kokinos has performed over 10,000 vein procedures over the past 20 years and brings this experience to all of her patients.

Lots of centers treat venus reflux or “leaky valves” when they show up as painful and unsightly varicose and spider veins. Fast cosmetic fixes, however, can often mask more serious underlying circulation issues that only a vascular surgeon is trained to address. For this reason, it is vitally important that patients understand their options for treatment as well as the credentials of their treating physician.

NO PATIENT SHOULD UNDERGO A VARICOSE VEIN TREATMENT PROCEDURE WITHOUT FIRST HAVING HAD A DETAILED VASCULAR ULTRASOUND STUDY BY A REGISTERED VASCULAR ULTRASONOGRAPHER FOLLOWED BY A RPVI READ OF THIS STUDY.

At South Bay Vascular Center and Vein Institute we are Board Certified Vascular Surgeons. We are NOT phlebology doctors nor cardiologists who have learned how to treat cosmetic veins or Peripheral Vascular Disease (PAD) at a weekend course or seminar and who treat varicose and spider veins as a means to supplement their primary practice.

Vascular Surgeons have completed an accredited 5-7 general surgery residency program followed by an additional 2 years in an accredited vascular surgery fellowship program specifically focused on the treatment of arterial and venous disease…. and that’s after spending 4 years in medical school and 4 years in college. Treating diseases of the circulatory system IS our primary practice and it is what we have been trained to do.

Unlike many other cosmetic vein centers, every South Bay Vascular surgeon is either ABMS board certified or board eligible. Established as the Gold Standard in medicine, board certification is only awarded to a select few physicians following their completion of a rigorous training in a board eligible fellowship program. Even after completing fellowship training, board certification is not granted until after the physician has passed a series of exhaustive clinical and written examinations and must be renewed every 10 years.

“Phlebologists” on the other hand sometimes refer to themselves as being “Board Certified” in Phlebology. In actual fact there is no such ABMS designation. Instead, board certification in “Phlebology” is granted by an association of Phlebologists and not by the American Board of Medical Specialties. A Phlebology board is received simply by taking a written exam , without having completed a rigorous and specialized clinical fellowship.

Dr.’s Kokinos and Pineda provide an unmatched level of varicose vein care and treatment in the greater San Jose area. Compassionate care in a personalized setting using the most advanced Varicose Vein Treatment options sets them apart as the regions foremost varicose vein care experts. We are proud to bring the highest level of vascular care to our patients and would be honored to work alongside you, our patient, in your ongoing efforts to live a healthy and productive life.

We look forward to meeting you at our office. Call our office today to schedule an appointment at 408-376-3626.

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