Tag: Varicose Veins

BLOOD THINNING MEDICATIONS PART 2: ANTIPLATELETS: PLAVIX AND ASPIRIN. WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Last week I began a description of the medications that vascular surgeons use with a blog post on drugs used for anticoagulation.  This week, I want to describe a group of medications that also thin the blood, albeit through a different mechanism.  As discussed last week, the coagulation cascade works to turn the blood from a liquid to a solid.  A special group of cells in the blood mixed with red blood cells called platelets works simultaneously with the coagulation cascade to serve as the glue so to speak between clumps of red blood cells.  This bond that platelets facilitate with clotted blood helps clot to attach and build upon other collections of clot, thereby facilitating the control of bleeding that the clotting system was designed for.

Obviously, in the case of vascular surgery we often times want to prevent blood clotting from occurring.  The main agents we use are aspirin and plavix (clopidogrel).  In the early 2000s literature from interventional cardiology for minimally invasive heart procedures found that placing patients on aspirin and plavix together reduced the incidence of recurrent heart attacks as well as death.  This literature from cardiology has been extrapolated to the lower extremity circulation and allows the interventions we perform in the lower extremities to fix blood flow to stay open for a long period of time.  In addition to the use of aspirin and plavix for lower extremity arterial blockages, we also use it in patients who have had a stroke in order to help prevent them from having another stroke.

Aspirin is a low strength blood thinner that patients can take orally as an 81 mg tablet once a day.  In the body aspirin blocks a specific enzyme called cyclooxygenase.  When cyclooxygenase is inhibited, the enzyme cannot help to produce chemicals in the blood called prostaglandins.  Prostaglandins are normally responsible for creating an environment that stimulates the clotting of blood via complex but mild mechanisms.  Studies have shown generally that patients with cardiovascular disease have a lower incidence of death, stroke, and heart attack over time than patients who do not take aspirin.  In general, I tend to make sure that all my patients who have peripheral vascular disease take aspirin as a general preventative measure.

Plavix is a much higher strength blood thinner that binds directly to platelets and completely inhibits their function.  When used in concert with aspirin, the blood becomes thin enough to prevent the recurrent blockage of vessels that we have opened up.

Overall the large majority of my patients who receive procedures to fix blood flow to the foot are placed on aspirin and plavix.  If you think you might benefit from these medications or are in need of a procedure to fix the blood flow to your feet or brain, please do not hesitate to call my office to schedule an appointment!

 

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.

CLICK ON THE LINK BELOW TO READ HOW OUR PATIENTS DESCRIBE THEIR EXPERIENCE AT SOUTH BAY VASCULAR.

https://www.google.com/search?q=south+bay+vascular+center&rlz=1C1GGRV_enUS748US759&oq=&aqs=chrome.0.69i59i450.91302019j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

 

PART 2: WHY DO MY TOES, ANKLES, AND FEET HURT AT NIGHT? RAYNAUD’S SYNDROME

Posted on by Michael Kokinos

Last week I wrote the first part of a four-part series about foot pain at night.  Specifically, I talked about venous disease as a cause of foot pain.

Today, I want to talk about another common cause of foot pain at night: Raynaud’s Syndrome. 

As a quick review, last week we talked about the two main types of blood vessels in our bodies: arteries and veins.  Arteries bring blood from the heart to the feet under high pressure.  Veins bring blood back from the foot to the heart under low pressure.

Raynaud’s Syndrome is a disease of the arteries, particularly the small arteries, in the feet.

(Though Raynaud’s can also affect the hands as well). 

Before we dive into Raynaud’s Syndrome though, I need to briefly review another anatomical system in our bodies that is involved in Raynaud’s Syndrome: The nervous system.

In general, we have two broad types of nerves.

  1. There are nerves that are responsible for sensation and for moving muscle and
  2. There are nerves that are responsible for regulation of bodily function.

Diving a little bit deeper into the kinds of nerves that regulate bodily function, there are the

  • Sympathetic nervous system: The sympathetic nervous system, amongst other things, is responsible for opening blood vessels in the legs and arms and increasing blood flow when exercise is necessary
  • Parasympathetic nervous system: The parasympathetic nervous system in similar fashion opens the blood vessels leading to the intestines to allow for the digestion of food.

In patients with Raynaud’s Syndrome, sometimes their sympathetic nervous system does not function properly resulting in the constriction of blood vessels that lead to the hands, fingers, feet, and toes.  When it happens, blood vessels in the fingers and toes typically first turn blue because of the lack of oxygen; then white because of the lack of blood flow; and finally red, once the constriction ends and the blood flow returns to the fingers and toes.  During this constriction of the blood vessels, patients can have significant pain, numbness, tingling, and, in very severe cases, ulcers (defects in the skin with exposure of underlying fat and muscle) and gangrene (black and dead tissue).

Interestingly, environmental and social triggers play a significant role in Raynaud’s Syndrome episodes of vessel constriction.  Factors including stress, caffeine, alcohol or other drugs, and cold temperature can all induce a painful episode with lack of blood flow to the hands and feet.

Not much is known about the cause of Raynaud’s Syndrome or specifically why it happens.  Sometimes, Raynaud’s Syndrome can occur on its own without any other related disease.  In other cases, the patient has another inflammatory disorder like lupus or Sjogren’s Syndrome that is known to be highly associated with Raynaud’s Syndrome.

Though we do not fully understand the causes of Raynaud’s Syndrome there are many treatment strategies that can help.  Starting with behavioral modifications and certain blood pressure medications that can reduce spasm to specific procedures aimed to reduce the spasm of the vessels induced by the sympathetic nervous system, there is so much that I as a vascular surgeon can do to help patients with Raynaud’s Syndrome.  If you think that you might suffer from Raynaud’s Syndrome, please do not hesitate to call our office on 408-376-3626 to schedule an appointment. 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.

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

GILROY, CA. VASCULAR SURGERY CARE

Posted on by Angelica Rodezno

South Bay Vascular Center and Vein Institute is a full service vascular surgery clinic and accredited vascular ultrasound testing lab located at 8420 Church in Gilroy, CA. Dr. Polly Kokinos offers cutting edge care to patients suffering from vascular and arterial conditions and continue their 20 year commitment of caring for patients in the South Bay.

Patients suffering from swollen, aching legs; painful, non-healing leg wounds; blood clots (DVT); dialysis access problems; clotted grafts; varicose veins and peripheral arterial disease (PAD) no longer need to travel to the greater San Jose area as local care continues to expand into the South Bay. World class surgeons, bringing state of the art technology offer a whole new level of Vascular care to the greater Gilroy, Hollister, Salinas and Hwy 152 corridor to the Central Valley Community.

Recognized as one of the most experienced and respected vascular surgeons in Northern California, the practice of Dr. Kokinos is focused on restoring the circulatory health of their patients thereby helping them return to a normal way of life. Together, our surgeons have performed more complex vascular procedures than any other Vascular Surgeons in Northern California. Recognized as San Jose’s and Silicon Valley’s most respected varicose vein experts Dr. Kokinos has performed over 20,000 vein procedures over the past 25 years and are not only the most highly trained vein specialists in San Jose, they are also the most experienced varicose vein experts in all of San Jose, Silicon Valley and the entire San Francisco Bay Area.

Call today to schedule an appointment at 408-376-3626.

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

VEINS, VEINS, VEINS…VARICOSE VEIN TREATMENT IN SAN JOSE

Posted on by admin

South Bay Vascular Center and Vein Institute is Northern California’s #1 varicose vein treatment center and vein repair clinic. Our ABMS board certified vascular surgeons have performed more successful varicose vein procedures than any other physicians in the region and are the best trained vein specialists in the area. Every vascular surgeon at South Bay Vascular Center and Vein Institute has completed a board eligible fellowship training program in both general as well as vascular surgery and has been trained to both identify and to treat any level of venous disease.

Unlike interventional radiologists, interventional cardiologists, phlebologist’s and dermatologists who perform varicose vein procedures to supplement the income from their primary speciality, VASCULAR SURGEONS have spent their entire careers treating diseases of the circulatory system. They spend all their time diagnosing and treating any venous and/or arterial abnormalities. More importantly, when the problem is more than a simple cosmetic issue (most commonly experienced as leg swelling or aching) the vascular surgeons of South Bay Vascular Center are the ones to take care of it. They have the most advanced ultrasound testing facility, angiography suite and screening protocols in the entire region to help diagnose deeper systemic circulatory diseases such as DVT’s (blood clots) and iliac vein compression.

Many of the patients who visit our clinic find us after their vein treatments at other “Vein Speciality” clinics fail to help them achieve their desired outcomes. Unfortunately, many of these same patients tell us they were led to believe that varicose vein surgery is a relatively easy procedure and can be performed by any level of licensed physician after a basic course in cosmetic vein treatment modalities.

Having served the South Bay for over 20 years, Dr. Kokinos and the staff of South Bay Vascular Center and Vein Institute have performed over 20,000 successful Varicose vein procedures. In addition to her clinical practice, Dr. Kokinos is recognized nationally as an expert in the treatment of varicose veins, peripheral arterial disease, chronic limb ischemia and iliac vein compression. Together with her partner, Dr. Carlos E Pineda, Dr. Kokinos is proud to bring this level of care and experience to every one of her patients and is honored to be entrusted with the care and treatment of them.

Understand your treatment options. Ask your “Vein Specialist” about what happens if you have a complication with your procedure. 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. Most importantly, check the primary board speciality of your varicose vein “specialist”. If it isn’t vascular surgery, there is someone more qualified and better trained to perform the procedure.

Remember, these are your legs. You deserve the best..and you deserve to “Love Your Legs Again”.

CALL US AT SOUTH BAY VASCULAR CENTER AND VEIN INSTITUTE.

408-376-3626

DR. KOKINOS CHOSEN TO PRESENT AT 2017 OEIS MEETING

Posted on by Angelica Rodezno

Dr. Kokinos was selected as a speaker at this years OEIS (Outpatient Endovascular and Interventional Society)meeting that will be held March 31- April 2 in San Diego California. Dr Kokinos will be presenting her expertise in the establishment and operation of cutting edge outpatient treatment facilities.

Congratulations Dr. Kokinos on this honor.

Dr. Polyxene Kokinos and her partner, Dr. Carlos E Pineda of South Bay Vascular Center and Vein Institute, operate San Jose’s leading center for the treatment of Varicose Veins. As a Board Certified Vascular and General Surgeon, Dr. Kokinos is recognized by her peers as the one of the countries leading experts on the treatment of deep venous disease and is frequently sought out as a speaker. South Bay Vascular specializes in treating peripheral arterial disease (PAD) and is the regional center of excellence for amputation prevention.

If you or anyone you know suffers from unsightly and painful varicose veins, peripheral arterial disease, non-healing wounds or is facing a diabetic amputation, please call our office at 408-376-3626 to schedule a consultation. WE CAN HELP!

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

PREVENTING DIABETIC AMPUTATIONS IN SAN JOSE

Posted on by Angelica Rodezno

Every year over 160,000 amputations are performed in America. 60%-80% of Medicare patients who undergo amputation never walk again. Worse yet, there is a 30-50%, 2-year mortality rate following an amputation…meaning that between 30% and 50% of all patients undergoing an amputation die within 2 years of their procedure.

Recent advancements in both imaging and medical device technology have significantly improved a patients chances for a different outcome: avoiding amputation. Educating patients about these new procedures, however, is still very difficult because many of these new advances are known only to the surgeons and universities pioneering them. In fact, recent studies show that more than 54% of patients were not even assessed using diagnostic angiograms to determine if blood flow could be restored to their affected limbs prior to the amputation. Earlier this year, Medicare published figures showing that a full 67% of medicare patients who underwent a major amputation never even had a re-vascularization procedure in an attempt to save their limb.

Dr.’s Kokinos and Pineda are recognized as specialists in the field of lower limb re-vascularization and limb salvage. Having performed more pedal access re-vascularization cases (approaching the affected limb via the foot instead of the groin) than any other physicians in the region provides these South Bay Vascular surgeons with the experience and judgement to help patients avoid diabetic amputations and to treat patients with advanced cases of peripheral arterial disease (PAD) or what is otherwise known as Chronic Limb Ischemia (CLI).

If you or someone you know is facing the possibility of lower limb amputation, STOP! CALL US FOR A SECOND OPINION. South Bay Vascular is Taking a Stand Against Amputation and you should too. Call us at 408-376-3626 to schedule a thorough evaluation of your options. We are specialists in the area of lower limb re-vascularization and we provide hope when others say there is none.