ACHING TIRED OR HEAVY LEGS?
Tag: Varicose Veins
SOUTH BAY VASCULAR ANNOUNCES THE OPENING OF THE SOUTH BAYS ONLY DIALYSIS ACCESS CENTER WITH FULL TIME VASCULAR SURGERY COVERAGE
South Bay Vascular Center and Vein institute is pleased to announce the opening of the South Bay’s only Dialysis Access Center with full time Vascular Surgery Coverage.
The new dialysis access center is the only full service access center of its kind in the South Bay. By offering full time vascular Surgery coverage the new center provides an unmatched level of care not found anywhere else in the South Bay. Dialysis access complications are treated quickly and effectively enabling dialysis patients to return to their dialysis sessions with minimal disturbance to their lives. Complications encountered in dialysis can be completely treated by qualified surgeons without the need for secondary referrals and or delays in the treatment of clotted or failed grafts.
The new center has an on-site accredited full service vascular lab to assist patients in the rapid and accurate diagnosis and treatment of any complications associated with dialysis access.
We can be reached toll free at 1-855-WE-D-CLOT
SOUTH BAY VASCULAR PLEASED TO ANNOUNCE THE OPENING OF A NEW DIALYSIS ACCESS CENTER IN THE SOUTH BAY
South Bay Vascular Center and Vein Institute is pleased to announce the recent affiliation of Local Vascular Surgeons Dr. Polyxene Kokinos MD and Carlos E. Pineda MD with long time community Interventional Radiologists Dr. Anup Singh and Dr. Raj Tandon in the opening of a full time dialysis access center.
Dr.’s Kokinos, Pineda, Singh and Tandon will provide full time coverage in their Campbell, CA Angiography Suite and provide immediate one-call service to local dialysis centers when surgical intervention is needed to enable ongoing dialysis for their patients.
By dialing 1-855-WE-D-CLOT (1-855-933-2568) Local Dialysis centers will now have an immediate option for treating any complications associated with a patient dialysis session, enabling a quick return for patients to continue their treatments.
The new dialysis access center is the only full service dialysis access center in the South Bay with full time vascular surgery coverage.
Full time coverage and Immediate access to care by board certified vascular surgeons and interventional radiologists
Ease of use: One-call service vs being sent to a hospital emergency room
Trusted local physicians providing compassionate care in a personalized setting,
Experienced care in a state of the art facility conveniently located in Campbell, CA.
Dedicated physicians, committed to South Bay patients for over 60 years of combined service
One site accredited full service Vascular Lab
Our specialities include
Thrombosed or failing AV fistulas and grafts
Placement of temporary dialysis catheters
Surgery to place fistulas and grafts
1-855-WE-D-CLOT
TEN MISCONCEPTIONS ABOUT VARICOSE VEINS
Last weekend, during my daughter’s water polo game, I noticed the coach for the opposing team was limping and had a very swollen left leg. With a closer look I realized he had the hyperpigmentation (skin darkening) of chronic venous disease and ugly bulging varicose veins easily the size of my thumb all over the inside of his calves. I decided to go ask him about them, as they looked awful, the man was clearly in pain, and I was concerned. After a brief conversation with the coach, where he told me various “old wives’ tales” it dawned on me that he probably wasn’t alone thinking the way he did so I thought I should post this blog in an attempt to clear up these ten common misconceptions about varicose veins. Here goes:
“Varicose veins are simply a cosmetic problem”
About half of the patients we see in our practice for varicose veins complain about the pain they experience because of their veins. Because these patients are experiencing pain and suffering, many times varicose veins are categorized as a Medical condition and not just a cosmetic issue. This is especially true if they are accompanied by leg aching, throbbing, swelling, or discoloration. Venous disease affects about 40 million people in the United States and about 1 million end up with ulcers that are painful and difficult to heal. As a medical condition, depending on the severity of a patients condition, insurance often covers for the procedure to be done. That way, patients are not forced to pay out of pocket to rid themselves of their painful and ugly veins.
“Varicose veins can cause strokes, heart attacks, or gangrene”
Although varicose veins are a circulatory problem, the blood vessels causing strokes, heart attacks, and gangrene are arteries not veins. The patient profile of patients suffering from vein issues (women, multiple pregnancies, family history, standing occupation) is very different from those that get arterial problems (smokers, diabetics, patients with high blood pressure or cholesterol). Because of this, patients suffering from varicose veins should consult with their physicians to determine if this problem is accompanied by any underlying,and potentially more serious, circulatory issues
“Only women get varicose veins”
Although venous disease is more common in women, about 40% of our patients are men. Unfortunately, men tend to present with more advanced disease or longer standing symptoms.
“I have had my veins just like this for twenty years”
Venous disease does progress if not treated and currently there are several outpatient office procedures that can be done with excellent results and low risks
“It is not worth treating varicose veins because they just come back”
The treatment of venous insufficiency is one of the more successful treatments in medicine, as long as the underlying cause is treated- ie. the underlying veins that have the leaky valves. In the old days, patients were treated simply with removal of the bulgy veins. Because the underlying saphenous veins that had leaky valves were not treated, the bulgy veins come back. Now that we do ultrasound to “map out” the diseased veins, the recurrence rate should only be about 10% at 10 years.
“Insurance will not cover any varicose vein treatment”
Although insurance companies have absolutely made the criteria for coverage for venous disease much more difficult over the last ten years, most patients who do have leaky valves in their underlying valves are covered. Sclerotherapy for spider veins and the simple removal of bulgy veins for appearance are almost never covered today.
“Varicose veins are “surplus parts” that I might need someday”
They are abnormal blood vessels that develop usually because there is an underlying medical problem- vein valve failure or “leakiness”. The underlying greater saphenous vein, that usually is the one that has the leaky valves, is sometimes used in open-heart surgery or arterial vascular bypass surgery. However, today, it is not commonly used as those operations have been replaced to a large extent by less invasive procedures using balloons and stents.
“ Varicose veins are just part of getting old as is my leg pain”
Although it is true that there is an increase in the incidence of varicose veins as one gets older (one study found that 75% of women over the age of 65 had venous issues), it is NOT a normal part of aging to feel heaviness, aching, or throbbing in the legs. It is important to go have those symptoms evaluated by a vascular surgeon as often it can be easily treated.
“Treatment of my varicose veins will lay me up for weeks”
Until about 15 years ago, the main treatment for varicose veins was a difficult procedure called vein stripping. This was generally done under general anesthesia, in a hospital where one was admitted, with two moderate sized incisions in the groin and at the ankle. It generally took patients several weeks to recover. The field was revolutionized by the introduction of endovenous ablation, which currently is an office procedure, done under local anesthesia where the patient usually has NO post-operative pain. Most patients return to all of their normal activities with 24-48 hours.
“You have to have bulging veins to have a vein problem”
Many patients who present with heavy, aching or swollen legs actually do not have bulging varicose veins but are found to have a problem on evaluation. In order to diagnose venous disease, it is important to have a VENOUS REFLUX ULTRASOUND. This is not the same as a vein ultrasound to look for blood clots that primary care doctors often order at hospitals. It is critical to have this test done at an ICAVL accredited laboratory as it is extremely technologist dependent. A good exam will take about 30 minutes per leg and will examine veins with the patient in a standing or head slanted up position from the groin to the ankle.
WHAT ARE VARICOSE VEINS?
Varicose veins are raised, ropey, enlarged veins. They usually appear on the legs and can cause the leg to swell, itch, ache, and in severe cases, can cause ulcers. Normal vein valves close after blood travels up the vein, preventing blood from moving backwards (refluxing) down the vein. Varicose veins form when valves in the vein fail (become incompetent). Valves become incompetent for a variety of reasons, including trauma and pregnancy. Once a valve becomes incompetent, the vein below the valve is exposed to higher pressure and becomes dilated. This causes other valves to fail and other veins to dilate.
WHAT ARE THE SYMPTOMS OF VARICOSE VEINS?
Varicose veins are dark blue in color and commonly appear on the backs of the calves or on the inside of the legs. But they can form anywhere on your legs, from your groin to your ankle. They protrude or bulge from under the skin and feel ropey. Varicose veins cause an achy or heavy feeling in the legs, and burning, itching, throbbing, muscle cramping and swelling in your legs. Prolonged sitting or standing makes your legs feel worse, while elevating your legs makes them feel better. Varicose veins can also cause skin ulcers near your ankle.
HOW ARE VARICOSE VEINS TREATED?
Both invasive and non-invasive methods are available to treat varicose veins. Non-invasive methods include wearing compression stockings, exercising, leg elevation, losing weight, not wearing tight clothes, avoiding long periods of standing or sitting and not crossing your legs while seated. Invasive treatments include endovenous therapy, ligation, and phlebectomy. Endovenous therapy is treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls and cause the vein to close and then be reabsorbed by the body. Ligation is tying off a vein to cause it to shrink. Phlebectomy is the term used for the removal of varicose veins.
WHAT IS ENDOVENOUS LASER THERAPY?
Endovenous Laser Ablation (EVLT), a treatment for varicose veins, is an advanced, highly effective treatment for varicose veins. EVLT works by using targeted laser energy to close off problem veins, thus relieving the symptoms and appearance of varicose veins and restoring healthy, attractive legs. This treatment is ideal for large varicose veins, including the greater saphenous veins.
The EVLT™ Procedure is minimally-invasive and virtually pain-free. While surgical vein treatment methods can cause scarring and other side effects, the laser energy used in EVLT minimizes risks and complications. Laser energy is delivered directly to the target vein to shrink the walls, which eventually causes the vein to close. Blood flow is diverted to other, healthy veins, eliminating the varicose vein bulging, discoloration, and pain.
EVLT is performed as an outpatient procedure, usually in less than an hour, with only local anesthesia. This means that recovery time is dramatically reduced. Most patients can resume normal activities immediately following treatment, while enjoying superior clinical and aesthetic results.
WHAT IS RADIOFREQUENCY ABLATION OF VARICOSE VEINS?
Radiofrequency ablation – the Closure Procedure – is similar to endovenous laser therapy. A radiofrequency probe is placed in the vein under ultrasound guidance. Then the vein is anesthetized using local anesthesia. Next, the vein is heated along its entire length by slowly withdrawing the probe from the vein. This causes the vein to clot and close, stopping the reflux (Leaking valves). Radiofrequency ablation is an outpatient procedure, can be performed under local anesthesia, and takes about 45 minutes. Possible complications are continued leg swelling, numbness, tingling, and blood clots in the legs. Patients may have bruising and mild pain for up to 4 weeks.
To date, Dr. Kokinos has successfully performed over 10,000 cosmetic vein procedures and is regarded as one of the premier Vascular Surgeons in the area to provide this service. If you suffer from painful varicose or unsightly legs, please call our office today to discuss your treatment options.
If you have already undergone a cosmetic vascular procedure and continue to experience pain and leg swelling, Dr. Kokinos is one of the few physicians in the area offering an FDA approved treatment to address this complication. We are happy to meet to evaluate your leg swelling, especially if it is left leg swelling and to discuss available treatment options for this unfortunate complication of cosmetic vein procedures.
VASCULAR ULTRASOUND LAB ACCREDITATION: WHY IT’S IMPORTANT
Taken from the IAC Vascular Testing Accreditaton Website
IAC accreditation demonstrates a commitment to quality care.
The purpose of the IAC Vascular Testing accreditation program is “to ensure high quality patient care and to promote health care by providing a mechanism to encourage and recognize the provision of quality vascular diagnostic evaluations by a process of accreditation.” Through the accreditation process, facilities assess every aspect of daily operation and its impact on the quality of health care provided to patients. While completing the accreditation application, facilities often identify and correct potential problems, revise protocols and validate quality improvement programs. Because accreditation is renewed every three years, a long-term commitment to quality and self-assessment is developed and maintained. Facilities may use IAC accreditation as the foundation to create and achieve realistic quality care goals.
IAC accreditation provides a confidential peer-review.
Designed to serve facilities as an educational tool, IAC accreditation is made up of two crucial steps. First, facilities conduct a detailed self-evaluation using the IAC Standards and Guidelines for Vascular Testing Accreditation and the Online Accreditation application. Completion of the application requires detailed information on all aspects of facility operation as well as the submission of actual case studies for review. The case studies are crucial in determining the facility’s compliance with the IAC Standards, and are the basis for judgment of the quality of work that facilities perform. Once the self-evaluation is completed, the documents and case studies are reviewed by the IAC Vascular Testing Board of Directors. All aspects of the review are confidential.
IAC accreditation is a recruiting tool.
Accredited facilities can use their accreditation as a recruiting tool to attract the best and brightest physicians, sonographers and technologists. Talented professionals look for high-quality programs, and accreditation assures potential employees that a facility is dedicated to achieving the highest standards for patient care.
IAC accreditation is intersocietal.
The intersocietal, multi-specialty approach is the foundation of the accrediting divisions under the IAC umbrella. IAC Vascular Testing is a nonprofit organization established with the support of the sponsoring organizations. Representatives from these sponsoring organizations, including physicians, sonographers and technologists, serve on the IAC Vascular Testing Board of Directors. All areas of vascular testing were represented on the Board during the creation of the Standards for accreditation, and all areas continue to steer the accreditation process.
IAC accreditation is proven successful.
Offering accreditation for more than 20 years, the IAC Vascular Testing (formerly ICAVL) pioneered the intersocietal approach to imaging accreditation in 1990, as the first of the Intersocietal Accreditation Commission (IAC) divisions to be developed. Today, reimbursement in more than 30 states hinges on either facility accreditation or technologist certification. The number of IAC Vascular Testing accredited facilities in the U.S., Canada and Puerto Rico continues to grow, with more than 2,600 sites currently holding the accreditation. The IAC offers multi-modality accreditation through its programs dedicated to Vascular Testing, Echocardiography, Nuclear/PET, MRI, CT / Dental CT, Carotid Stenting, Vein Center and Cardiac Electrophysiology.
IAC accreditation demonstrates accountability.
Health care organizations are held to very high levels of accountability, by peers and by the general public. In numerous states, reimbursement directives that require accreditation of the facility have been instituted by Medicare carriers as well as private, third-party insurers (please visit Payment Policies section for the current list). Similar draft payment policies are pending throughout the United States. Facilities attaining accreditation before it is required for reimbursement demonstrate a willingness to surpass current expectations. The general public and members of the vascular testing community will recognize an unmatched commitment to providing quality health care by facilities that achieve IAC accreditation.
HOW ARE VARICOSE VEINS TREATED?
Both invasive and non-invasive (i.e surgical and non-surgical) methods are available to treat varicose veins. Non-invasive methods include wearing compression stockings, exercising, leg elevation, losing weight, not wearing tight clothes, avoiding long periods of standing or sitting and not crossing your legs while seated. Invasive treatments include endovenous therapy, ligation, and phlebectomy.
Endovenous therapy is treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls and cause the vein to close and then be reabsorbed by the body. Ligation is tying off a vein to cause it to shrink. Phlebectomy is removal of varicose veins. Only after your physician evaluates a patients vascular ultrasound study are they in a position to discuss the best treatment option for their patients. The vascular surgeons of South Bay Vascular Center and Vein Institute have successfully treated tens of thousands of varicose vein patients in their 20 year history of serving the silicon valley community. With offices in Campbell and Morgan Hill, Dr. Kokinos and her staff are honored to meet with you to discuss any questions you may have regarding varicose veins or any other circulatory related medical condition. Please call our office today to schedule an appointment to help us evaluate your treatment options. 408-376-3626
IS VEIN DISEASE COVERED BY INSURANCE
One of the questions I am most often asked when doing screenings for vein disease is “Is treatment covered by insurance?” As usual, most medical questions are not easily answered and so the answer is yes, and no. All insurance companies consider varicose vein disease treatments medically necessary, and will therefore cover it, if there are complications such as bleeding or ulceration. Most consider treatment medically necessary if there are symptoms and reflux can be demonstrated on a Doppler exam. Of course some of the newer treatments are considered “experimental” and therefore not covered. Spider vein treatments are considered cosmetic and no longer covered by any insurance plans of which we are aware. Lastly, not only does each insurance company have its own requirements but each individual policy can vary within the general guidelines of the company. Sounds confusing and it is. The best way to find out if your particular situation meets the requirements necessary for insurance coverage is to come in for an evaluation. Call us at 408-376-3626 to schedule an appointment to discuss your options.