Month: April 2016

What is a “Vein Doctor”?

Most people find three broad groupings of physicians who call themselves “Vein Doctors”: Vascular Surgeons, Phlebologists and Vein Specialists…(the third group is typically made up of Cardiologists, Interventional Radiologists and Dermatologist)

Vascular Surgeons:
Vascular surgeons, are a sub-set of medical doctors who have trained for 4 years in medical school, followed by a 5-7 year General Surgery Residency Program followed by another 2 Year Vascular Surgery Fellowship. They are one of only three surgical specialties that include formal training in operative management and the medical care of patients with diseases of the blood vessels. After completing a rigorous course of study at an accredited training program vascular surgery fellows are eligible to sit for series of very difficult, multi-day written and oral examinations during which time they are evaluated by their peers to establish a minimum competency bench marked against a national database of practicing vascular surgeons. Only after successfully passing both parts of these difficult examinations can a board eligible vascular surgeon be granted ABMS Board certification. ABMS Board certifications are valid for 10 years after which Vascular Surgeons must re-test and pass their board examinations or lose their status as being Board Certified

Summary:

• Specifically trained to manage both the operative and medical care of patients with diseases of blood vessels.
• Required to take and to maintain very rigorous examinations to following a lengthy residency program.
• Hold hospital operative privileges
• Can provide complete post operative care, including for any potential complication that may result as a direct result of the procedure performed.

*The American Board of Medical Specialties (ABMS) was first established in 1933 to assist in the development and use of standards in the ongoing evaluation and certification of physicians. ABMS is recognized as the “gold standard” in doctor certification and believes that better trained physicians means better care for patients. There are only 24 ABMS board certified medical specialities. Only ABMS Board Certified physicians can be privileged to work at Joint Commission certified hospitals. (see the ABMS website for additional iniformation at http://www.abms.org/)

Phlebologists:
Phlebology doctors are doctors who take care of vein issues. The American Board of Phlebology was only recently established in 2007 with the goal of setting standards of practice, establish training programs in venous disease, but IS NOT an ABMS accredited speciality. Any physician, however, who has performed a residency in any one of the 24 recognized ABMS specialties can call himself or herself a phlebologist and say they are “board certified” in phlebology if they simply pass a written test and have additional documentation of having had some experience dealing with venous disease. Simply taking a “written test”, however, is very different than having participated in a board eligible residency program where the training prepares physicians to address ANY outcome that may arise from complications during a procedure. It’s very important to keep in mind that Practitioners who call themselves “board certified” phlebologists have not had adequate training in a specialty that is surgical or invasive in nature; they cannot manage independently any problem that may arise during the patient’s care and they are not prepared to diagnose and or to treat any postoperative problem that may result as a direct result of the care by the phlebologist.

“Board certification” in phlebology is VERY DIFFERENT than an ABMS Board Certification and should NEVER be considered an equivalent certification.

Phlebology “Board Certification” DOES NOT require the physician to have hospital admitting privileges in this specialty. In the course of their treatment, if a problem arises, phlebologists must send their patient to the hospital through the emergency room and have an ABMS board certified vascular surgeon treat their patient and deal with the complication. Phlebology is not one of the 24 recognized ABMS medical specialties, but, the term “Board Certification” is used by Phlebologists to evoke a certain level of professional training. Consequently, this concept of board certification can be very confusing to patients.

The harsh reality is that board certification in phlebology should not convey to the public that the physician has had proper training in the care and treatment of vascular disease.

Summary

• Phlebology doctors are NOT specifically trained to manage the operative (invasive) and medical care of patients with diseases of blood vessels. Their specialized vein training is obtained via a series of short “Professional Development” and or weekend courses.
• Phlebology doctors achieve board certification via a written examination, not following an extensive residency training program
• Phlebology doctors can NOT provide complete post operative care, especially for any potential complication that may result as a direct result of the procedure performed.
• Phlebology doctors can not treat vascular disease as a speciality and are limited to the cosmetic treatment of Varicose veins.

Vein Specialist:
Vein specialist is a “catch-all” phrase used by a multiple of medical sub-specialties, primarily Cardiologists, Interventional Radiologists and Dermatologists. Physicians from each of these groups, ARE typically ABMS “board certified” in their respective fields, but also perform cosmetic vein procedures as a means to help supplement their practices. Most often, however, Vein Specialists have developed their Varicose Vein Treatment expertise at courses and it is not their primary specialty. It IS VERY IMPORTANT TO KNOW that these doctors HAVE undergone very specialized, sophisticated and advanced RESIDENCY training in their respective fields of practice. However, they are not trained to do surgery and often learn to do the surgical aspect of venous work at a course. Cardiologists, Interventional Radiologists and Dermatologists have all had extensive procedural and medical training and are all ABMS certified specialities.

Summary

• Vein Specialists are typically ABMS Board Certified Cardiologists,Interventional Radiologists or Dermatologists
• These specialists HAVE achieved Board Certification following an intensive residency training specific to their primary fields of study
• These doctors can become Varicose Vein specialists following supplementary course work, but are NOT specifically trained in the diagnosis and treatment of all aspects of Arterial and Venous disease.

One of the most important tools used in the diagnosis of vascular disease is a comprehensive ultrasound examination. Our full-service, ICAVL accredited vascular ultrasound lab makes us the only “free-standing”* private practice in the South Bay to offer this service on site. Why is this important? The answer to this question is simple. The Institute for Vascular Testing allows us to provide high quality vascular ultrasound studies quickly, accurately and without putting our patients through the hassle of visiting a hospital. Our state of the art imaging equipment in a stand alone facility allows our registered ultrasonography technologists to generate the most advanced studies available. In turn, these studies are read by a RPVI accredited Vascular Surgeon, and not a radiologist…that’s important, because instead of being one of a thousand studies being read by a hospital radiologist, the Vascular Surgeon examines the physics and flow parameters of blood; not just the static image of a physical structure. Vascular Surgeons know exactly what to look for as it relates to circulatory issues so that they can build a treatment plan specific to their patients individual needs.

Accurate vascular ultrasound studies are the primary tool a vascular surgeon uses to help diagnose a problem. Without a good study to construct pictures of a patients blood flow and blood vessels easily diagnosed circulatory problems are often over looked. IVT is honored to receive this national recognition as one of the premiere vascular ultrasound laboratories in the country.

*Free Standing indicates that a lab is managed by Vascular Surgeons and Vascular Medicine specialists and not controlled by managed care and or a large hospital corporation.

Blockage of the deep venous circulation in the abdominal/pelvic area in now recognized as a major cause of Chronic Venous Disease. Chronic Vein Insufficiency (CVI) occurs when the veins cannot pump enough blood back to the heart. In many cases CVI MAY be caused when either the iliac vein in your pelvis becomes compressed by the overlying artery or from a blockage following deep venous thrombosis (DVT). Many patients experience the result of this iliac vein compression as leg swelling, particularly left leg swelling. See below.

Intravascular ultrasound (IVUS) imaging is a minimally invasive diagnostic procedure that can be used to help diagnose Chronic Venous Disease. During this simple procedure where IVUS is used, a specially designed ultrasound catheter is guided by your vascular surgeon so that they can acquire images of compressed or obstructed vessels that allows them to develop a treatment option for re-establishing normal blood flow through these areas.

Dr. Kokinos, a board certified vascular and general surgeon in Silicon Valley, CA., is recognized as an expert in this rapidly expanding area of vascular surgery. She has successfully used IVUS to help diagnose and treat hundreds of patients in her Campbell, CA. outpatient facility. The procedure is done quickly and easily and a growing body of data suggests that stenting, guiding by IVUS as part of the same procedure, may effectively re-open compressed or obstructed veins with SIGNIFICANT improvement in symptoms, including pain, swelling and ulceration.

If you experience leg swelling, especially left leg swelling, call our office today to speak with our physicians to discuss if IVUS is right for you. 408-376-3626 or visit our website at www.southbayvascular.com

Every year thousands of patients in the US undergo cosmetic vein procedures in the hope of getting rid of their swollen legs and unsightly varicose veins. Unfortunately, in a large percentage of these patients, a simple cosmetic procedure fails to address a more serious underlying vascular issue and, even when the procedure is successful, patients complain of continued leg swelling, heaviness, and pain in their legs. Internet searches for, “Why do my legs continue to swell following my varicose vein surgery?” are everywhere on the internet and lead many patients to simplified, incomplete answers leaving them in a difficult position where they continue to suffer and have no answers for where to go next.

Over the past 5 years, significant advances in medical imaging and device technology have given Vascular surgeons new ways to treat leg swelling. Today, with the help of this new technology, trained vascular surgeons are able to restore normal blood flow to the lower legs in a straightforward, outpatient procedure that has led to significantly better outcomes than ever before possible.

Dr. Kokinos, a board certified vascular and general surgeon, performs these straightforward procedures in her outpatient, state of the art, angiography suite in Campbell, CA. She is a leading expert in the treatment of Iliac Vein Compression. Later this month, Dr. Kokinos will share her findings and outcomes at one of the pre-eminent vascular surgery conferences in Miami, Fl. OEIS, where she will speak to a global audience about the care and treatment of patients suffering from swollen legs.