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


  • 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

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.


  • 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.


  • 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.


Deep vein thrombosis (DVT) is a vein condition in which a blood clot forms inside a deep vein, usually in the large veins of the lower legs or thighs. If left untreated, deep vein thrombosis can develop into a serious, or even fatal, condition. Patients at risk for DVT should therefore seek prompt medical attention. Patients who live in the San Jose, California region can take advantage of the expert care provided at South Bay Vascular Center & Vein Institute. This center is uniquely qualified to diagnose DVT with an accredited on-site vascular ultrasound laboratory.

If left untreated, the blood clots that form with deep vein thrombosis can dislodge and travel to the lungs. This very serious complication is known as a pulmonary embolism. In the worst-case scenario, a pulmonary embolism can be life-threatening, which is why vein doctors recommend immediate hospitalization if a pulmonary embolism happens.

At South Bay Vascular Center & Vein Institute’s expert vein clinic in California’s South Bay, vein disease treatment begins with understanding the risk factors associated with deep vein thrombosis. Dr. Kokinos and her staff help their patients learn about their individual risk factors, in order to provide a better understanding of what’s causing the disorder. There are many risk factors for developing vein diseases like deep vein thrombosis. Many of the most significant factors relate to genetics — if a family member has suffered from a deep vein disease, the likelihood of developing the condition rises.

Inherited blood clotting disorders in general are especially problematic and may lead to deep vein thrombosis later in life.
Sedentary behavior or sitting in a car or plane for many hours is another common risk factor for DVT. Muscles that sit still for many hours a day do not circulate blood as well as active muscles. Staying active and getting regular exercise will therefore help lower this risk factor. In addition to lowering one’s risk of DVT, exercising daily also has many other benefits for vascular health, so it is a great way to help prevent vein problems. Pregnancy is another known risk factor for DVT. The reason is that pregnancy causes changes in blood flow that can stress veins in the legs and pelvis, leading to abnormalities in blood flow. Undergoing surgery, or sustaining an injury, can also increase the risk of developing deep vein

Some anesthetics used in surgery can cause changes in blood vessels that make veins more prone to developing clots. In addition, during surgery, patients can be immobile for many hours, thus causing stasis of the blood in their veins. The most common procedures after which DVT is diagnosed are orthopedic or gynecologic procedures. Deep vein thrombosis can happen in the veins in the leg or in the pelvis. It has often been missed when it is the pelvic veins called the iliac veins because doctors who are not specialists in this field, like those at South Bay Vascular, do not know to look at them. More and more commonly, we are finding that an anatomic compression of the iliac vein, called May-Thurner’s syndrome, which is found in up to 30% of all people, is at the heart of a DVT that seems to not have a good cause. At South Bay Vascular center, Dr. Kokinos is a national leader in the diagnosis and minimally invasive treatment of this problem.

Dr. Kokinos and her team, in San Jose, California, have the trustworthy expertise that patients need to treat this condition. At South Bay Vascular Center and Vein Institute, treating deep vein thrombosis for San Jose, CA residents is a specialty. To learn more about DVT risk factors and prevention, as well as the different types of vein treatments in San Jose, California, prospective patients can contact South Bay Vascular Center and Vein Institute


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.


In recognition of her exceptional surgical skills and long term dedication to the Silicon Valley community, Columbia’s Good Samaritan hospital in San Jose, CA. recently appointed Dr. Kokinos to Chair their Division of Cardiovascular Surgery. In her capacity as chair, Dr. Kokinos will work with physicians and administration to expand the current cardiovascular service options available to patients. Additionally, a key function of her appointment is to establish the appropriate criteria and surgical protocols needed to maintain high levels of physician competency.

Congratulations, Dr. Kokinos, on your recent appointment.


Do you Suffer From Iliac Vein Compression?

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

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

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

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

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

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

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



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


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.

If you or anyone you know suffers from swollen legs, especially left leg swelling, have been diagnosed with a DVT (blood clot), or experience leg swelling, or excessive pain following a cosmetic vein procedure (EVLT, Laser Sclerotheraphy etc.) ask your physician to speak with you about May-Thurners Syndrome and Iliac Vein Compression. We can help fix your swollen, achy legs and can help you get back your life. Please give us a call to discuss your treatment options at 408-376-3626 or visit our website at

Patient with left leg swelling