Author: Michael Kokinos

Peripheral Arterial Disease (PAD)

PAD is not JUST a circulation issue. It is a serious, progressive, and potentially life-threatening condition that demands expert evaluation and management. Yet far too often, patients are referred to a range of specialists, Cardiologists, Interventional Radiologists, Podiatrists, Primary Care Physicians none of whom may have the training, tools, or long-term perspective to fully diagnose and treat the root cause: blocked arteries in the legs.

So what makes a vascular surgeon the right specialist for PAD? And more importantly, why can choosing the wrong type of physician have devastating and even irreversible consequences?

PAD Is Not a Symptom: It’s a Systemic, Life-Altering Disease

PAD occurs when arteries in the legs become narrowed or blocked due to atherosclerosis. The result is a restriction in blood flow, depriving muscles and tissues of vital oxygen and nutrients. Left untreated, PAD can lead to:

• Non-healing wounds
• Tissue loss and gangrene
• Major amputations
• Increased risk of heart attack and stroke
• Premature death

In fact, studies show that PAD carries a 5-year mortality rate of up to 30%, rivaling many cancers[^1].

Yet despite this, many patients are misdiagnosed or underdiagnosed, often dismissed with vague labels like neuropathy, venous insufficiency, age-related pain. These oversights stem not from malice, but from a lack of specialized training and the consequences can be devastating.

Not All Doctors Are Created Equal

Patients often feel reassured when a doctor belongs to a big-name institution or wears the title interventionalist. But here’s the uncomfortable truth: just because someone can perform a procedure doesn’t mean they should.

There is a vast disparity in physician skill, experience, and judgment when it comes to PAD. A general cardiologist may be able to place a stent. A radiologist may be able to interpret an image. But PAD requires more than technical proficiency; it requires deep, nuanced clinical decision-making, long-term follow-up, and the ability to treat not just the blockage, but the entire vascular system.

And that’s exactly what a vascular surgeon is trained to do.

The Role of the Vascular Surgeon: Breadth, Depth, and Continuity

Vascular surgeons are the only specialists who are trained in both open and endovascular procedures, giving them a full arsenal of options to treat PAD at every stage. Unlike other proceduralists, they don’t rely on a single technique or device; they tailor the approach to the patient.

Most importantly, they see the big picture. They manage the entire arterial system, including the heart, kidneys, and brain. They monitor long-term progress. They handle complications. They know when NOT to intervene and when to act swiftly.

In contrast, patients treated by less experienced providers often suffer from:

• Incomplete revascularization
• Delayed wound healing
• Repeat procedures that fail to address the core issue
• Amputations that might have been prevented

Poor Physician Judgment Can Cost Lives

One of the most sobering realities in medicine is that not all decisions are made with the patient’s best interest at heart. In a healthcare system increasingly driven by productivity metrics, referral relationships, and profit margins, patients are sometimes steered toward procedures or providers based on financial incentives rather than medical necessity.

In PAD, these misjudgments are not academic, they’re life-and-limb decisions. A poorly placed stent can lead to re-occlusion. A missed diagnosis can allow an ulcer to turn necrotic. An unnecessary amputation can sentence a patient to a shortened, limited life.

And that’s why experience matters. Judgment matters. And trust matters.

Why Dr. Polly Kokinos Should Be Your First Call

Dr. Polly Kokinos is a double board-certified vascular surgeon who has dedicated her entire career to the prevention, diagnosis, and treatment of peripheral arterial disease. Her patients benefit not only from her surgical skill but from her unwavering commitment to patient-centered care; care that prioritizes outcomes over profits, people over procedures.

Dr. Kokinos has seen firsthand what happens when PAD is treated too late or not at all. She understands the gravity of this disease, and the consequences of even one misstep. That’s why she insists on thorough diagnostic workups, collaborative care with podiatrists and primary care providers, and most importantly, honest, compassionate conversations with patients and families. And,  that’s why more independent private practice physicians in Santa Clara County refer more PAD patients to her than to all the other vascular surgeons in the valley combined. 

Not every story ends in a happily ever after. But with the right specialist, the right diagnosis, and the right care plan, many patients can walk longer, live fuller, and face their future with dignity; not despair.

Mary’s* Cold Feet

Mary was just living her life, curled up on her couch with a cup of tea, her toes always cold no matter how thick her socks were. She figured it was nothing—maybe her circulation was off, or the Bay Area chill was hitting harder than usual. But after a while, it wasn’t just the cold. Her feet started looking pale, and a little scratch from her cat took weeks to heal. Something felt wrong, so she booked a visit with her regular doctor, hoping for answers.

Her primary care doc was nice enough—checked her out, ran some basic tests, and told her it was probably nothing serious. “Just keep an eye on it,” he said, sending her home with a pat on the back. But weeks passed, and her feet didn’t get better. If anything, they got worse—the cold turned into a nagging ache. Frustrated, Mary pushed for a second opinion. This time, she saw another doctor, someone a friend recommended. He took it more seriously, mentioning something about blood flow, maybe veins acting up. He prescribed some creams and told her to elevate her legs at night. It sounded good, but it felt like a guess—like he was throwing stuff at the wall to see what stuck. The creams didn’t help, and the ache spread. Mary was starting to worry she’d waited too long.

You’re walking to the mailbox when your legs start aching. Your feet feel cold even in socks. That cut on your shin? Still there after a month. These aren’t random annoyances—they’re signs of peripheral arterial disease (PAD), a sneaky condition where blocked arteries starve your legs of life giving oxygen and nutrients. Ignoring them could cost you big—think infections or worse. The fix? A vascular surgeon. Let’s break down the four signs you can’t miss and why Dr Kokinos and her team at South Bay Vascular Center and Vein Institute may be your answer.

The Big Four Signs

PAD doesn’t shout—it whispers. Here’s what to listen for:

1. Leg pain at night or walking—a heavy, tired feeling that won’t quit.
2. Cold or discolored feet—toes turning pale or blue mean trouble.
3. Non-healing wounds—sores that linger way too long.
4. Weak pulses in your feet—hard for you to check, but a pro can tell.

Seeing one or more? PAD might be knocking.

PAD vs. Venous Disease: Know the Difference

Don’t mix up PAD with venous problems. PAD clogs arteries, cutting off oxygen to your legs. Venous disease messes with veins, causing swelling or varicose veins. PAD’s the serious one—linked to diabetes and kidney failure. Too many think it’s “just circulation.” It’s not. It’s a call for expert help.

Dr Polyxene Kokinos: A Board Certified Vascular Surgeon

Your heart doctor or imaging specialist might try, but vascular surgeons own this game. Trained at Columbia University Medical School, UCSF General Surgery and Washington University in St Louis, Dr Kokinos’ 30 year career has been entirely focused on diagnosing and treating circulatory related illnesses. The Journal of Vascular Surgery proves Vascular Surgeons outshine others when it comes to treating peripheral arterial disease—fewer setbacks, better fixes.

South Bay Vascular Center and Vein Institute: Santa Clara’s Trusted Answer to PAD

Picture this: A surgeon who’s studied at elite institutions, spent almost three decades building trust with referring physicians and treating patients with unmatched care is located right here in the South Bay area. As an independent practitioner, she’s dedicated her entire career to treating local patients in our community; not red tape.  Her focus is on her community. That’s why Dr Kokinos still takes call and treats patients at all the local area hospitals: Good Samaritan, O’Connor, El Camino Los Gatos and El Camino Mt. View. No other vascular surgeon in the area can make that claim and her track record—limbs saved, lives changed—makes her the most trusted around. She’s your answer to PAD’s quiet threats.

Act Early, Win Big

Catch those signs early, and you’ve got options. Dr Kokinos can help you modify lifestyle—more walking, less smoking—or prescribe meds. If the problem turns out to be more serious that originally expected, Dr Kokinos has your back as well. She’s the best in the region leveraging outpatient surgical techniques like stents or bypasses to get you back on your feet.  Thanks to modern tech and her years of experience you wont be handed a referral slip and told to start all over with another doctor.  Wait too long, and PAD could mean amputation. With her, early action wins.

Don’t Ignore the Signs

Those four signs aren’t quirks—they’re PAD’s warning lights. Don’t wait—get checked now. Next time you visit your primary care physician make sure to “Take off your socks and show them your toes”. Ask them for a referral to Dr Kokinos at South Bay Vascular Center and Vein Institute. Visit us at www.southbayvascular.com to learn more about Dr Kokinos’ practice. We can help! 408-376-3626.

To Lisa’s primary care physician, her leg pain was “just aging”. When the pain got worse at night and Lisa couldn’t sleep unless she hung her leg off the side of the bed, her husband knew something else might be going on. Maybe Lisa’s leg pain was more than just aging; maybe she had a back problem and was pinching a nerve when she laid down. Maybe her muscles were just cramping because she had been on her feet too long that day.

Jumping onto his computer he googled “why does my wife’s leg hurt at night when she lies down to go to sleep.  First he read that leg pain at night might be more than just “aging”. Next he found something he never knew before….Leg pain at night might be a warning sign that his wife Lisa’s leg pain might be a whole lot worse than what their primary care doctor  had told them. Digging further, he found out that Lisa was not alone. That many people had leg pain when they went to bed. And then he found it: an article on Peripheral Arterty Disease (PAD). Every thing the article described fit Lisa’s symptoms to a tee. But now what?

What Lisa’s husband discovered was that primary care physicians often miss or underdiagnose PAD. Unfortunately, that kind of underdiagnosis can put a patients limbs and, in some cases, the lives of their patients at risk. Fortunately, in Lisa’s case, her huband stumbled across South Bay Vascular Center and Vein Insitutes website where Dr Kokinos and her team of vascular surgeons are specially trained to diagnose these very unique and specific circulatory problems.

So,why do primary care physicians underdiagnose PAD? What makes a Vascular surgeon uniquely trained to diagnose patients suffering from this kind of disease?

PCP Pitfalls

Studies say 50% of PAD cases go unseen by PCPs—busy with colds, not blood vessels, PCP’s seldom ask patients to “take off their socks” so that they can examine their patient’s toes. Stressed for time and constrained by what insurance companies reimburse primary care physicians, many PCP’s simply don’t have the time nor the staff to spend the amount of time they need to fully examine and address the concerns of their patients. Compounding this problem is that many patients don’t even realize they are suffering from PAD until their symptions get more serious. Consequently, leg pain, cold feet and non-healing wounds get shrugged off. PAD’s an artery issue, not venous, and it’s serious.

Vascular Surgeons: The Fix

Trained at top programs, vascular surgeons spend years studying and training to diagnose and to treat circulatory problems. Their entire speciality is dedicated to treating patients suffering from circulatory disease. They’re vessel experts, and studies like the Journal of Vascular Surgery show they’re the best at catching and fixing PAD. Remember, most vascular surgeons actually begin their training by studying to be general surgeons and then continue for another 2 years to subspecialize in vascular surgery. Vascular surgeons dedicate their entire careers to the diagnosis and treatment of vascular related illnesses.

Feet: PAD’s Secret Window 

PAD blocks leg arteries, and your feet feel it first. Coldness, discoloration, weak pulses, or slow-healing sores scream trouble. It’s not venous disease—those are vein issues. PAD’s an artery crisis, tied to serious stuff like diabetes. A foot exam spots it when others don’t. That’s why if you experience leg craps that get worse at night, next time you visit your PCP, “Show them your Toes”!

Santa Clara’s Trusted Checkup

Dr Kokinos of South Bay Vascular Center and Vein Institute trained at some of the world’s finest schools and has spent almost three decades serving Santa Clara as an independent surgeon. Her foot exams aren’t just routine—they’re lifesavers, backed by experience and a community’s trust.

As a specialist, Dr Kokinos uses the most advanced imaging technology on the planet to examine her patients. Modern imaging—like ultrasound—lets her peek inside your arteries during a foot exam. Far more than anything a primary care physician is trained to do. Most importantly, Dr Kokinos brings her entire experience to everyone of her patients. Her exams are quick, painless, and precise. When she’s done, you have your answer: The right answer.

Don’t Settle 

PCPs miss PAD; a vascular surgeon will not. Get the care you deserve—now.  If you are suffering from leg cramps when walking or can’t sleep at night because of the pain in your legs, Dr Kokinos can help. Ask your primary care physician for a referral to Dr Kokinos at South Bay Vascular Center and Vein institue at 408-376-3626 or schedule one for yourself or a loved one by visiting our website at www.southbayvascular.com

—

Leg Pain at Night? Why Santa Clara’s Top Vascular Surgeon Is Your Lifeline

You’re jolted awake by a sharp, throbbing pain in your leg. It’s not the first time—maybe not even the tenth. You rub it, shift positions, and hope it’s just a cramp or a sign of a long day. But what if it’s more? That nagging leg pain at night could be peripheral arterial disease (PAD), a condition where clogged arteries rob your legs of blood. It’s not just annoying—it’s a warning. Left untreated, PAD can steal your mobility or worse. The good news? Dr Kokinos is a board-certified vascular surgeon with offices in San Jose and Gilroy; she trained at the world’s best institutions and has 30 years of private practice experience. No other vascular surgeon in Santa Clara County can make these same claims.  Best of all, her team at South Bay Vascular Center and Vein Insitute is here to help. Let’s explore why that pain keeps coming and how Dr Kokinos can get you the right care to help stop it.

Why PAD Strikes at Night 

PAD happens when fatty buildup blocks the arteries in your legs. During the day, you might feel it as a heavy ache when you walk—doctors call it “claudication.” But at night, when you’re still, the reduced blood flow really stings. Your muscles crave oxygen, and without it, they scream. It’s NOT like venous disease, which might swell your legs—PAD is an ARTERY problem, often tied to diabetes or heart trouble. Brushing it off as “old age” is a mistake too many make. And, don’t be suprised if even your primary care physician incorrectly diagnosis PAD. PAD is not the first thing on their mind when it comes to leg pain and restless nights. Knowing the signs and signals of PAD, you may have more options that you were told.  This is your body begging for help.

More Than Just Pain: PAD’s Calling Cards

Leg pain at night isn’t PAD’s only trick. Watch for these too:

– Cold feet or toes that look pale or bluish—blood’s not reaching them.

– Non-healing wounds—cuts or sores that linger for weeks.

– Weak pulses—a doctor can feel this, but you might sense something’s off.

If these sound familiar, it’s time to stop guessing and start acting.

Vascular Surgeons: The Nighttime Pain Experts

You might think, “Can’t my regular doctor fix this?” Not quite. Primary care physicians often miss PAD—studies say up to 50% of cases slip by. Cardiologists and radiologists can pitch in, but vascular surgeons are the pros. Trained at elite universities and top fellowship programs, they specialize in blood vessels—arteries included. Research from the *Journal of Vascular Surgery* shows they get better results: fewer complications, longer-lasting fixes. In Santa Clara County, Dr Kokinos’  nearly 30 years of private practice experience makes her the go-to for restless nights.

Doctor Polyxene Kokinos (Dr K):Santa Clara’s Trusted Lifeline 

Imagine a doctor who’s studied at the best schools worldwide, then spent decades perfecting her craft right here in Santa Clara County. As an independent practitioner, she’s not tied to big-hospital bureaucracy—she’s all about her patients. Silicon Valley is the epi-center of technology and innovation…that’s not just high tech computers and microprocessors. It’s medical technology as well. And that’s where Dr K stands head and shoulders above the rest. Shes been in private practice for nearly 30 years; she was at the head of the pack when it comes to treating PAD. Her practice has been the training ground for other surgeons in the area, teaching them the skills and tricks for treating PAD. She’s the best of the best and for that, she’s earned a reputation as the most trusted vascular surgeon around, turning sleepless nights into peaceful ones. Her patients don’t just get relief; they get their lives back.

Modern Relief, Right Here 

Here’s the exciting part: PAD treatment’s gone high-tech. Forget long hospital stays—new devices like stents and balloons, paired with advanced imaging. Dr Kokinos provides you the kind of treatment you need….the level of treatment you deserve.  Dr Kokinos and her staff at South Bay Vascular Center and Vein Institute are dedicated to help fix your arteries in an outpatient clinic. You’re in and out, healing at home by bedtime. She might use angioplasty to widen a blockage, a bypass to reroute blood, or even shave away plaque with an atherectomy. Whatever your legs need, her skill and tools deliver.

What Happens Without Help?

Ignore that pain, and PAD digs in deeper. Those cold feet could turn into sores that won’t heal. Diabetes or kidney issues might tag along, making it a triple threat. Worst case? Amputation looms if blood flow dies completely. But with a vascular surgeon’s care—especially one with her track record—that’s a future you can dodge.

End the Pain Now

That leg pain at night isn’t a life sentence—it’s a signal. Dr Kokinos, A vascular surgeon with world-class training and Santa Clara most trusted vascular surgeon can silence it. Don’t let PAD steal your sleep or your legs. Get checked by the best—your lifeline’s waiting. Ask your doctor or podiatrist for a referral to Dr Kokinos at South Bay Vascular Center and Vein Institute. Call to schedule a second opinion at 408-376-3626. www.southbayvascular.com

A Wake-Up Call You Can’t Ignore

Picture this: You’re tossing and turning at night because your legs won’t stop aching. You shake it off as a cramp or maybe just “getting older.” But then it happens again—and again. Or maybe you’ve got a small cut on your foot that just won’t heal, no matter how much ointment you slather on it. If this sounds familiar, you might be dealing with peripheral arterial disease (PAD)—a condition where the arteries in your legs get clogged with fatty buildup, slowing down blood flow. Left unchecked, PAD can spiral into serious problems, even amputation. The good news? There’s hope—and it starts with seeing the right doctor: a board-certified vascular surgeon.

PAD vs. Other Conditions: Clearing the Confusion

So, what exactly is PAD? Think of your arteries like highways for blood. When they get blocked, oxygen and nutrients can’t reach your legs and feet. That’s different from peripheral venous disease, which affects veins and causes issues like swelling or varicose veins. A lot of folks mix these up or think PAD is no big deal—just “bad circulation.” But here’s the truth: PAD is a serious condition tied to diabetes, kidney failure, and even heart disease. Ignoring it isn’t an option.

Top 4 Signs of PAD

How do you know if you’ve got PAD? Watch for these top four signs:

1. Leg pain at night or when you walk (it might feel like a heavy, tired ache).
2. Cold or discolored feet (think bluish or pale skin).
3. Slow-healing sores or wounds—those stubborn sores that stick around way too long.
4. Weak pulses in your feet (a doctor can check this easily).

Why a Vascular Surgeon Is the Gold Standard

You might wonder, “Can’t my heart doctor or X-ray guy fix this?” Not quite. Sure, interventional cardiologists and radiologists can treat PAD, but vascular surgeons are the real pros when it comes to blood vessels. They’ve got years of specialized training at the world’s top universities and fellowship programs to handle everything from diagnosis to surgery. Studies in the *Journal of Vascular Surgery* back this up, showing vascular surgeons have better outcomes for PAD patients—like fewer complications and longer-lasting results. In Santa Clara County, one independent surgeon with nearly 30 years of private practice stands out, trusted for her dedication to the community.

Advances in PAD Treatment

Here’s where it gets exciting: Thanks to advances in medical tech, treating PAD doesn’t always mean a big hospital stay anymore. New devices—like tiny stents to prop open arteries—and cutting-edge imaging tools let vascular surgeons fix your legs in an outpatient clinic. That means less time under the knife and more time back on your feet. Pretty cool, right?

Dr Polyxene Kokinos: Santa Clara’s Trusted Expert

In Santa Clara County, one vascular surgeon has earned a reputation as the most trusted in her field. Trained at Columbia University Medical School, UCSF General Surgery and Wasington University Vascular Surgery Fellowship Dr Kokinos brings decades of experience, compassion and expertise to your care. Most importantly, Dr Kokinos has dedicated her entire career to serving patients as an independent practitioner…not one who just decided they might make more money in private practice after spending the vast majority of their time working for university health systems and corporate medical groups. Her patients don’t just get treatments—they get results, from healed wounds to saved limbs.

The Role of Family and Primary Care

PAD can be sneaky, and that’s where family comes in. If you’ve noticed Dad limping or Mom complaining about leg pain, nudge them to see a vascular surgeon. Primary care doctors might miss PAD—sometimes because they’re focused on other issues. Studies suggest up to 50% of PAD cases go undiagnosed in regular checkups, making a specialist’s care crucial.

What Happens if PAD Goes Untreated?

What happens if you ignore PAD? It’s not pretty. Those non-healing leg wounds can turn into infections that won’t quit. PAD’s also linked to kidney failure and diabetes—conditions that make it even harder to fight back. Worst case? Amputation. Don’t let that happen—early treatment saves lives and limbs.

Conclusion: Take Charge of Your Legs

PAD might sound daunting, but it’s beatable—if you act fast. Remember, tell your doctor that you want to “Show Them Your Toes” Those leg pains at night or slow-healing wounds aren’t “just life.” They’re signs you need a vascular surgeon with world-class training. Dr Kokinos and her team at South Bay Vascular Center and Vein Institute are here for you.   Ask your physician or podiatrist for a referral to Dr Kokinos at South Bay Vascular Center and Vein Institute at 408-376-3626 or schedule one yourself for a second opinion at www.southbayvascular.com. We are here for you!