Category: Blog

WOUND CARE

Posted on by Angelica Rodezno

Millions of Americans suffer from wounds that don’t heal. It’s a problem most don’t even think about until they or a loved one develops this type of wound. After all, every one of us has fallen or hurt ourselves with a resulting wound. It generally hurts for a little, we put a little Neosporin or a band-aid on it, and forget about it. Pretty soon, it is gone, and there is a little or big scar in its place. However, as we get older, and develop medical issues, this healing may not happen. A wound that has been “open” for more than four weeks, is called a chronic wound, and often needs the special attention of a wound care center. In these centers, team of specially trained nurses and doctors use a variety of diagnostic and therapeutic tools to help promote healing.

Several different problems can contribute to wound healing. The most common of these is a circulation issue. Either the arteries are blocked that supply oxygen and nutrients to help heal the wound, or the veins that promote drainage of toxins and fluids are not functioning properly. This can occur either because they have leaky valves, or because they too are blocked. In general, it has been discovered that about 70% of wounds seen in wound care centers have an underlying vascular issue. This problem is most often an issue with leg or foot wounds. For this reason all of these should be consulted on by a vascular surgeon, a specialist in treating circulation problems. Simple tests, most of which are not invasive, can reveal problems in the arteries and veins. It is very important to do this, because treating these issues alone can greatly improve the wound healing rate.

Other issues that can contribute to wound healing problems include diabetes, poor nutrition, infection, pressure on the wound, and certain medications (such as steroid use). These can often be addressed by the wound care specialists and thus improving the ability of the wound to ultimately heal.

Silicon Valley’s South Bay Vascular Center and Vein Institute doctors are recognized as the leading wound care physicians in the greater San Francisco Bay Area. Dr. Kokinos is the medical director at both the Verity/O’Connor Wound Care Center in San Jose and St Louise Hospital Wound Care Center in Morgan Hill, CA. and is recognized as the regional expert in the greater San Francisco Bay Area.

VENOUS DISEASE AND WOUND HEALING

Posted on by Angelica Rodezno

One of the most common contributors to the development of leg wounds is venous disease. This can occur either because of venous insufficiency—leaky valves in the leg veins or because of issues stemming from a DVT (deep venous thrombosis). Both of these problems contribute by causing high pressure at the ankles that impair the healing of the wounds. Silicon Valley’s South Bay Vascular Center and Vein Institute doctors are recognized as the leading wound care physicians in the greater San Francisco Bay Area and Dr. Kokinos is the medical director at both the Verity/O’Connor Wound Care Center in San Jose and St Louise Hospital Wound Care Center in Morgan Hill, CA.

Venous wounds have a classic appearance. The wound is generally around the inner or outer ankle bone and the skin around the wound is often very dark (hyperpigmented). The skin can also be quite leathery. Not everyone with a venous wound has varicose (bulgy) veins, but many do. These can often be painful, and even with excellent care, can take many months to heal. Although the diagnosis can be made by simple examination, it is important to do an ultrasound to get a roadmap of the venous system so that any problems that can be fixed are addressed.

The specialists who deal with the venous system best are called vascular surgeons. These doctors can deal with both leaky valves as well as blockages in the system. It is felt to be very important not only in helping these wounds heal, but in preventing them from coming back, to treat the underlying venous issues. For the leaky valves, this is done by sealing the veins closed, often using the VNUS closure catheter or a laser fiber. For blocked veins, they can often be treated with stents that will hold them open. These procedures are all minimally invasive and can be done in the office setting. With all venous ulcers, compression using medical grade stockings is vitally important. In addition, there is evidence that using an old drug called Trental or a newer one called Vasculera can help heal these wounds faster.

WOUND CARE EXPERTS IN SAN JOSE

Posted on by Angelica Rodezno

Polyxene Kokinos MD, a Board Certified Vascular and General Surgeon of South Bay Vascular Center and Vein Institute was recently appointed as the new medical director of the O’Connor and St. Louise Hospital’s wound care clinics. Dr. Kokinos brings over 25 years of vascular surgery experience to her new position as medical director and is recognized as a national expert in the treatment of peripheral vascular and arterial disease. Dr. Kokinos has a special interest in the treatment of lower extremity and deep venous disease and is recognized as one of the country’s leading experts in this area. Working in partnership with the award winning Wound Care Center at O’Connor hospital, Dr. Kokinos was selected as the new medical director because of her cutting edge work in peripheral revascularication and ability to bring blood back into the lower leg and foot. Building upon the exceptional wound care services already in place at the O’Connor wound care center Dr. Kokinos will focus on providing state of the art minimally invasive (outpatient) procedures as the next breakthrough in wound care treatment.

Dr. Kokinos and her Partner Dr. Carlos Pineda, both board certified vascular surgeons are recognized as two of the leading wound care doctors in San Jose, Silicon Valley and all of Northern California. While podiatrists have always been the traditional starting point for the evaluation of and treatment of non-healing leg wounds, it is only the Vascular Surgeon who is fellowship trained to be able to evaluate and to treat the underlying cause of most non-healing wounds: poor circulation. Unfortunately, in many instances skin supplements, hyperbaric chambers and wound debridement are not enough to correct the underlying circulatory issues responsible for non-healing leg, foot and ankle wounds.

Dr. Kokinos is honored to be selected as the medical director at the O’Connor and St Louis Wound Care clinic’s and is excited to bring patients the most recent advances in wound care treatment to help keep Silicon Valley’s best wound care clinics at the forefront of patient care.

KPIX-TV CHANNEL 5 TO FEATURE SOUTH BAY VASCULAR CENTER ON SATURDAY OCTOBER 21, 2017 AT 7:00 PM

Posted on by Angelica Rodezno

KPIX- TV CBS Channel 5 will feature South Bay Vascular Center and Vein Institute as a Vascular Surgery Center of Excellence on Saturday October 21, 2017 at 7:00 PM.

Recognized as the premiere Vascular Surgery practice in the greater San Francisco Bay Area, Dr. Polyxene Kokinos and Dr. Carlos Pineda will discuss their cutting edge approach for preventing lower limb amputations. Additionally, the program will focus on advanced surgical techniques to re-establish blood flow to aid in diabetic wound healing and the resolution of asymmetrical leg swelling.

Produced by Medical Media Group, South Bay Vascular Center is honored to be featured in this special presentation.

Please join us by watching KPIX -TV Channel 5 on October 21st at 7:00 PM.

PERIPHERAL ARTERIAL DISEASE (PAD) INTERVENTION AND TREATMENT

Posted on by Angelica Rodezno

Over the past 15 years the interventional treatment for peripheral arterial disease (PAD) has changed significantly with endovascular revascularization replacing surgically invasive procedures as the dominant intervention. Early detection and treatment are important to control the disease and to allow patients a full selection of treatment options.

Diagnosis
Many types of health care providers can diagnose and treat PAD. Family physicians, internists, physician assistants, nurse practitioners and vascular specialists can all diagnose PAD by examining a patient’s medical and family history, performing a physical exam, and conducting diagnostic tests. PAD can be diagnosed through a variety of diagnostic procedures including:

  • Ankle-brachial index (ABI):A common test used to measures the difference between blood pressure at the arm and at the ankle. A difference in the two areas indicates restricted blood flow.
  • Ultrasound
  • CT and MR angiograms
  • Angiography
  • Blood tests

Treatment
There are multiple options for treatment of PAD, ranging from medical interventions, surgical revascularization, and endovascular therapy. Vascular Surgeons are uniquely qualified and trained to treat patients diagnosed with PAD. Approaches to treatment include:

  • Minimally invasive endovascular procedures
  • Medical management
  • Exercise and lifestyle modifications
  • Surgical bypass Amputation

South Bay Vascular Center and Vein Institute is the recognized as the regional treatment center for the treatment and care of patients suffering from Peripheral Arterial Disease. Dr.’s Kokinos and Pineda specialized training and state of the art interventional facility offers patients a unique alternative to a hospital setting and provides the highest level of care for the treatment of PAD as an alternative to limb amputation.

If you or a loved ones suffers from PAD, call our office today at 408-376-3626 to schedule a visit.

We offer hope when others say there is none.

www.southbayvascular.com

PERIPHERAL ARTERIAL DISEASE (PAD)

Posted on by Angelica Rodezno

According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 18 million people in the United States suffer from Peripheral Artery Disease (PAD), a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. Estimates suggest that anywhere from 12 to 20 percent of individuals over the age of 60 are living with PAD. Approximately 160,000 to 180,000 of the estimated 18 million Americans with PAD will undergo a limb amputation as result of PAD-related condition this year, resulting in lower quality of life, high medical costs, and shorter life expectancy.

But even with these alarming numbers, general population awareness of PAD is estimated at only 25 percent. Symptoms of severe PAD include leg pain, wounds on the toes or feet, gangrene and a loss of leg mass compared to the rest of the body. Individuals are at greatest risk for PAD if you have high cholesterol, high blood pressure, or diabetes. African American and Hispanic populations are also at higher risk as are individuals with a history of smoking. Improvements in technology have allowed for the migration of interventional services from hospitals to same-day interventions at a physician’s office, which offers a more cost-efficient and patient-preferred alternative to inpatient care.

It is crucial for patients to have access to PAD screenings in the community setting to ensure the appropriate treatments are performed before undergoing an amputation. South Bay Vascular Center and Vein Institute is the leading center for the treatment of PAD in San Jose, Santa Clara County, and Silicon Valley.

If you or a loved one is facing a possible lower limb amputation, call our office to schedule a secondary consultation before agreeing to an amputation.

We offer hope when others say there is none.

408-376-3626

www.southbayvascular.com

SEPTEMBER IS PAD AWARENESS MONTH

Posted on by Angelica Rodezno
What is Peripheral Arterial Disease?
Peripheral artery disease (PAD), also known as claudication, poor circulation, vascular disease, or hardening of arteries, is a chronic, life-threatening circulatory condition. PAD causes narrowing or blockage of the vessels that carry blood from the heart to the legs. The primary cause of PAD is atherosclerosis, or the buildup of plaque in the arteries. This occurs when arterial inflammation, cholesterol, calcium and scar tissue build up, forming plaque that clogs the arteries and slows blood flow to the legs. The more plaque that builds up on the inside walls of the blood vessels carrying blood from the heart to legs and arms, the more the arteries lose flexibility and narrow, putting patients at greater risk.
Risk factors for PAD
Smoking
High blood pressure
Diabetes,
High cholesterol
60+ years old.
PAD patients are at high risk of developing critical limb ischemia (CLI), a chronic condition that results in severe pain in the feet or toes, even while resting. Complications of poor circulation can include sores and wounds that won’t heal in the legs and feet. Left untreated, the complications of CLI could result in amputation of the affected limb. PAD patients are also at greater risk for heart attack and stroke. Studies have found that the total annual US costs for patients with PAD exceed $21 billion, including nearly $10 billion for hospitalizations. In Medicare alone, one study estimated spending on PAD accounted for more than 2% of all Medicare spending. PAD has been identified by the Institute of Medicine (IOM) as a priority area for comparative effectiveness research. One study suggested that endovascular therapy appears to be the least costly option in the short-run for patients with PAD.
Symptoms Blockages can restrict blood flow to the muscles, causing muscle cramps, tightness or weakness, especially during activity. In the early stages of PAD, patients may not experience any symptoms. If PAD is not treated, though, blockages may continue to grow and restrict, or even completely block, blood flow.
Common symptoms include:
Leg pain when walking
Muscle pain or cramping in legs and calf triggered by activity
Leg numbness or weakness
Coldness on lower leg or foot
Sores on toes, legs or feet that won’t heal
Change in color of legs
IF YOU OR ANYONE YOU KNOW SUFFERS FROM ANY OF THESE CONDITIONS WE CAN HELP! CALL US TODAY AT
408-376-3626 TO SCHEDULE AN APPOINTMENT.

HOW CAN A SWOLLEN LEG BE RELATED TO CANCER?

Posted on by Angelica Rodezno

How Can A Swollen Leg Be Related To Cancer? Many people know that leg swelling is a normal part of pregnancy. Or that if your heart or kidneys are not working properly, then fluid can “back up “ into your legs and cause swelling. Unfortunately, one problem that most people do not associate with leg swelling is cancer. This is unfortunate, because many people have leg swelling, most specifically an unprovoked deep venous thrombosis causing that swelling, as the first sign of their cancer. What does that mean?

Deep venous thrombosis (DVT), or a blood clot in one of the deep veins in the leg, is very common in the United States. This usually presents as unilateral leg (when only one leg swells) swelling, especially of the calf and ankle. As many as 900,000 people a year are diagnosed with a DVT and about 100,000 of them DIE of either the DVT or a pulmonary embolus (PE). A pulmonary embolus is when the blood clot travels to the lung and causes the death of a part of the lung. Most of the time, a DVT is provoked, or has a cause. Common reasons for a DVT include long car or plane rides, having orthopedic or other surgery, being on bedrest or being very sedentary, being on birth control pills, or having unusual proteins in the blood that cause one to clot more easily.

Sometimes, however, a patient develops a blood clot without having a history of one of these things. When that happens, it is VERY important to be worked up for the possibility of a hidden cancer. This is because studies have shown that if someone develops a DVT with none of the “normal” risk factors, the chance of diagnosing cancer in that patient is one in ten in the first year after the DVT.

It is therefore very important that if you are told you have a DVT, that you be screened for cancer. This can be done simply with a thorough history and physical, some lab work, and possibly some Xrays, depending on your history. It is important NOT to just go to the urgent care, be told you have a blood clot, and just take your blood thinners. Please go see a vascular surgeon who can both manage the medication for you blood clot, follow it up with ultrasounds, and do the proper work-up to ensure that it is not the sign of something bad.
South Bay Vascular Center and Vein Center specializes in the treatment of DVT and Swollen Legs. If you or anyone you know suffers from blood clots (DVT’s) or swollen legs, please call our office to schedule a consultation at 408-376-3626

DON’T SUFFER FROM SWOLLEN LEGS OR NON-HEALING LEG ULCERS ANY LONGER. WE CAN HELP!!

Posted on by Angelica Rodezno

The sequence of photos below shows the before and after pictures of an 87 year old man who had seen multiple doctors over a 3-4 months period of time for his severe right leg swelling. This was not only causing him discomfort, but caused him to fall because of the imbalance it led to. He was found on a regular venous ultrasound in our accredited vascular lab to have abnormal flow in his right iliac vein.

The next day, we took him to our Campbell angiography suite for a 45 minute outpatient procedure. There, using both venography (injection of contrast into the vein through a small straw like catheter in the groin) and IVUS (intra-vascular ultrasound) we diagnosed a scarred and blocked right iliac vein system. This was easily treated with a stent and balloon.

Unfortunately, this was found to be a result of a combination of radiation treatment the patient had received 20 years before for his prostate cancer as well as because of a return of his cancer. This tumor (seen on CT scan) was surrounding his vein. When he came back five days later for a check, his right leg swelling was gone as was his leg heaviness and aching.

Please note, compression of the iliac vein usually (80%) occurs on the left. Often, if leg swelling occurs on the right, it may be a sign of a tumor or mass pushing on the vein in the abdomen.

Patient with right lower leg swelling before procedure

Inserting a wire into the diseased vessel. Notice the light colored area where no blood was flowing.

Opening the diseased vessel using a “balloon”.

Placing a stent in to the opened vessel to maintain blood flow. Notice how even blood flows through the opened vessel

Patient 5 days after surgery with leg swelling almost completely resolved

If you or anyone you know suffers from lower leg swelling, call us today to set up a consultation to evaluate your treatment options.

408-376-3626

South Bay Vascular Center and Vein Institute