Category: Blog

Periheral Arterial Disease

Peripheral Arterial Disease (PAD) is a silent, creeping condition that affects millions of people, often without them even realizing it until it’s too late. Imagine your body as a bustling city, with arteries as the highways delivering oxygen-rich blood to every corner. Now picture those highways narrowing, clogged with debris, slowing traffic to a crawl—or stopping it entirely. That’s PAD in a nutshell: a circulatory disorder where plaque buildup restricts blood flow to your limbs, most commonly your legs. Left unchecked, it can impace your ability to walk, threaten your limbs, and even cut your life short. But there’s hope—and it starts with understanding the disease, recognizing its signs, and seeking the right care from someone who truly gets it.

For over 30 years, Dr. Polyxene (Polly) Kokinos, a board-certified vascular surgeon at South Bay Vascular Center & Vein Institute (southbayvascular.com), has dedicated her career to fighting PAD in the South Bay community. She’s not just a doctor; she’s a lifeline for patients and their families, offering personalized care that big hospitals often can’t match. Unlike other local Vascular Surgeons who decided to leave large health care institutions and or academic settings because they thought more money could be made as an independent practioner, Dr Kokinos has spent her entire career serving her local community; putting her patients first and not the institution where she worked.  Her name isn’t associated with the “halo” of large health care systems or universities. Her reputation is based on results: Not the names of universities or health care systems. 

This guide will walk you through everything you need to know about PAD—its symptoms, risks, and treatments—while showing why expertise, trust, and a human touch matter when your health is on the line.

What Is Peripheral Arterial Disease?

PAD is a form of atherosclerosis, where fatty deposits, cholesterol, and other substances build up inside your arteries, forming plaque that narrows or blocks them. While it can affect any artery outside the heart or brain, it most often hits the legs and feet. Think of it as a plumbing problem: when the pipes get clogged, the water can’t flow. In PAD, that “water” is blood, and without it, your muscles and tissues suffer.

According to the CDC, about 8.5 million Americans over 40 have PAD, and Dr. Kokinos has seen her share of them in her Silicon Valley practice. She’s treated over 25,000 patients in her career, from those with mild discomfort to those facing amputation. Her work at South Bay Vascular stands out because she’s built a nationally accredited surgery center designed specifically for vascular care—something you won’t find in a typical hospital. This focus lets her tackle PAD with cutting-edge tools and a deep commitment to each patient’s story.

Symptoms: Listening to Your Body’s Warnings

PAD can be sneaky. About half of those with it don’t even notice symptoms at first, which is why it’s often called a “silent killer.” But when signs do show up, they’re hard to ignore—if you know what to look for.

• Leg Pain While Walking: The classic symptom is intermittent claudication—cramping, aching, or heaviness in your calves, thighs, or buttocks that kicks in during activity and fades with rest. It’s your muscles crying out for oxygen they’re not getting.
• Pain at Rest: In severe cases, the pain doesn’t stop. It might wake you up at night, gnawing at your feet or toes. Dr. Kokinos often hears patients describe this as a relentless ache that forces them to dangle their legs off the bed for relief.
• Cold Feet or Legs: If one leg feels colder than the other, it could mean blood isn’t reaching it properly.
• Skin Changes: Look for shiny, thin, or discolored skin—sometimes bluish or pale—on your legs or feet. Hair loss on your legs can also be a clue.
• Sores That Won’t Heal: A cut or ulcer that lingers, especially on your toes or feet, is a red flag. In PAD, poor blood flow stalls healing, raising the risk of infection or gangrene.
• Black Toes: This is an emergency. Tissue death from lack of blood can turn toes black, signaling critical limb ischemia—a stage where amputation looms if untreated.

Dr. Kokinos stresses early detection. “I’ve seen too many patients wait until their toes are black before they come in,” she says. “By then, we’re racing against time. If you’re hurting when you walk or noticing these changes, don’t brush it off—get checked.”

Risks: Who’s in the Crosshairs?

PAD doesn’t strike randomly. Certain factors crank up your odds, and knowing them can push you to act sooner.

• Age: It’s most common after 50, with 12-20% of people over 60 affected.
• Smoking: This is the big one—smokers are four times more likely to develop PAD, and symptoms hit a decade earlier than in nonsmokers.
• Diabetes: High blood sugar damages arteries over time, making diabetics prime targets. Dr. Kokinos notes that anyone with diabetes for 15+ years should see a vascular surgeon, no excuses.
• High Blood Pressure and Cholesterol: These fuel plaque buildup, narrowing those vital highways.
• Family History: If heart disease or stroke runs in your family, PAD might, too.
• Race: African Americans face higher rates, partly tied to diabetes and hypertension prevalence.

Dr. Kokinos has a knack for connecting with patients on these risks. “I sit down with them and their families,” she says. “We talk about their life—smoking habits, diet, how they feel day to day. It’s not just a checklist; it’s about understanding what’s putting them at risk and how we can turn it around together.”

Treatment: Taking Back Control

The good news? PAD is treatable, especially when caught early. Treatment splits into two goals: easing symptoms and preventing disasters like heart attacks, strokes, or amputations. Here’s how it works.

• Lifestyle Changes: Step one is tackling the root causes. Quit smoking—Dr. Kokinos calls it “the single best thing you can do.” Exercise, like supervised walking programs, can boost circulation. A heart-healthy diet cuts cholesterol and plaque growth.
• Medications: Statins lower cholesterol, blood pressure meds ease artery strain, and antiplatelet drugs (like aspirin) prevent clots. For pain, cilostazol can help you walk farther.
• Procedures: When lifestyle and meds aren’t enough, Dr. Kokinos steps in with advanced options at South Bay Vascular.
  • Angioplasty uses a balloon to open blocked arteries, sometimes with a stent to keep them wide.
  • Atherectomy shaves plaque away, and
  • Bypass surgery reroutes blood around a blockage using a vein or synthetic graft. Her center’s state-of-the-art imaging and tools make these precise and effective.

Dr. Kokinos doesn’t just operate and send you home. “I give my patients my cell phone number,” she says. “If something’s wrong, I want to know right away. This isn’t a job to me—it’s a promise to be there for them and their families.”

Why Not All Vascular Surgeons Are Equal

Here’s the kicker: PAD care isn’t one-size-fits-all, and neither are vascular surgeons. Dr. Kokinos stands apart for reasons that matter to patients. She’s spent 30 years honing her craft, serving as chair of vascular surgery at Good Samaritan Hospital and leading wound care clinics in San Jose and Gilroy. Unlike many surgeons tied to big hospital systems, she’s independent, running a practice built on trust, not quotas.

At South Bay Vascular, you’re not a number on a list. “Big hospitals can feel like factories,” she explains. “Patients get rushed through, and families feel lost. I’m here for one patient, one family at a time.” Her accredited surgery center offers tech most hospitals can’t match, letting her tackle complex cases with precision. And her team—fluent in languages from Spanish to Mandarin—ensures everyone feels heard.

The Stakes Are High—And So Is the Hope

PAD isn’t just about leg pain. It’s a warning sign of heart disease and stroke risk. Untreated, it can lead to amputation—160,000 to 180,000 Americans lose limbs to PAD-related issues each year. But Dr. Kokinos offers a lifeline. “We offer hope when others say there’s none,” she says, echoing her practice’s motto. Her patients walk again, heal wounds, and reclaim their lives because she fights for them.

If you suspect PAD, don’t wait. Show your doctor your feet—take off those socks—and ask for a referral to a vascular surgeon. Better yet, call South Bay Vascular at 408-376-3626. Dr. Kokinos and her team are ready to listen, guide, and stand by you. This isn’t just about treating a disease; it’s about building trust, deepening relationships, and giving you and your family a future worth living for.

Throbbing Leg Pain at Night

If you’ve been following our Throbbing Leg Pain at Night series, you now understand how peripheral arterial disease (PAD) progresses into critical limb ischemia (CLI) and why choosing the right vascular surgeon can mean the difference between saving your leg and losing it. But there’s another factor at play—timing.

Every day you ignore your nighttime leg pain, your risk of irreversible damage, infection, and amputation increases. In this final part of the series, we’ll discuss why delaying treatment could cost you more than just your mobility—it could cost your life.

Why Waiting is the Worst Thing You Can Do

Many patients dismiss leg pain at night as a temporary issue or assume it’s related to aging, muscle fatigue, or even restless leg syndrome. But PAD and CLI don’t resolve on their own—they only worsen.

Consider these hard facts:

• Within six months of CLI diagnosis, 25% of patients will need an amputation.

• After a major amputation, 50% of patients die within five years.

• If CLI goes untreated, there is an 80% chance of losing the limb or life within one year.

When your body signals distress with throbbing leg pain at night, it’s not something to sleep on—it’s a life-threatening emergency.

How Rapid PAD Progression Leads to Amputation

PAD doesn’t just affect your legs; it impacts your entire cardiovascular system. The same blockages in your leg arteries can also exist in your heart and brain, putting you at higher risk for heart attack and stroke.

What Happens When PAD is Ignored?

1. Reduced Oxygen Supply – Blocked arteries deprive your limbs of oxygen-rich blood, causing worsening pain.

2. Tissue Breakdown Begins – Without circulation, tissues start to weaken, leading to non-healing sores.

3. Ulcers Become Infected – Open wounds are a breeding ground for infection, increasing the risk of gangrene.

4. Limb Becomes Unsalvageable – Once tissue death begins, amputation may be the only option left.

Why Dr. Polly Kokinos is the Go-To Expert for PAD & CLI

Not all vascular surgeons are skilled in limb salvage procedures—but Dr. Polly Kokinos at South Bay Vascular is one of the few in Santa Clara County with an unmatched track record of saving limbs even in advanced cases of CLI.

Her independent practice ensures:

 No financial incentives influencing medical decisions

 Access to advanced, minimally invasive treatments

 A dedicated team that prioritizes long-term vascular health

If you’re experiencing throbbing leg pain at night, don’t wait. Call Dr. Kokinos today and take the first step toward saving your leg—and your life. If your legs throb and ache at night ask your physician for a referral to Dr Kokinos and her team at South Bay Vascular Center and Vein Institute or call to schedule a second opinion on your own. 408-376-3626

Throbbing Leg Pain at Night A Warning Sign of PAD and Critical Limb Ischemia

If you’ve ever been awakened by throbbing leg pain in the middle of the night, don’t ignore it. While it may seem like a circulation issue that will pass, this symptom could be an early warning sign of peripheral arterial disease (PAD)or worse, a sign that the condition has progressed to critical limb ischemia (CLI), the most severe and dangerous stage of PAD.

The Link Between Nighttime Leg Pain and PAD

PAD is a progressive disease caused by plaque buildup in the arteries, restricting blood flow to the legs. Early signs often appear as intermittent claudication leg pain triggered by walking that eases with rest. However, as PAD advances, the pain doesn’t stop when you sit down.

Why does the pain worsen at night?

During the day, gravity helps blood flow to your legs. But when you lie down, that effect disappears. If your arteries are already narrowed or blocked, your legs may not receive enough oxygen-rich blood, causing deep, throbbing pain especially in the feet and toes.

Does dangling your legs off the bed bring relief?

Many patients instinctively dangle their feet over the edge of the bed to relieve the pain. This position forces gravity to help blood reach the feet, offering temporary relief. However, this is a major red flag indicating severe PAD.

Could it be Critical Limb Ischemia (CLI)?

If PAD has progressed to CLI, throbbing leg pain at night is just the beginning. Without proper blood flow, the skin and tissues in your feet and legs may start to break down, leading to non-healing wounds, ulcers, or gangrene and without urgent intervention, amputation may become necessary.

PAD Progression: From Silent to Severe

Nighttime leg pain doesn’t appear overnight. It’s part of a larger continuum of worsening vascular disease:

• Early PAD: Mild narrowing of arteries causes leg cramps with exercise but no symptoms at rest.
• Moderate PAD: Pain becomes more frequent, even while sitting or lying down.
• Severe PAD (CLI): Blood flow is so restricted that tissues start to die, leading to non-healing wounds, infection, and potential limb loss.

Understanding where you fall on this spectrum is crucial in preventing disease progression. The sooner you seek expert vascular care, the better your chances of preserving your leg and avoiding life-altering complications.

In Part II, we’ll discuss why choosing the right vascular surgeon can mean the difference between saving a limb and losing one. Not all vascular specialists are the same, and trusting the wrong provider especially physicians operating within a large hospital systems or those struggling to make their own private practices financially viable and where financial interests often dictate care can lead to devastating outcomes.

Continue reading to learn why Dr. Polly Kokinos at South Bay Vascular is Santa Clara Countys most trusted vascular expert and the best choice for preventing PAD-related amputations.

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.