Category: Blog

PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

Posted on by Michael Kokinos

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night?  Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists.  Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night.  Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

  • Veins are blood vessels that bring blood BACK from the feet to the heart.
  • Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet.  As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes.  The increase in venous pressure at the ankle typically results in

  • Varicose veins,
  • Swelling,
  • Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
  • Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting.  Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles.  When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles.  When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause!  Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon.  Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes.  Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

 

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

FIXING BLOCKED ARTERIES

Posted on by Michael Kokinos

The most common disease that I treat as a vascular surgeon is a medical problem called peripheral vascular disease.  Specifically, peripheral refers to the legs, and vascular disease refers to blockages of the arteries.

Because peripheral vascular disease is the most common disease that I treat, I want to talk today about what I can do as a vascular surgeon to fix these kinds of blockages in the arteries!

First though, let me explain why blockages to the arteries of the legs are bad.  When not enough blood flow reaches the legs, patients can have pain in their calves or buttocks that limits their ability to walk longer than a city block.  When the blockages are very severe, they can also have pain in their feet and toes even when they are not moving or develop non-healing ulcers and gangrene.  When I open blockages in patients’ legs, I allow them to walk again, or I give them the ability to heal their ulcers and gangrene pain free.  The improvement in patient lives is the most exciting aspect of my job!

There are two main approaches to performing what we call revascularization. Revascularization refers to the opening of old passageways or creation of new passageways to bring blood directly from the heart to the foot without any obstruction.

  • Open Surgery: In the early decades of vascular surgery, namely the 1980s and 1990s the primary way to treat peripheral vascular disease was to perform an open surgical bypass.  If there was a blockage in the thigh, I would surgically expose above and below the blockage and take a synthetic tube or the patient’s own vein and then sew it above and below the blockage.  This would allow the flow of blood to bypass the blocked segment, hence, the reason we call this surgery a bypass!  Though this procedure does produce robust flow, it necessitates large surgical incisions that cause significant pain and are susceptible to poor wound healing and/or infection.

 

  • Endovascular Surgery: In the 2000s, an innovative approach called endovascular surgery started to become more widely used and is now actually standard of care today.  Indeed, I prefer to treat patients with peripheral vascular disease with endovascular surgery whenever possible.  We access the arterial system of the leg with a needle in the groin.  Through that needle we put in a strong wire and over that wire we can then advance several different instruments over catheters.  In general, there are three different techniques I can employ in my efforts to re-establish blood flow to an area that is no longer receiving blood due to some type of arterial blockage.
    • Balloons: The most basic instrument is a balloon that expands and breaks up the narrowing or blockage.
    • Stents: If the balloon does not work, we can use a self-expanding tube called a stent.
    • Atherectomy: If the stent does not work, we can use a special device called atherectomy.  Atherectomy involves the use of a device that can literally cut the plaque out of the artery and aspirate all the debris.

 

These three technologies allow the reopening of arteries from the toes to the pelvis and only necessitate a 2 mm puncture site in the skin of the groin to be used.  There is little to no risk of infection and the procedure can be performed several times over the course of the patient’s life.  On the other hand, surgical bypass can only be performed twice—three times—during the patient’s life due to the development of dense scar tissue after each operation.

 

If you have trouble walking because of pain in your buttocks or calves or have pain in your feet and toes or ulcers that will not heal, please do not hesitate to call my office today at 408-376-3626 to schedule an appointment.  The chances are that I will be able to help take your pain and ulcers away! We Can Help

www.southbayvascular.com

ANEURYSMS: WHAT ARE THEY AND WHY IS IT IMPORTANT TO KNOW IF YOU HAVE ONE?

Posted on by Michael Kokinos

Of the many reasons that a patient can be referred to a vascular surgeon, one is that their referring physicians believes that their patient may have developed an aneurysm.  Aneurysms, typically speaking, form in arteries which are the specialized vessels that carry blood from the heart to the rest of the body under high pressure.  When the wall of an artery weakens, it can develop into a balloon-like dilation called an aneurysm. (See below). This most commonly occurs in the main blood vessel in your abdomen, which is called the abdominal aorta. When the blood vessels dilate to 50% greater than their normal diameter, the vessel has become an aneurysm.

 

 

Interestingly, the reason why aneurysms form is actually poorly understood.  We know that smoking cigarettes and a family history of aneurysms increases the risk that a patient will develop an aneurysm, but no direct cause-effect relationship has been established.  Diabetes mellitus, however, appears to have a protective effect.  That is, the presence of diabetes appears to help prevent aneurysms!  The other health risks of diabetes including neuropathy and infection, of course, make diabetes an undesirable health problem to have.

Aneurysms have two main catastrophic problems: Rupture and thromboembolization.  (to learn more about aneurysms visit our website at https://www.southbayvascular.com/aneurysms/  Rupture refers to a tear in the wall of the blood vessel resulting in a leakage of blood.  When aneurysms in the abdomen rupture, the amount of blood loss into abdomen can be life threatening and result in death within seconds.  Thromboembolization refers to the formation of blood clot within the aneurysm that then breaks off and goes somewhere else.  When aneurysm and associated blood clot form in the abdomen, these blood clots can break off and travel to the leg resulting in a lack of blood flow to the legs.  Such a sudden cessation of flow to the legs can result in the death of the foot and/or legs within hours.

As you can see arterial aneurysms can be very troublesome.  Luckily, vascular surgeons have many tools and instruments that we can use to treat these aneurysms in a minimally invasive way.  In my blog next week, I will go over the different options for treating aneurysms in the abdomen.  If you or someone you love have been told that you may have an aneurysm, please call our office immediately to schedule an appointment for a full vascular work-up. 408-376-3626

We Can Help!

 

WHAT IS “ENDOVASCULAR” SURGERY?

Posted on by Michael Kokinos

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

  • Open surgery is just as you might think!  It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures.  Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
  • Endovascular surgery is a recent development that only began in the 1990s.  Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel.  Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel.  Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot.  For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage.  If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open.  There is also a technology called atherectomy which literally means cutting out plaque.  The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric.  We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed.  Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm!  As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients.  If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!

WHY DIABETES IS BAD FOR YOUR FEET

Posted on by Michael Kokinos

Everyone knows that diabetes, otherwise known as high blood sugar, is bad for you.  What most people don’t realize, however, is just how many people in the US have diabetes and the impact diabetes has on their feet. In 2021 the CDC released the following info graphic:

 

As a vascular surgeon the primary issue I see in patients with diabetes is foot infection.  But how does diabetes specifically make it more likely for patients to develop foot infections?  My hope in writing this blog today is to give patients a complete understanding of what happens to the feet of people with diabetes.

High concentrations of sugar in the blood lead to what physicians call an inflammatory state in the arteries, or blood vessels that take blood from the heart to the rest of the body.  The inflammatory state results in scarring and narrowing in the arteries.  However, only smaller blood vessels such as the ones in the eyes, toes/feet, and kidneys are affected significantly.  In the feet, the scarring affects both arteries that supply the feet and toes themselves as well as the arteries that supply the nerves.

With a lack of blood flow to the nerves of the feet, patients lose sensation in their toes and feet.  Thus, when a patient has an accidental injury like a scratch or a bruise, no pain is registered, and the area continues to be traumatized and unable to heal.  In addition, the muscles of the foot lose their ability to contract, and they then relax into positions that create bony prominences that erode through the skin and cause ulcers.  Finally, the nerve damage also results in the loss of natural oils in the skin that then makes the skin dry and prone to cracking.  This cracking then increases the chance of ulceration and foot infection.

As you can see, diabetes is very bad for the foot!  If you are diabetic and see an ulcer on your foot or have either pain or numbness, do not hesitate to call our office at 408 376-3626 to schedule an appointment today! Visit our website at www.southbayvascular.com to learn more. We Can Help!

BLOOD CLOTS

Posted on by Michael Kokinos

Today, I want to give insight into one of the more common questions I receive as a vascular surgeon: How do I know if I have a blood clot?

Why is this important? Here are a few facts directly from the US Center for Disease Control and Prevention (CDC).

  • Anyone can develop a blood clot.
  • In the United States, as many as 900,000 people are affected by DVT’s each year and
  • About 100,000 people die of PE annually.

Many factors can put you at risk for a blood clot. These include:

  1. Major trauma
  2. Cancer
  3. Being 55 and older
  4. Having a personal or family history of blood clots
  5. Immobility (such as being on bed rest or difficulty with walking)
  6. Pregnancy, or using estrogen containing medications such as birth
    control pills, patches, and hormone replacement therapy
  7. Obesity
  8. Smoking

Almost half of all blood clots occur either during or soon after discharge from a hospital stay or following surgery. The more risk factors you have, the greater your risk of developing a blood clot will be.

The medical term for blood clot is Deep Vein Thrombosis. (DVT) Veins at their most fundamental level are blood vessels that return blood from the body (e.g. feet, hands, intestines, kidney, etc.) back to the heart.  In the legs, there are two main sets of veins: superficial and deep.  Deep veins are very close to the muscle and bones.  Superficial veins are very close to the skin, hence the name superficial.  The word thrombosis derives from the Greek word of the same spelling, thrombosis, which means curdling.  In contemporary medicine thrombosis refers to the blood’s transition from liquid to solid.  With all these words explained, we can see that a deep vein thrombosis refers to blood clots that are in the deep system of veins in the legs.  Though superficial veins can become clotted as well, the symptoms that result are usually not as severe as a deep vein thrombosis.

Once the deep veins of the legs are blocked, blood becomes trapped in the veins below and the blood pressure in the veins increases.  Consequently, the leg and foot will become swollen, blue, and tender.  Patients often complain of a “tension” or “pulling” sensation in the groin, thigh, and behind the knee.  These feelings of tension and pulling are often also considered as very painful.  Because of the swelling there may be severe difficulty with tasks as simple as walking to the bathroom or a few feet.

PE’s: A Silent Killer

Sometimes, a piece of clot can break off from the legs and travel to the lungs.  This is called pulmonary embolism or PE.  Pulmonary refers to lungs and embolism refers to something that breaks off from one place and travels to another.  When patients have a blood clot associated with a pulmonary embolism, they will experience:

  • Shortness of breath
  • Palpitations/fast heart rate, and
  • In very severe cases, dizziness associated with fainting.

Recognize The Signs and Symptoms of a Blood Clot

DVT (Arm or Leg) – if you experience any of these, call your doctor as soon as possible.

  • Swelling of your leg or arm
  • Pain or tenderness not caused by an injury
  • Skin that is warm to the touch, with swelling or pain
  • Redness of the skin, with swelling or pain

PE (Lung) – if you experience any of these, seek medical attention immediately.

  • Difficulty breathing
  • Chest pain that worsens with a deep breath
  • Coughing up blood
  • Faster than normal or irregular heartbeat

Blood Clots Can Be Prevented

  • Know your risks and recognize signs and symptoms.
  • Tell your doctor if you have risk factors for blood clots.
  • Before any surgery, talk with your doctor about blood clots.
  • See your doctor as soon as you can if you do have any symptoms.

    I hope this blog post can shed some light on blood clots.  If you or someone you know are experiencing these types of symptoms, please do not hesitate to visit our website at www.southbayvascular.com to call our office at 408 376 3626 to schedule an appointment today!

    FOOT PAIN AT NIGHT?

    Posted on by Michael Kokinos

    As vascular surgeons, many of the consultations and questions we receive revolve around one issue: foot pain!  As people age there can be many sources of foot and leg pain and I want to shine some light onto a few of the most common causes that I see.  They include peripheral vascular disease, chronic venous insufficiency, diabetic foot disease, and sciatica.

    Peripheral Vascular Disease:

    In all people there are two main kinds of blood vessels, arteries, and veins.  Arteries bring blood from the heart to the feet.  Veins bring blood back from the feet to the heart.  In individuals who have a history of

    • High blood pressure,
    • High cholesterol,
    • Diabetes,
    • Obesity,
    • Smoking

    The arteries that lead to the feet can develop blockages, otherwise known as Peripheral Vascular Disease.  When too many blockages develop, the feet do not receive the amount of blood they need to stay alive, and they become very painful.  When this happens, patients tend to hang their feet in dependent positions off the side of the bed at night to allow gravity to help the blood travel through the blockages to the feet.  The pain tends to concentrate on the forefoot and toes where the blood vessels are the smallest.

    Chronic Venous Insufficiency

    With vein disease, patients tend to have swelling in the legs below the knee including the ankle and feet.  Normally, there are structures in the veins called valves that allow blood to go to the heart but not to go back down towards the feet.  In patients with vein disease, these valves leak and cause blood to pool in in the legs below the knees.  After patients are standing or sitting upright for extended periods of time, the pressure in the veins of the legs builds resulting in an aching pain as well as also causing varicose veins, dark discoloration of the skin, and, in the worst cases, ulcers on the leg.

    Diabetic foot disease

    Diabetic foot disease is one of the most common problems I see as a vascular surgeon.  These patients describe numbness much more often than pain.  This numbness is a result of the inflammatory damage that high sugar levels in the blood can inflict on the nerves of the foot.  Sometimes, even when these patients develop ulcers, they do not feel any pain because the nerve damage is so severe.  As such, patients with diabetic foot ulcers, though they can experience pain, often experience numbness as well.

    Sciatica

    Lastly, sciatica can also be a cause of leg and foot pain.  The nerves that detect sensation from the legs and foot originate from the spinal cord in the back of the pelvis and abdomen.  As such, when these nerves are pinched they tend to cause the patient to feel a pain radiating from the lower back or buttock down the leg and sometimes even to the foot.  This radiating pain can be easily distinguished from the pain of peripheral vascular disease and venous insufficiency which is concentrated in the legs and feet.

     

    If you or anyone you know suffers from leg pain at night and if any of these stories seem to fit the pain or discomfort that you may be having in your legs, please call one of our South Bay Vascular Offices in either Campbell or Gilroy CA at 408 376 3626 today to schedule an appointment! We Can Help!

    ARTERIES AND VEINS….WHAT’S THE DIFFERENCE?…AND HOW DO THEY WORK?

    Posted on by Michael Kokinos

    As a vascular surgeon, one of the more common questions I receive from patients and from friends and family alike is what do I actually do?  I find the question interesting because before I went to medical school, I did not even know that the field of vascular surgery existed!  Vascular surgeons operate on the blood vessels all around the body including the chest, arms, neck, abdomen, and legs. One key thing to remember is that Vascular surgeons do NOT work on a person’s heart. Heart doctors are more commonly known as cardiologists and cardiac surgeons.

    There are two different types of blood vessels: arteries and veins.  Arteries are the tubes that bring blood from the heart to the rest of the body including arms, legs, head, abdomen, and legs.  Arteries allow blood to travel at high speed with the pressure provided by the contraction of the heart.  Common health problems like high blood pressure, high cholesterol, smoking, and diabetes can result in blockages of the arteries that lead to the foot.  Once the blockages are severe enough, a patient can have pain in the calves and feet as well as ulcers or gangrene of the toes and feet that do not heal.  In addition to the effects on the legs, patients can also develop narrowing in the carotid arteries that supply the brain, the arteries that lead to the arm, and the arteries that lead to organs in the abdomen.

    On the other hand, veins are the tubes that bring blood back to the heart from the body.  After dropping off oxygen and nutrients to the tissue, the blood returns to a low-pressure state and thus moves at a low speed in the veins back to the heart.  Because of the low pressure, specialized structures called valves exist in the veins to make sure that after blood goes back to the heart, the blood does not reflux back into the vein.  When reflux occurs, the venous pressure can increase and cause ulcers, swelling, and varicose veins in the legs.

    If you have ulcers on your feet that have not healed or varicose veins or swelling in your legs that are limiting your life, do not hesitate to call our office at 408-376-3626 to schedule a consultation. We can help!

    Visit our website at www.southbayvascular.com to learn more about who we are, what we can do, and how we can help restore your circulatory health.

    South Bay Vascular Center and Vein Institute

     25 years of compassionate vascular care for South Bay communities

     

    YOU HAVE A BLOOD CLOT. NOW WHAT?

    Posted on by Michael Kokinos

    One of the most common consultations that we as vascular surgeons receive is for deep vein thrombosis, otherwise known as blood clots.  Deep veins refer to the location of the vein that has the problem.  In the legs we have two main sets of veins: Deep and superficial.  Deep veins are within the muscle and close to the bones whereas superficial veins are close to the skin; hence their names!

    Thrombosis refers to the process of the blood turning from a liquid into a solid form.  Normally, thrombosis occurs in response to an injury to stop bleeding from a wound.  However, when thrombosis occurs in the deep veins, it stops blood from being transported from the foot back to the heart.  The obstruction of flow results in swelling and pain below where the thrombus, or clot, has formed.

    There are many causes of blood clots, but the most common causes include:

    • Traveling for extended periods of time in a sitting or resting position.
    • Trauma, including accidents which cause broken bones or bruises.
    • Narrowing of the veins of the pelvis, and
    • Specific genetic mutations that increase the likelihood of the blood forming clots. 
    • In older patients, another potential cause of blood clots without any other cause is cancer.  Cancer, unfortunately, can result in the release of chemicals and hormones within the body that make clotting more likely.

    For patients who develop a blood clot in the context of traveling, narrowed pelvic veins, or having a traumatic injury to the affected leg, treatment involves a 3-month course of blood thinning medication followed by ultrasound tests to determine the stability of the clot.  If the symptoms improve and the clot remains stable, then the medication to thin the blood can be stopped at 3 months.

    For travelers who are forced to sit for extended periods without being able to move, making an effort to walk around intermittently throughout the traveling can be helpful.  For example, on the plane, every 30 minutes stand up and walk up and down the aisle 3-4 times.  For patients who have a traumatic injury to their leg, the best choice would be to avoid, if possible, situations that led to the particular accident.  Finally, in patients with narrowed pelvic veins, I as a vascular surgeon can help relieve the narrowing with a special minimally invasive procedure called a venogram.  In the procedure, I place a self-expanding tube called a stent into the compressed vein via a small 2 mm puncture site in the groin to make sure the compressed vein remains open.

    For those patients who did not have a traumatic accident, narrowed pelvic veins, recent travel, or a high suspicion of cancer, referral to a hematologist, or a doctor who specializes in disorders of the blood, can be helpful.  The hematologist can help order special genetic tests to determine if there is a genetic predisposition to forming clots.  In patients who do end up having genetic mutations, long-term placement on blood thinning medications can help prevent further events.

    If you are anyone that you know is suffering from a blood clot, please do not hesitate to call our office on 408-376-3626 to schedule an appointment!  The expertise that vascular surgeons have in this area of medicine is critical to ensure a good outcome!

    TRANSCAROTID ARTERY REVASCULARIZATION: THE FUTURE OF CAROTID SURGERY

    Posted on by Michael Kokinos

    One of the most gratifying problems we help treat for patients is carotid artery disease.  The carotid arteries supply the brain with blood.  In patients with high blood pressure, high cholesterol, diabetes, and a history of smoking, the carotid arteries can become narrowed and form blood clots that then go into the brain and cause strokes.  Traditionally, vascular surgeons have fixed this carotid artery narrowing’s with a surgery called a carotid endarterectomy.  The carotid artery is dissected out and cut open.  The plaque is then removed, and the carotid artery is sewn back together.

    Over the past five years, however, I have had the opportunity to perform a new technique involving carotid stenting called trans carotid artery revascularization or TCAR.  Stents are self-expanding metal tubes that we can use in the carotid artery to stop clots from forming in narrowed areas.  TCAR uses a suction machine to reverse flow in the carotid artery during the placement of a stent to minimize the risk of inadvertent stroke during the procedure itself.  After having performed over 20 of these procedures in the past two years, I can say with confidence that the flow reversal and stenting that TCAR provides is a highly safe and successful way to treat carotid artery disease.  Furthermore, the length of the incision, postoperative pain, and risk of nerve damage and bleeding are all much less with TCAR than with CEA.

    I am so happy to be able to offer this revolutionary, safe, and effective therapy to all my patients at South Bay Vascular Center.  Should you or anyone you know have any problems with your carotid arteries or a stroke, please do not hesitate to call us today at 408-376-3626 to schedule a consultation.

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