Tag: Leg Swelling

BLOOD THINNING MEDICATIONS PART 2: ANTIPLATELETS: PLAVIX AND ASPIRIN. WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Last week I began a description of the medications that vascular surgeons use with a blog post on drugs used for anticoagulation.  This week, I want to describe a group of medications that also thin the blood, albeit through a different mechanism.  As discussed last week, the coagulation cascade works to turn the blood from a liquid to a solid.  A special group of cells in the blood mixed with red blood cells called platelets works simultaneously with the coagulation cascade to serve as the glue so to speak between clumps of red blood cells.  This bond that platelets facilitate with clotted blood helps clot to attach and build upon other collections of clot, thereby facilitating the control of bleeding that the clotting system was designed for.

Obviously, in the case of vascular surgery we often times want to prevent blood clotting from occurring.  The main agents we use are aspirin and plavix (clopidogrel).  In the early 2000s literature from interventional cardiology for minimally invasive heart procedures found that placing patients on aspirin and plavix together reduced the incidence of recurrent heart attacks as well as death.  This literature from cardiology has been extrapolated to the lower extremity circulation and allows the interventions we perform in the lower extremities to fix blood flow to stay open for a long period of time.  In addition to the use of aspirin and plavix for lower extremity arterial blockages, we also use it in patients who have had a stroke in order to help prevent them from having another stroke.

Aspirin is a low strength blood thinner that patients can take orally as an 81 mg tablet once a day.  In the body aspirin blocks a specific enzyme called cyclooxygenase.  When cyclooxygenase is inhibited, the enzyme cannot help to produce chemicals in the blood called prostaglandins.  Prostaglandins are normally responsible for creating an environment that stimulates the clotting of blood via complex but mild mechanisms.  Studies have shown generally that patients with cardiovascular disease have a lower incidence of death, stroke, and heart attack over time than patients who do not take aspirin.  In general, I tend to make sure that all my patients who have peripheral vascular disease take aspirin as a general preventative measure.

Plavix is a much higher strength blood thinner that binds directly to platelets and completely inhibits their function.  When used in concert with aspirin, the blood becomes thin enough to prevent the recurrent blockage of vessels that we have opened up.

Overall the large majority of my patients who receive procedures to fix blood flow to the foot are placed on aspirin and plavix.  If you think you might benefit from these medications or are in need of a procedure to fix the blood flow to your feet or brain, please do not hesitate to call my office to schedule an appointment!

 

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

CLICK ON THE LINK BELOW TO READ HOW OUR PATIENTS DESCRIBE THEIR EXPERIENCE AT SOUTH BAY VASCULAR.

https://www.google.com/search?q=south+bay+vascular+center&rlz=1C1GGRV_enUS748US759&oq=&aqs=chrome.0.69i59i450.91302019j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

 

BLOOD THINNING MEDICATIONS PART 1: ANTICOAGULANTS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Over the next few weeks, I want to discuss the medications that vascular surgeons may prescribe.  These medications include anticoagulants, antiplatelets, statins, and other miscellaneous agents.  This week I will discuss anticoagulants!

Anticoagulation refers to agents that STOP the clotting of blood.  The clotting of blood starts with what is known as the coagulation cascade.  The cascade refers to a series of consecutive events each involving special proteins that are needed to occur for blood to form a clot.  Different anticoagulants block specific parts of the cascade.  The main reason we usually see patients with anticoagulants are for hypercoagulable states, certain heart arrhythmias like atrial fibrillation, and deep vein thromboses otherwise known as blood clots.  Hypercoagulable states are specific genetically inherited disorders that result in the blood being more likely to clot.  Atrial fibrillation and other arrhythmias can cause blood clots to form in the heart.

 

Anticoagulant agents are given to prevent the formation of clots in the heart that can then break off and go to the brain, hands, feet, kidneys, or any other part of the body and cause problems. 

 

Deep vein thrombosis or blood clots mandate the prescription of anticoagulant therapy to ensure that more blood clot does not form.

 

Anticoagulants can be broken up by many different classification schemes.  For the purposes of this blog, I will limit our discussion here to agents that are appropriate for the OUTPATIENT (Outside of the hospital) setting.  Please speak with you private physician to answer any additional questions you may have regarding Anticoagulation medication of feel free to reach out to me directions for more information on how anticoagulation is used. Anticoagulation agents that are used during hospitalization or in the IN-PATIENT setting in patients are outside the scope of this article.

 

Up until the 2010’s the mainstay of anticoagulation therapy was with a drug called warfarin (Trade name: Coumadin).  Warfarin, though effective, requires the weekly or biweekly measurement of a specific lab for the blood called the prothrombin time.  The active monitoring of the prothrombin time facilitates modulation of dosing to always allow for safe levels of effective therapeutic anticoagulation.  Since the beginning of the 21st century new agents have come to market that require only taking one or two pills a day.  They include Xarelto or Rivaroxaban and Eliquis or apixaban.

If you have a question about how your medications may be affecting your vascular disease, please do not hesitate to call and schedule an appointment today!

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

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!

    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!

    ONE PATIENT, ONE DOCTOR, ONE NURSE; SOUTH BAY VASCULAR CENTER’S COMMITMENT TO PERSONALIZED CARE

    Posted on by Michael Kokinos

    Unlike so many big box medical centers (Kaiser, Sutter, PAMF, Stanford) where patients are often “overwhelmed” as soon as they get to the parking lot, South Bay Vascular Center and Vein Institute offers world class, cutting edge vascular surgical care in a kinder, gentler environment.  Individualized patient care, although talked about and marketed heavily by these corporate health systems, more often than not falls far short of patient expectations as higher order operational efficiencies and profitability concerns impact the kind of care patients actually experience in these larger health care systems.

    ONE PATIENT; ONE DOCTOR; ONE NURSE. 

    Putting patients at the center of everything that a physician does is a philosophy that sounds obvious…but is that always the case? At South Bay Vascular Center we are honored by the chance to earn your trust and to serve as your physicians; BUT, we also know that we must EARN the trust of every patient that we see.  That’s why our CREDENTIALS are NOT Enough…That’s why our REPUTATION is NOT enough. That’s why unmatched patient care is at the center of everything that we do. That’s why when patients come to our facility for a procedure each patient has their own nurse from start to finish to ensure the greatest patient care experience from start to finish. 

    We know patients have options for their vascular care and that’s why we work hard to ensure that any patient referred to us by another doctor or that comes to us on their own has the confidence to know they’ve made the right choice of doctor to help them with their vascular related illnesses. ONE PATIENT; ONE DOCTOR; ONE NURSE is just one of the many ways that South Bay Vascular Center demonstrates our commitment to our patients in our efforts to provide the most advanced vascular care options offered anywhere in the world.

    OUR TEAM

    Together with her full time, highly skilled team of critical care and surgical nurses, radiological technicians, RVT certified Ultrasound Technologists and scrub assistants, Dr Kokinos provides unmatched peripheral vascular surgical care in her Nationally Accredited Surgical Facility. As diverse as Silicon Valley is, our staff reflects this same diversity as we have native speaking staff fluent in over 10 different languages. Be it Vietnamese, Mandarin, Korean, Russian, Tagalog, Hindi, Spanish, French, Greek or English, we have staff to make our patients comfortable in their native tongue.

    OUR FACILITY

    The South Bay Vascular Ambulatory Surgery facility is one dedicated entirely to the practice of Vascular Surgery and houses a specialized inventory of vascular medical devices and imaging equipment that surpasses the number of vascular medical devices and imaging equipment at Good Samaritan and O’Connor Hospitals combined. Together with her highly trained and specialized team, Dr Kokinos brings over 30 years of surgical experience and 7 years of specialized surgical experience operating in a specially built vascular surgery outpatient facility to her patients.  Other physicians may claim to have the kind of training and experience that Dr Kokinos has in the outpatient environment, but NO other Vascular Surgeon in Silicon Valley comes anywhere close to having the kind of experience and outcomes Dr Kokinos does when it comes to providing care to the patients who come to her for the treatments and care of their vascular disease.

    Put another way, for 25 years Dr Kokinos and her team at South Bay Vascular Center and Vein Institute have provided unmatched, compassionate and individualized vascular surgical care to South Bay communities. It is why more independent physicians refer their vascular patients to Dr Kokinos than to all the other Silicon Valley vascular surgeons combined. When it comes to your health, we know that it’s not just our credentials and our experience that count.  It’s not about just having an accredited facility or a staff of travelling specialists to help when needed…   It’s about the RIGHT KIND OF EXPERIENCE EVERY TIME YOU NEED IT.

    RESULTS matter when it comes to your health because sometimes you don’t get a second chance.

    South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say there Is None.

    Call us at 408-376-3626. We Can Help

    FOOT PAIN AT NIGHT: IT MIGHT BE MORE SERIOUS THAN YOU THINK

    Posted on by Michael Kokinos

    Many patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol wake up at night with pain in their foot or toes. Some believe this is arthritis or gout; others think it is the result of just spending too much time on their feet during the day.  Patients often self-adapt to this problem, as it usually develops slowly over time, but when questioned about their sleep habits, they will sometimes tell you that they sleep in a recliner or they sleep with their leg hanging over the side of the bed to make their pain go away.

    It is very common for elderly patients to get up at night to go to the bathroom. Sometimes, however, it’s actually foot pain that wakes them up.  Once up, they get out of bed because that makes their feet feel better (again due to gravity) and after walking to the bathroom they can go back to sleep, pain -free for a couple of hours.  Even that small amount of walking helps to get their blood flowing again and makes it easier for them to go back to sleep.

    Sometimes, foot pain at night is the sign of a more serious condition.

    • Foot pain at night may be related to having poor circulation in the foot. The name for this in medical terms is “rest pain”. This is not “pain at rest” but rather pain that happens because the circulation cannot support the tissues even when they are at rest.

    Foot pain at night may be an early warning sign of critical limb ischemia.

    • Chronic Limb Ischemia is another term for lack of blood flow;  if you experience this rest pain at night and it goes away after hanging your foot over the side of the bed or chair you are sleeping in, immediately call and speak with your doctor to set up an appointment for them to evaluate your symptoms. Although it may come on slowly, the arteries in your feet may be so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes need to keep them nourished. Left untreated, this blockage can lead to a more serious problem, amputation or even death.

    What’s important for the patient to realize is that chronic limb ischemia causes the foot and leg to get swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem

    If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor OR schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you may need immediate help. This truly is a sign that your foot is starving for oxygen and blood and that if left untreated, might lead to an unnecessary amputation. Help is possible, however and if treated early enough, those suffering from these symptoms can be helped significantly.

    If you suffer from painful feet in the middle of the night, WE CAN HELP

    contact us today  at 408-376-3626 to learn more about PAD and how Dr. Kokinos can help, click here.

    South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say There Is None.

     

     

    THE “RIGHT” EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH

    Posted on by Michael Kokinos

    The “RIGHT” Experience Counts When It Comes to Your Health! South Bay Vascular Center and Vein Institute is the Bay Area’s Most Trusted Varicose Vein Clinic and Treatment Center.

    Having performed over 20,000 vein procedures in the past 24 years, more independent doctors refer their vein patients to Dr. Polyxene (Polly) Kokinos than to any other vascular surgeon in the greater Silicon Valley region. Recognized as San Jose’s most experienced Vascular Surgeon and Varicose Vein Expert, Dr Kokinos offers cutting edge care to patients suffering from all forms of both arterial and venous disease.

    Here’s why more local doctors refer to South Bay Vascular than to any other Vascular Surgery Center in the Valley:

    • The “RIGHT” Experience Counts When it Comes to your Health: South Bay Vascular center has been treating vein patients in a private practice setting for over 24 years.
    • Cutting edge vascular care in a fully accredited, state of the art, and private out-patient surgery center dedicated entirely to the practice of vascular surgery.
    • Access to the most Advanced Imaging and Device technologies found anywhere in the world.
    • On-site fully staffed IAC accredited Vascular Ultrasound Clinic that is operated full time by Registered Vascular Technologists (RVT).
    • Vascular Studies ready by RPVI certified Vascular Surgeons.
    • Same day availability for Hemodialysis Access de-clots.
    • “One-Doctor, One Patient, One Nurse” practice philosophy means we put the patients first.
    • Full time access to practice physicians
    • Easy access to care: No admissions departments.
    • RESULTS:   We are MORE than just a colorful website and a Google Adwords campaign. Remember, all that glitters is NOT Gold!  https://www.southbayvascular.com/blog/varicose-vein-doctors/

     Trust the doctor your physician does.

     Remember, Its Not Just Experience That Counts.

    When It Comes to Your Health, It’s The “RIGHT” Experience that Matters!

    Dr Polyxene Kokinos, Silicon Valley’s Vascular Surgeon.

    Call us today at 408-376-3626 to schedule your vein consultation.

    Click here to learn more about Dr Kokinos  NOT JUST VASCULAR CARE, EXCEPTIONAL VASCULAR CARE

    VARICOSE VEIN DOCTORS

    Posted on by Michael Kokinos

    Type “Varicose Vein Doctor” into your Google search and in seconds, you’re overwhelmed by results.

    Each link points to a different website.  Each site claims their “Vein Doctor” is the “best” and every practitioner claims to have the “bona-fides” to back-up these claims. Credentials span the continuum from Academic Institution Affiliations, (claiming to be X, Y or Z University Affiliated); to Chair-Personships (they “chaired’ this or that medical departments in the “Big Box” health care systems they came from (i.e. Kaiser, PAMF, or Sutter) to Medical Journal Publications…all this in an apparent attempt to equate administrative responsibilities with clinical excellence. Some of the bolder in the group even claim they trained at the best medical schools hoping to convince potential patients that by attending a great medical school they are the best physician for the procedure.

     

    AN ESPECIALLY CONCERNING TREND IS A PHYSICIAN’S USE OF GOOGLE ADWORDS TO ADVANCE THEIR MESSAGE

     

    If a vein doctor’s website shows up in your Google Search and you see that the listing starts with the word “AD” …be careful. It means that the owner of this practice is paying Google a special Advertising fee to get their name to the top of the search results. This is an attempt by this physician to “BUY LEGITIMACY”.  Businesses PAYING google to display their ads above the practitioners who have EARNED this privilege is a great way for Google to make money. Unfortunately, it can be deceiving to people who think that because a doctor’s website pops up at the top of the search results that they must be the best. (On a separate note…If a physician’s website DOES show up at the top of the search results and DOES NOT have the word “AD” in front of it, IT IS a sign that this physician has many website visitors and that they have been around for a long time…Especially if this listing is followed by a large number of Google Reviews.)  It also means that this physician has EARNED their reputation, and NOT purchased their website ranking. A word of warning to patients searching for an experienced vein care professionals. Anyone can pay to elevate their search rankings on Google; regardless of their experience.

     

    IGNORE websites with paid “AD’s”, especially if they don’t have any verified Google reviews. 

     

    To make things even more difficult, it can be very confusing just trying to figure out what kind of doctor actually does varicose vein procedures. Some doctors call themselves “Vein Specialists”. Others call themselves “Vein Experts”. You’ll also see the labels “Phlebologist” and “Vascular Expert”. Finally, there is the “Vascular Surgeon”. You ask yourself, do all of these physicians fix varicose veins? If so, what’s the difference? (Learn more by clicking on the following link). https://www.southbayvascular.com/blog/vascular-surgeon-vs-phlebologist-vs-vein-specialist/ Every one of these “Vein Doctors” promises to rid you of your ugly, painful veins, leg swelling and non-healing ulcers. Every one of them posts photos showing off their work to prove their point.

    Let’s face it, it’s confusing. All you really want is to get your veins “fixed” so that next time you get invited to a pool party you can wear shorts or a skirt again without being “mortified” by how bad your legs look. So, what’s next?

    Lost in this hype, finding the right doctor to treat your varicose veins might seem impossible. Choosing the best doctor for your specific vein condition is a difficult decision and not one that you should take lightly.  Only after serious consideration of the available options should this decision be made and in the best of all worlds, it should be made in consultation with your primary care physician…and this is the probably the most important message in this post.

    LISTEN TO YOUR PRIMARY CARE DOCTOR

    They’ve been in this community a long time and they know who is good and who is not. Their referral should be your number one reason to make an appointment with a Varicose Vein Doctor.

    In the best of scenarios, patients should visit as many doctors as they can; interview them and question them about everything relating to their condition and their ability to help you…but remember, your primary care doctor has been doing this for a long time. They’ve got the benefit of having seen the results from different doctors and on the strength of their recommendation, you should have the confidence to know that you are making the right choice.

    Here are a few things varicose vein patients should keep in mind:

    1. Remember, these are your legs. You deserve the best and you deserve to “Love Your Legs Again”.
    2. Don’t be frightened to ask your doctor tough questions.
      • Don’t just ask your vein doctor how long they have been in practice, ask them how long they have been doing these specific kinds of vein procedures. Ask them how many of these procedures they’ve done.
      • If your doctor is in private practice, ask them how long they have owned their own practice. This is important because getting things done right in a private practice is significantly more difficult than getting work done in a University Hospital or Big Box Medical System.
      • How many of these procedures have you done RECENTLY….if they do less than 25-30/ month, you might want to seriously consider finding another option
      • What kind of complications might you expect…every person is different and if your doctor says your legs will look as good as they did when you were 20, you might want to consider seeing someone else.
      • Who does your ultrasounds…are your ultrasound techs RVT’s (Registered Vascular Technologists?) Are they done “in-house” by full time Vascular ultrasonographers or are they done by “travelling” ultrasonographers who just work in their office a few times a week and who are not full time employees of the medical office.
      • Most importantly, is your Vascular lab IAC Accredited? This is especially important as your doctor will make their diagnosis on the basis of your ultrasound report and an IAC accreditation guarantees the best of the best studies are being done at that particular lab.
      • Who reads the ultrasounds….is it an RPVI registered physician, not simply a radiologist… as the two physicians will look for vastly different signs relating to vascular disease and health. Keep in mind if the study isn’t read correctly, the procedure can go poorly.
    3. Finally, ask your “Vein Specialist” about what happens if you have a complication Ask your provider if they have “Admitting privileges” at the local hospital in the event something goes wrong during the procedure and what their plan is if their procedure fails.

     

    EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH!

     

    South Bay Vascular Center and Vein Institute brings 24 years and 20,000 vein procedures to you as our patients. As the leading independent Vascular Surgery practice in the San Francisco Bay Area, more local independent physicians refer their vein patients to Dr Kokinos than to any other vascular surgeon in the greater Silicon Valley Region.

    WE OFFER HOPE WHEN OTHER SAYS THERE IS NONE!

    Call us today at 408-376-3626 to schedule your vein consultation

    LEG SWELLING: SYMPTOMS AND SIGNS

    Posted on by Angelica Rodezno

    Do you Suffer From Iliac Vein Compression?

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

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

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

    May Thurner’s Syndrome, also known as iliac Vein Compression, is a condition where the main artery supplying blood to the leg pushes down or compresses the main vein taking blood back to your heart. In the illustration below you can see in the far right graphic a “representation” of this compression. One way to help think of what happens when a patient suffers from iliac vein compressions is to consider what happens when a car tire partially runs over a garden hose in your driveway.

    If the hose was “on” when you drove over it, water will continue to come out of the hose end but the flow rate will decrease. In a similiar way, blood returning to your heart will continue to flow if you have developed iliac vein compression, but the rate at which it returns is slowed down, resulting in a pooling of blood (i.e. swelling) in your leg.

    Chronic pain and swelling in one leg (especially the left side) may be caused by Iliac Vein Compression. This is a little-known but fairly common condition that can greatly impact your quality of life—and may lead to more serious complications. In fact, studies have shown that in a full 30% of ALL people, the left iliac vein can be significantly compressed by the right iliac artery resulting in some kind of leg symptom….aching, heaviness, and most commonly, swelling or non-healing of wounds in the leg veins.

    Swollen legs ARE NOT a normal part of aging or weight gain. And it’s not something you have to “just live with.”

    Leg swelling is a special area of interest of Dr. Polly Kokinos, and she has been active in doing clinical research to find better ways to diagnose and to treat this condition. To diagnose and to treat this condition and the potentially deadly side effects caused by it (Blood Clots or Deep Venous Thrombosis) Dr. Kokinos has assembled a highly skilled team of vascular ultrasonographer’s who have developed a specialized screening protocol to evaluate for Iliac Vein Compression. Using state of the art ultrasonic imaging technology Dr. Kokinos’ Registered Vascular Ultrasonographer’s use this new protocol to scan up into the abdomen of their patients to examine the physics of the blood flow in this area. If a compression is identified during this ultrasound exam, Dr. Kokinos is able to further verify and treat this problem using a super specialized device called IVUS (Intra-vascular ultrasound) where she can insert a miniuture camera into the actual vein to determine the length of the compression after which she can place a stent to “re-open” this compressed vessel to re-establish normal blood flow.

    To date, Dr. Kokinos has successfully performed over 200 of these iliac vein stent procedures in her state of the art out-patient angiography suite. She has lectured extensively at major vascular surgery meetings on her approach and success helping patients reduce leg swelling, increase the rate of wound healing and return to a normal way of living and is seen by her peers as an expert in this technique.

    If you are currently experiencing a swollen leg, have a non healing leg, foot,or ankle wounds or have ever suffered a blood clot (DVT) please contact our office at 408-376-3626 to schedule an appointment.

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

    We can help!

    A SWOLLEN LEG IS NOT NORMAL

    Posted on by Angelica Rodezno

    Leg Swelling: Iliac Vein Compression
    Chronic pain and swelling in one leg, (especially the left side) may be caused by iliac Vein Compression. This is a little-known but fairly common condition that can greatly impact your quality of life – and may lead to more serious complications. Leg swelling is NOT a normal part of aging or weight gain. And it’s NOT something you have to “just live with.”

    Leg swelling is a special area of interest of Dr. Polly Kokinos, and she has been active in doing clinical research to find better ways to diagnose and to treat this condition. South Bay Vascular Center and Vein Institute is recognized as the leading treatment center for evaluating and treating left leg swelling. If you have been told there is nothing to do for your leg swelling, call us at 408-376-3626 for an evaluation. We offer hope when others say there is none!

    About Iliac Vein Compression:
    Iliac vein compression (also known as May-Thurner Symptom) is an anatomic condition that occurs when the left iliac vein gets squeezed and compressed between the lumbar spine and the right iliac artery. This compression prevents the adequate drainage of blood from the leg, which can cause serious problems such as swelling, aching, blood clots, and non-healihg ulcerations. (See Diagram)

    Symptoms:

    • Swelling, heaviness and aching in one leg, especially the left leg
    • Recurrent blood clots, especially in the left leg
    • Non healing wounds or dark dry skin in the ankle or shin

    Solutions
    South Bay Vascular Center and Vein Institute is the leading leg swelling clininc in Northern California offering cutting-edge treatment options that very few other facilities can deliver. We are at the forefront of diagnosing Iliac Vein Compression using regular vascular ultrasound and in treating it with the newest endovascuar techniques using IVUS (intravascular ultrasound) and stents in an outpationt office setting.

    If you or a loved one are suffering from leg swelling or any other vascular problems, please call our office today at 408-376-3626 to schedule an appointment. Our offices in Campbell and Gilroy remain open to safely treat patients even during the COVID-19 crisis.