Tag: Leg Swelling

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.

LEG SWELLING IS NOT A NORMAL PART OF AGING

Posted on by Angelica Rodezno

Leg swelling is not a normal part of aging—
and can be a sign of serious issues.
by Polly Kokinos, MD, RPVI

Chronic leg swelling on one side (usually the left leg) may be caused by Iliac Vein Compression, which is a little-known but fairly common condition that occurs when the left iliac vein gets “squeezed” between the spine and the right iliac artery. Although this condition is not life-threatening, leg swelling can greatly impact one’s quality of life, and can lead to wound healing problems or deep blood clots.

Dr. Polyxene (Polly) Kokinos is the founder of South Bay Vascular Center and Vein Institute and one of Northern California’s most experienced and trusted vascular surgeons. She has been active in doing clinical research for this condition and has treated more of these types of patients than any other physician on the West Coast.

Dr. Kokinos explains, “Many patients have the common misconception is that leg swelling is a normal part of aging—or caused by being a few pounds overweight. That is not often the case. Problems in the circulation system can cause a variety of serious issues, ranging from spider veins and varicose veins and leg swelling, non-healing wounds, and blood clots. These are not just cosmetic problems.”

With over 20 years of experience, Dr. Kokinos and her team of specially trained professionals are dedicated to providing compassionate outpatient care for patients suffering from a wide range of circulatory problems such as swollen, aching legs, non-healing leg wounds, blood clots (DVT), dialysis access problems, varicose veins, and peripheral arterial disease (PAD).

South Bay Vascular’s main office in Campbell includes a medical clinic, state-of the art ultrasound lab and nationally accredited out-patient ambulatory surgery center all under one roof. Patients receive the most advanced treatment available as well as compassionate care in a warm, welcoming environment. Patients say that the friendly office staff is very responsive scheduling appointments, answering questions, and handling all insurance claims.

With offices in both Campbell (2255 South Bascom Avenue) and Gilroy (8420 Church Street), South Bay Vascular clinics are easily accessible to patients throughout the South Bay. To learn more, call
408-376-3626 or visit SouthBayVascular.com.

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

LEG SWELLING: BEFORE AND AFTER PHOTOS FOLLOWING THE PLACEMENT OF AN ILIAC VEIN STENT

Posted on by Angelica Rodezno

Photos of patient who had suffered with right leg swelling for three months before coming to see us. The patient was found to have a problem with their right iliac vein (in the pelvis) that we easily treated with a 45 minute outpatient procedure placing a stent in the vein through a small puncture in their groin. Five days later, his swelling was almost completely gone.

If you have had painful or annoying one-sided leg swelling we may be able to help. Call us today for a consultation at 408-376-3626. South Bay Vascular Center and Vein Institute is the regional leader in treating leg swelling due to iliac vein compression.

DR. KOKINOS CHOSEN TO PRESENT AT 2017 OEIS MEETING

Posted on by Angelica Rodezno

Dr. Kokinos was selected as a speaker at this years OEIS (Outpatient Endovascular and Interventional Society)meeting that will be held March 31- April 2 in San Diego California. Dr Kokinos will be presenting her expertise in the establishment and operation of cutting edge outpatient treatment facilities.

Congratulations Dr. Kokinos on this honor.

Dr. Polyxene Kokinos and her partner, Dr. Carlos E Pineda of South Bay Vascular Center and Vein Institute, operate San Jose’s leading center for the treatment of Varicose Veins. As a Board Certified Vascular and General Surgeon, Dr. Kokinos is recognized by her peers as the one of the countries leading experts on the treatment of deep venous disease and is frequently sought out as a speaker. South Bay Vascular specializes in treating peripheral arterial disease (PAD) and is the regional center of excellence for amputation prevention.

If you or anyone you know suffers from unsightly and painful varicose veins, peripheral arterial disease, non-healing wounds or is facing a diabetic amputation, please call our office at 408-376-3626 to schedule a consultation. WE CAN HELP!

ACHING TIRED OR HEAVY LEGS?

Posted on by Angelica Rodezno

TEN MISCONCEPTIONS ABOUT VARICOSE VEINS

Posted on by Angelica Rodezno

Last weekend, during my daughter’s water polo game, I noticed the coach for the opposing team was limping and had a very swollen left leg. With a closer look I realized he had the hyperpigmentation (skin darkening) of chronic venous disease and ugly bulging varicose veins easily the size of my thumb all over the inside of his calves. I decided to go ask him about them, as they looked awful, the man was clearly in pain, and I was concerned. After a brief conversation with the coach, where he told me various “old wives’ tales” it dawned on me that he probably wasn’t alone thinking the way he did so I thought I should post this blog in an attempt to clear up these ten common misconceptions about varicose veins. Here goes:

“Varicose veins are simply a cosmetic problem”

About half of the patients we see in our practice for varicose veins complain about the pain they experience because of their veins. Because these patients are experiencing pain and suffering, many times varicose veins are categorized as a Medical condition and not just a cosmetic issue. This is especially true if they are accompanied by leg aching, throbbing, swelling, or discoloration. Venous disease affects about 40 million people in the United States and about 1 million end up with ulcers that are painful and difficult to heal. As a medical condition, depending on the severity of a patients condition, insurance often covers for the procedure to be done. That way, patients are not forced to pay out of pocket to rid themselves of their painful and ugly veins.

“Varicose veins can cause strokes, heart attacks, or gangrene”

Although varicose veins are a circulatory problem, the blood vessels causing strokes, heart attacks, and gangrene are arteries not veins. The patient profile of patients suffering from vein issues (women, multiple pregnancies, family history, standing occupation) is very different from those that get arterial problems (smokers, diabetics, patients with high blood pressure or cholesterol). Because of this, patients suffering from varicose veins should consult with their physicians to determine if this problem is accompanied by any underlying,and potentially more serious, circulatory issues

“Only women get varicose veins”

Although venous disease is more common in women, about 40% of our patients are men. Unfortunately, men tend to present with more advanced disease or longer standing symptoms.

“I have had my veins just like this for twenty years”

Venous disease does progress if not treated and currently there are several outpatient office procedures that can be done with excellent results and low risks

“It is not worth treating varicose veins because they just come back”

The treatment of venous insufficiency is one of the more successful treatments in medicine, as long as the underlying cause is treated- ie. the underlying veins that have the leaky valves. In the old days, patients were treated simply with removal of the bulgy veins. Because the underlying saphenous veins that had leaky valves were not treated, the bulgy veins come back. Now that we do ultrasound to “map out” the diseased veins, the recurrence rate should only be about 10% at 10 years.

“Insurance will not cover any varicose vein treatment”

Although insurance companies have absolutely made the criteria for coverage for venous disease much more difficult over the last ten years, most patients who do have leaky valves in their underlying valves are covered. Sclerotherapy for spider veins and the simple removal of bulgy veins for appearance are almost never covered today.

“Varicose veins are “surplus parts” that I might need someday”

They are abnormal blood vessels that develop usually because there is an underlying medical problem- vein valve failure or “leakiness”. The underlying greater saphenous vein, that usually is the one that has the leaky valves, is sometimes used in open-heart surgery or arterial vascular bypass surgery. However, today, it is not commonly used as those operations have been replaced to a large extent by less invasive procedures using balloons and stents.

“ Varicose veins are just part of getting old as is my leg pain”

Although it is true that there is an increase in the incidence of varicose veins as one gets older (one study found that 75% of women over the age of 65 had venous issues), it is NOT a normal part of aging to feel heaviness, aching, or throbbing in the legs. It is important to go have those symptoms evaluated by a vascular surgeon as often it can be easily treated.

“Treatment of my varicose veins will lay me up for weeks”

Until about 15 years ago, the main treatment for varicose veins was a difficult procedure called vein stripping. This was generally done under general anesthesia, in a hospital where one was admitted, with two moderate sized incisions in the groin and at the ankle. It generally took patients several weeks to recover. The field was revolutionized by the introduction of endovenous ablation, which currently is an office procedure, done under local anesthesia where the patient usually has NO post-operative pain. Most patients return to all of their normal activities with 24-48 hours.

“You have to have bulging veins to have a vein problem”

Many patients who present with heavy, aching or swollen legs actually do not have bulging varicose veins but are found to have a problem on evaluation. In order to diagnose venous disease, it is important to have a VENOUS REFLUX ULTRASOUND. This is not the same as a vein ultrasound to look for blood clots that primary care doctors often order at hospitals. It is critical to have this test done at an ICAVL accredited laboratory as it is extremely technologist dependent. A good exam will take about 30 minutes per leg and will examine veins with the patient in a standing or head slanted up position from the groin to the ankle.

BLOOD CLOTS (DEEP VENOUS THROMBOSIS‐DVT) A SILENT KILLER

Posted on by Angelica Rodezno

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. DVT is a very feared complication of venous disease because it can lead to a pulmonary embolus, a clot in the lung that can be deadly.

There are several symptoms to DVT but the most common are the sudden onset of pain and swelling in your leg. This does not happen in your foot, but happens, most commonly in the back of your calf or your entire thigh. Usually, the painful part of your leg is also swollen. This comes on abruptly and generally does not go away even after a few days. It is very important to go to your regular doctor and get an ultrasound of your leg. If this is “normal” but the swelling or pain persists, then you should go see a vascular surgeon as more testing (such as CT scan or specialized ultrasound) may need to be done. This is quite important to do quickly as some treatments only work if they are done within a week of the development of symptoms.

If you are diagnosed with a DVT, you should be treated with blood thinners immediately. The role of blood thinners is not to actually “dissolve” the clot in your leg, but rather to prevent it from travelling to your lung and causing a Pulmonary Embolus. The blood thinners also work to prevent the clot from becoming more extensive. If this is your first blood clot, you should be treated for 6 weeks to 3 months with blood thinners depending on why the blood clot occurred. The risk factors for developing blood clots include long plane or car rides, immobility (after an operation or injury), obesity, being very sedentary, pregnancy, having had an orthopedic or gynecologic procedure, some genetic factors (hypercoagulable syndromes), dehydration, and cancer. It is important if there if there is not a clear reason for the blood clot, that a search for a hidden cause be done.

Dr. Kokinos and the staff at South Bay Vascular Center and Vein Institute are experts in the identification of and treatment of blood clots. If you or anyone you know suffers from the rapid onset of pain and or swelling following a medical procedure and or long trip (most common on long airplane flights) please contact your primary physician immediately or call us at 408-376-3626 to discuss your treatment options.