YOU HAVE A BLOOD CLOT. NOW WHAT?

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

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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WHY DON’T THE WOUNDS ON MY LEGS AND FEET HEAL ANYMORE?

Hi! Dr. Lau here again with South Bay Vascular. Today, I wanted to shed some light on one of the most common issues that we see in vascular surgery, non-healing wounds of the feet and toes. My hope is that after reading this blog you will have a better understanding of what causes leg wounds and ulcers; why sometimes they won’t heal on their own, and what we in vascular surgery can do to help them heal.

Ulcers, generally speaking, develop because of TWO main causes: nerve damage induced by diabetes and lack of blood flow. When patients have elevated levels of sugar in their blood with diabetes, the sugar forms toxic compounds that damage nerves in the foot. Consequently, the patient cannot feel injuries that would otherwise cause a normal patient to adjust position to stop the injury. With this loss of sensation ulcers form at the point of repeated injury that the patient cannot feel.

The second cause, a lack of blood flow, develops over decades in patients who smoke and who have high blood pressure and high cholesterol. These medical problems cause hardening and narrowing of the blood vessels, otherwise known as atherosclerosis.

In patients with diabetes, I coordinate carefully with my podiatrist colleagues who are experts in specialized footwear and surgical interventions that alleviate common areas of trauma. In patients with poor blood flow, I, as a vascular surgeon, can perform minimally invasive surgery to restore blood flow to the affected area. We use wires and specialized tubes to gain access to the blood vessels and then use balloons to break open the narrowing’s and self-expanding tubes called stents to keep the vessels open. Afterwards, we use a specialized x-ray machine called fluoroscopy to see that the narrowing’s have opened again to allow blood to flow back to the area. Patients usually leave to go home the same day with only a 2-millimeter puncture in their groin and are back to normal activity the day after surgery!

If you or anyone you know has a wound on their leg, foot or toe that hasn’t healed in more than two weeks, please call our office at 408 376 3626 to schedule an appointment.

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

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

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

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

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

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

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

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

PREVENTING DIABETIC AMPUTATIONS IN SAN JOSE

Every year over 160,000 amputations are performed in America. 60%-80% of Medicare patients who undergo amputation never walk again. Worse yet, there is a 30-50%, 2-year mortality rate following an amputation…meaning that between 30% and 50% of all patients undergoing an amputation die within 2 years of their procedure.

Recent advancements in both imaging and medical device technology have significantly improved a patients chances for a different outcome: avoiding amputation. Educating patients about these new procedures, however, is still very difficult because many of these new advances are known only to the surgeons and universities pioneering them. In fact, recent studies show that more than 54% of patients were not even assessed using diagnostic angiograms to determine if blood flow could be restored to their affected limbs prior to the amputation. Earlier this year, Medicare published figures showing that a full 67% of medicare patients who underwent a major amputation never even had a re-vascularization procedure in an attempt to save their limb.

Dr.’s Kokinos and Pineda are recognized as specialists in the field of lower limb re-vascularization and limb salvage. Having performed more pedal access re-vascularization cases (approaching the affected limb via the foot instead of the groin) than any other physicians in the region provides these South Bay Vascular surgeons with the experience and judgement to help patients avoid diabetic amputations and to treat patients with advanced cases of peripheral arterial disease (PAD) or what is otherwise known as Chronic Limb Ischemia (CLI).

If you or someone you know is facing the possibility of lower limb amputation, STOP! CALL US FOR A SECOND OPINION. South Bay Vascular is Taking a Stand Against Amputation and you should too. Call us at 408-376-3626 to schedule a thorough evaluation of your options. We are specialists in the area of lower limb re-vascularization and we provide hope when others say there is none.

ACHING TIRED OR HEAVY LEGS?

DR. KOKINOS SELECTED TO PRESENT AT THE AMERICAN VENOUS FORUM

Dr. Kokinos will be presenting an abstract on her clinical research regarding iliac vein compression at the national American Venous Forum in New Orleans early next year. This meeting is the largest venous meeting of the year, and is sponsored by the Society for Vascular Surgery.

Dr. Kokinos has been recognized nationally as an expert on May-Thurner’s Syndrome, or iliac vein compession. This problem can cause symptoms of (predominantly) left leg swelling, heaviness, aching, deep venous clots, and non-healing ankle or leg wounds. She has performed more intravascular ultrasound exams and stents of the deep venous system than any other doctor on the West Coast in the last year. She will be presenting her clinical research on using regular ultrasound, done by the specially trained registered vascular technologists in the ICAVL accredited Institute for Vascular Testing to diagnose this fairly common but widely underdiagnosed issue. Previously, patients needed to get CT scans which used significant amounts of radiation and contrast for the diagnosis. This problem is not only seen because of a common anatomic situation, but also often as a result of an undiagnosed blood clot (DVT) in the iliac or femoral vein after orthopedic, back, or gynecologic surgery.

If you have one leg that is more swollen or painful than then other, or have had a leg blood clot in the past, please call us at 408-376-3626 or visit us at www.southbayvascular.com.

SOUTH BAY VASCULAR CENTER IS “TAKING A STAND AGAINST AMPUTATION”

18 Million Americans Suffer from Peripheral Arterial Disease (PAD). Left untreated, PAD can lead to amputation. Each year 160,000 amputations are performed as a result of peripheral arterial disease.

South Bay Vascular Center and Vein Institute is Taking A Stand Against Amputation. Dr. Pineda and Dr. Kokinos recently attended the “Advanced Orbital Atherectomy Course in the Treatment of Complex PAD Below the Knee” at Metro Health Hospital, in Grand Rapids, Michigan. This course was led by Dr. Jihad Mustapha, a thought leader in the field of critical limb ischemia. The techniques included using alternate access sites (using the arteries at the ankle and foot for access), instead of using the traditional groin site. The course also included treatment of arteries in the foot, with the main goal being on limb preservation and amputation prevention. To date, Dr.’s Kokinos and Pineda have performed more procedures using pedal access than any other surgeons in the greater San Francisco Bay Area, and are recognized as leaders in this area.

The practices expounded by Dr. Mustapha and his team are the same techniques and principles the vascular surgeons at South Bay Vascular use in their care and treatment of PAD. These include: identification and aggressive medical management of risk factors, minimally invasive interventions when indicated, and continued surveillance to detect issues before they become clinically apparent.

At South Bay Vascular, we do use alternate sites frequently, and by using this approach, decrease the rate of groin complications and the length of time that the patient has to remain flat after a procedure. Furthermore, with our growing population of diabetics and patients with kidney disease, we are better equipped to manage critical limb ischemia and prevent amputations. This course is in support of our focus on taking care of patients at risk of losing a limb.

If you or a loved one is diabetic, has kidney disease (is on dialysis), or has been told they need an amputation, please contact us for a consultation with one of our surgeons and together we will Take A Stand Against Amputation.