Peripheral Artery Disease (PAD) is a common and often underdiagnosed circulatory disease where blood flow to the legs and feet is restricted by the narrowing of blood vessels due to plaque buildup.


  • Smoking is the most powerful predictor of PAD: Are you a current or former smoker?
  • 1 in 10 Americans over the age of 40 have PAD
  • Do you or your loved one have diabetes?
  • Struggle with high blood pressure or cholesterol?
  • Suffer from kidney disease?
  • Risk for amputation is 10 times greater in patients with both PAD and diabetes vs PAD alone


With an early diagnosis, you may have more treatment options and may have a better chance to reduce or eliminate your symptoms. Left untreated, however, PAD can lead to amputation and put you or your loved one’s quality of life and long-term health at serious risk.



If you or anyone you love suffers from any of the conditions listed above, please call our office at 408-376-3626 to schedule an appointment. Most insurances are accepted and our staff typically can schedule an appointment within a few days for an initial consulation and non-invasive vascular ultrasound study. All ultrasound testing is done in our on-site Vascular Ultrasound Lab, The Institute for Vascular Testing making it significantly easier for our patients to be fully evaluated in a single visit and in a single facility.



Many patients as they get older, get up at night to go to the bathroom or because of difficulty sleeping. One serious problem that can wake people up at night is pain in their foot or toes.

This most often occurs in patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol. Some believe this is arthritis or gout, but it is often 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.

This is a sign of critical limb ischemia—another word for lack of blood flow. The arteries are so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes require to be happy. Patients often self-adapt to this problem, as it does usually develop slowly over time. They sometimes will tell you their foot doesn’t bother them at night, but on further questioning, you learn they sleep in a recliner or they sleep with their leg hanging over the side of the bed.

The trick here is that when the leg is hanging down, gravity helps pull down a little more blood to the foot so that it doesn’t hurt. Interestingly, the foot often also gets swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem. …that’s why it is the “Right” experience that matters in diagnosing these kinds of vascular problems and why more local independent physicians refer their vein and vascular patients to Dr Kokinos than to any other vascular surgeon in the Silicon Valley Region. The patient often thinks that they get up at night to go to the bathroom, but the truth is the foot pain wakes them up, they get out of bed because that makes it feel better (again due to gravity), they go to the bathroom because they think they have to (or maybe really do), and then they can go back to sleep pain -free for a couple of hours. Usually , the pain does wake them up multiple times a night, and that ‘s why they often end up sleeping in a chair.

If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor or to schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you 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, contact us today  at 408-376-3626 to learn more about PAD and how Dr. Kokinos can help, click here.
