Dr. Krishna Chaitanya K H

Renal artery stenosis is when the renal arteries (blood vessels which supply blood to the kidneys) are stenosed or narrowed. This is often a result of atherosclerosis, which is caused due to increased levels of cholesterol in the blood. As it passes through the blood vessels, the fat molecules, because of their heaviness, get sluggish and settle down along the walls. This is known as plaque formation. They attract more fat molecules and the plaque continues to grow in thickness, thereby leading to a reduced diameter of the blood vessels. Over a period of time, the reduced blood supply affects the kidney’s normal functioning, resulting in a chronic kidney disease and kidney failure.

The kidneys are involved in the removal of toxins from the body, and hence, perform a very significant function. If they do not function well, then there is slow, but a definite accumulation of toxins within the body. This leads to various other complications, affecting almost the entire body and health. Therefore, it is essential that renal artery stenosis is identified and treated to minimize the effect on one’s health.

There are two aspects to this

1. First, there are no clear tell-tale symptoms to identify renal artery stenosis in its early stages.
2. Second, though there are a lot of medications available, they are only to manage the symptoms and do not help bring back the narrowed arteries to their original. This means the blood supply to the kidneys will continue to be reduced, thereby never restoring its function fully.

This is where surgery comes into the picture. There are three surgical options which are available, and each one of them ensures the renal arteries are restored to their normal functioning.

• Renal artery endarterectomy: The main cause of the stenosis, which is plaque, is surgically removed from the affected portions.
• Renal artery bypass: The portion of the artery which is affected is surgically removed, and a vein, usually from the leg, is grafted to replace the diseased part of the artery. This restores blood flow to the kidneys and improves their function.
• Percutaneous balloon angioplasty and stenting: This is the most commonly used procedure to treat renal stenosis now. It improves stenosis and also helps avoid complications. This is combined with an arteriogram, where the area of diagnosis is confirmed. Then a deflated balloon is passed through the artery and inflated to keep it in place.
• A stent is placed so that the balloon does not collapse and cause a re-stenosis. With current advances, this is done using local anaesthesia and sedation. Aspirin is also used on a daily basis to prevent clot formation.

Varicose veins are a condition marked by enlarged or gnarled veins. This typically affects the veins in the feet and legs. In most cases, varicose veins are a mere cosmetic concern but in some cases, it can be quite uncomfortable and painful. If left untreated, it can also lead to further complications.

Varicose veins may be caused by a lack of elasticity in the veins causing blood to pool in them and flow back-wards. This blood is deoxygenated and hence the veins appear blue. Women have a higher risk of suffering from varicose veins as compared to men. This risk also increases with age and weight. Pregnancy can also cause varicose veins. The most common symptoms of this condition are:

• visible veins just under the surface of the skin
• veins that appear blue and gnarled
• a dull ache in the legs
• throbbing or burning sensation in the calves
• pain in the legs that worsens after standing or sitting in the same position for a long time
• itching around the veins
• bleeding veins
• inflammation of the skin or ulcers around the ankles
• red or blue spider veins

Varicose veins can be treated with simple home remedies. Keeping the legs raised or wearing compression stockings can relieve the pain associated with varicose veins and prevent the condition from worsening. Exercise can also help improve blood circulation. If these home remedies are not effective, the patient may need to consult a doctor.

Varicose veins cannot be completely prevented. However, an individual can reduce the risk of suffering from this condition. Regular exercise and maintaining a healthy weight is crucial to do this as being overweight can increase the pressure on the legs and hence aggravate varicose veins. Women with a family history of varicose veins should also avoid wearing high heels and tight stockings.

Complications caused by varicose veins are rare. However, some people may experience bleeding on the surface of the skin. There are chances that the veins deep inside the muscle may get twisted which may lead to the swelling of the calf muscles. Varicose veins may also cause painful ulcers around the ankles and is a result of the buildup of fluid around the ankles.

All the complication must be reported to the doctor at the earliest to prevent the condition from worsening.

Diabetes is a lifestyle disease which is increasing in incidence. A number of people are being affected, and the age of onset is decreasing. The issue with managing diabetes is that it is a multi-system disease, and affects almost the entire body system. The circulatory, nervous, and musculoskeletal systems and overall metabolism are all severely affected as the disease progresses. Therefore, early detection is highly helpful as it aids in controlling the progression of the disease as well as in arresting its symptoms.

Infections, especially in the leg, which lead an individual to suffer from a diabetic foot are due to two reasons:

• Nervous system: Diabetes results in a reduced sensation of the nervous system, especially in the distant organs like the toes and legs. As the sensory perception is reduced, small hurts and wounds in the legs go unnoticed and the person does not feel any pain.
• Skin: Once diabetes sets in, the collagen formation and wound-healing capability is reduced. The rate of regeneration of tissues is reduced. So in addition to the reduced sensation, the rate of healing is also reduced.
• These wound infections could be limb threatening or non-limb-threatening. As the infection progresses from mild to moderate to severe, the wound progresses from a small ulcer to cellulitis involving the infection of the subcutaneous layer. This then progresses to gangrene, which refers to the death of the underlying tissue due to chronic infection. This infection gradually reaches the bone to cause osteomyelitis.

The primary problems with severe cases of diabetic foot include:

• Hypoxia it reduces the oxygen supply
• Debris due to infection and death of subcutaneous tissue
• Nutritional deficiencies is a common side effect of diabetes
• Lack of vascularity due to atherosclerosis and arteriosclerosis

How does surgery help?

• Sharp surgical debridement: This is done in cases that only have a deep cellulitis or gangrene. The infected tissue is marked out along with a good margin of normal tissue, completely debrided leaving normal margins. This allows diagnosing the extent of the infection, clear debridement, and also promotes wound healing. The skin closure is done with skin grafts from another portion, usually the thigh or torso. Postop care is essential for success.
• Amputation: In people where the infection is quite deep, with or without osteomyelitis (bone involvement), amputation may be required. This amputation may be only of the toes, the foot, or below or above the knee depending on the stage of identification and extent of infection. This helps in improved diabetic foot control as well as re-ulceration, which can be quite complicated.

While surgery comes with its own set of complications, it sometimes helps in treating severe diabetic foot infections. In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetes alters the metabolism and functioning of almost entire body system. The most important targets are the circulatory and nervous system, leading to peripheral vascular disease and neuropathy. Diabetic foot is the result of a combination of these two factors in the feet – altered/reduced blood flow to the feet combined with reduced sensation.

1. Neuropathy: When the sugar levels are poorly controlled, then the nerves in the legs are damaged, leading to reduced or absence of sensation. The patient cannot feel pain/heat/cold. Sensory neuropathy causes loss of protective sennsation leaving the foot at risk to repetative unnoticed trauma.
2. Peripheral vascular disease: The blood vessels which are away from the heart are affected, leading to poor blood flow from the legs to the heart. Proper blood flow is essential for overall health, and when this is affected, the peripheral foot health is affected.

Some of the common foot problems encountered in diabetics are listed below:

1. Fungal infections: Whether a person wears shoes regularly or not, they become more prone to fungal infections. The nails become discoloured, brittle, and break off. They are difficult to treat and may require oral medications.
2. Ulcers: Diabetic ulcers are very common. The combined effect of reduced sensation and reduced blood flow leads to ulcers, which are not painful (due to lack of sensation) and therefore are ignored and not treated promptly. They can progress and become severe, even sometimes leading to amputation. Fungal ulcer are most common in between toes and in creases of a diabetic patients
3. Corns: Diabetics are more prone to develop corns which are thick masses of skin near the bony area of a toe. This could be in areas where the shoes rub against the toes or between the toes where there is a lot of friction. Home care includes smoothing it with a pumice stone. The person should not try to remove them on their own.  Warts, bunions, ingrown toenails, hammertoes, etc., are also very common in diabetics.

Prevention/Treatment:

1. The first and most important step is to monitor and regulate the blood sugar levels within ranges ideal for you.
2. Warm water to be used for washing feet, and then to be dried well, to not leave a moist area between toes
3. Regular feet care to check for blisters, ulcers, wounds, etc.
4. Check toenails for overall health
5. Preferably wear closed toe shoes
6. Wear stockings or socks and shoes that fit well
7. Moisturise the skin well to avoid drying
8. Avoid exposing feet to extreme weather
9. Quit smoking
10. Ensure blood flow is maintained by not standing or sitting for prolonged periods and with regular exercise

In case you have a concern or query you can always consult an expert & get answers to your questions!

What is Aortic aneurysm?
The heart is the most important muscle in your body, and its primary job is to pump the blood across. The aorta is the largest blood vessel of the human body and is used by the heart to push the blood along. The Aorta is also one of the strongest vessels, but in some cases, due to the wear and tear condition the walls can weaken and bulge in what is called an aortic aneurysm. This can cause a rupture of the vessels as a result of which, blood gets leaked into the body.

Types of Aortic aneurysm:
There are two known types of aortic aneurysms. One of which is located in the chest and is known as the thoracic aortic aneurysm, and the one which forms in the abdomen is called an abdominal aortic aneurysm.

Thoracic aortic aneurysm
There are many causes of the Thoracic aortic aneurysm. Genes play a significant role in increasing the chances. The other factors can include high blood pressure, high cholesterol, infections and blockages in the arteries. Sometimes a traumatic injury due to an accident can also lead to the condition. The biggest disadvantage of the disease is that the symptoms do not occur in the early stages and only in their chronic stages they appear. Some of the symptoms include chest or back pain, difficulty in breathing, shortness of a breath and persistent cough. Diagnosis can be made by an X-ray, CT scan, and ultrasound. Medications can help to an extent in relieving the pain and symptoms but however, in some extreme cases surgery is required. During the surgery, a synthetic tube replaces the damaged artery- as a result of which the blood gets channelled without any hindrances.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Vascular disorders are disorders of the vessels in your body that carry either blood or waste products. The vascular system consists of the arteries (that carry blood away from the heart), veins (that carry blood to the heart) and lymph vessels (that carry waste products to be excreted from the body). The various diseases of the vascular or circulatory system are:

1. Peripheral Artery Disease: Peripheral arteries carry blood to the various organs and tissues in the body. Accumulation of cholesterol and fat in the vessels narrow the pathway for the blood to flow. This can impair blood flow to the tissues in the body and cause complications. Various medications used to lower cholesterol and blood pressure can also be used for peripheral artery disease.
2. Buerger's Disease: This disease causes obstructions in the veins and arteries in the legs. This can hamper blood supply in the toes and the feet. It causes pain and may require amputation in severe cases. Treatments for this disease include smoking cessation and medications to dilute blood vessels.
3. Aneurysm: An aneurysm is swelling in the blood vessel walls; it usually occurs in the aorta. The artery walls become fragile and are placed under a lot of stress; this may lead to a sudden rupture of the aortic vessels. This disorder is usually treated by surgical procedures.
4. Peripheral Venous Disease: Peripheral venous disease is characterized by damage to the valves that allows blood to flow in a single direction. Damaged valves can cause blood to flow backwards and therefore, accumulate. Treatments for this disorder are incorporating certain lifestyle habits such as quitting smoking and alcohol.
5. Blood clots in the veins: Blood clots may occur in the veins present inside the muscles of the thighs and lower legs which lead to deep vein thrombosis. You may be prescribed anti-coagulants, also known as blood thinners, to treat this disorder.

Causes
People with diseases such diabetes, high blood pressure, or kidney failure can be more likely to have vessel problems. Working with vibrating tools, being in cold temperatures, and smoking can worsen vascular problems. Causes of vascular disorders usually fit into one of 5 groups:

1. Traumatic, which occur after injury
2. Compressive, which occur when the pipes flatten
3. Occlusive, which occur when pipes are blocked
4. Tumors (growths) or malformations (deformed, tangled pipes), which may or may not be present at birth
5. Vessel spasms, which occur when abnormal control of vessels causes them to narrow

Symptoms
Symptoms of vascular disorders can include:

1. Pain
2. Abnormal color changes in the fingertips
3. Ulcers or wounds that do not heal
4. Hand problems when in cold temperatures or locations
5. Numbness or tingling of the fingertips
6. Swelling
7. Cool or cold fingers and/or hands

In case you have a concern or query you can always consult an expert & get answers to your questions!