Dr. Karthick Gunasekaran

An AV Fistula  is the term used for a surgically created connection between an artery and a vein, usually on the arm or forearm.

A Vascular Surgeon is the specialist for creating an AV Fistula, which serves as a lifeline for patients with end-stage disease of the kidneys requiring dialysis.

     A surgically created AV Fistula for dialysis

There are many options of the combination of artery and vein to be used for AV fistula on both arms. A good ultrasound doppler of the arm veins helps us to decide which is the best site for an AV Fistula surgery.

After an AV fistula is surgically created,  it needs a maturation time of about 4 - 6 weeks, after which it may be used for dialysis access.

  A fully matured AV Fistula, ready for dialysis access

The biggest advantage of an AV fistula is that it is a permanent solution for Dialysis throughout the lifetime of a patient, and carries minimal chances of failure and infection as it does not involve any artificial tube or graft to be placed inside the body.

If an AV fistula surgery is not possible due to unsuitable veins on the arms, a synthetic tube graft known as an AV graft may be surgically placed on the arm.

A surgically placed AV Graft for dialysis access

If an AV Fistula is failing, does not mature or gets blocked, there are many options for salvage of the fistula both surgically (thrombus removal) and endovascularly (Balloon angioplasty), to make it functional again.

A temporary venous access using different types of catheters may also be attained for dialysis, and involves placement of simple (Temporary) as well as complex (Permanent) catheters such as the PERMACATH for dialysis patients.

Endometriosis is a condition where the endometrial tissue lining the womb, grows outside the urethral lining. This can cause severe pelvic pain and a host of other complications, if it is not treated on time. 

Here is everything you need to know about this ailment.

Symptoms:

Owing to the location of this tissue and its painful protrusion through the lining or walls of the womb, one of the earliest and most painful symptoms experienced may include severe cramps and pain during the menstrual cycle. Also, the patient will experience pain in the lower abdomen region about a week before the onset of the cycle. Heavy bleeding as well as infertility may be experienced in such cases too. Sexual intercourse will also give rise to pain in the region, while discomfort will be felt during the bowel movements. Pain in the lower back will also be experienced throughout the menstruation period. 

Stages: There are several stages of this disease and its progression, each of which will require a different form of treatment. These four stages usually depend on the location, size, depth and number of the endometrial implants within the body of the patient.

1. Minimal Stages: In this stage, usually there will be small wounds and lesions as well as shallow implants on the ovaries. Inflammation in the pelvic cavity can also be felt in this stage.
2. Mild Stage: In this stage, there will also be light lesions and shallow implants which will spread over the ovaries as well as the pelvic lining.
3. Moderate Stage: In this stage, the implants will dig deeper into the ovaries and the pelvic lining, which will result in the growth of even more lesions.
4. Severe Stage: As the name suggests, in this stage the patient will experience deep implants along with lesions in the bowels and the fallopian tubes.

Treatment:

Non-Medical Treatments

1. Eliminate nonorganic dairy products, beef, and chicken – because organic foods contain no added growth hormones. Increase nutrient-rich foods, especially cruciferous vegetables (broccoli cauliflower, Brussels sprouts, kale, cabbage, and bok choy), soy, cold-water fish (small fish when possible) and fiber.
2. Limit alcohol intake. Remember to eat protein at each meal and at each snack to keep the hormones more stable.
3. Maintain healthy levels of body fat to limit endogenous estrogen production.
4. Supplement with vitamins and minerals (especially calcium and magnesium) to make up for what is lacking in your daily food intake – pharmaceutical grade is the best.
5. Supplement with omega–3 essential fatty acids as a natural anti-inflammatory.

Medical Treatments

There are varied forms of this treatment including pain relief medication for minimal to mild stage patients. Also, hormonal therapy with the help of supplements may be prescribed. Hormonal contraceptives may also be used. In such cases, medication like Danazol, Medroxyprogesterone, 

Gonadotripin releasing hormone agonists, and other such elements may be prescribed. Conservative surgery and radical surgery may follow, depending on the severity of the condition. Laparoscopy is the preferred form of treatment in such cases. A hysterectomy can be conducted as a final resort where the surgeon will remove the cervix as well as the uterus of the patient. This will make pregnancy impossible for the patient, thereafter. To stem estrogen production, the ovaries will also be removed. 

One must discuss all risks and complications before going in for a certain form of treatment for this ailment. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Causes and Symptoms of Renal Hypertension

High blood pressure is characterized by an increased force that the blood exerts on the blood vessels when it moves through the body. Renal hypertension is a blood pressure disorder where the arteries that carry blood to the kidneys become narrow, as a result of which the blood pressure through these vessels increases.

Causes

It is caused when the arteries that supply blood to the kidney get narrow or get blocked. This can cause the kidney to release specific hormones that signal the body to retain water and sodium. This can put additional pressure on the blood vessels which leads to increased blood pressure. It can also be caused by atherosclerosis which is characterized by hardening of the arteries. Improper development of the arteries can also lead to renal hypertension.

Symptoms

The symptoms of renal hypertension are:

• Feeling confused
• Blurred vision
• Regular headaches
• Bleeding from the nose
• Gradual decline in kidney function
• Possible long-term damage to the kidney
• Feeling lethargic and drowsy
• Loss of appetite
• Dryness in skin
• Muscle cramps
• Breathing difficulties

Treatments

The diagnostic procedure for this disorder consists of blood, urine, doppler ultrasound and CT angiography or MR angiography tests. Treatments for this disorder usually include medications to ease blood pressure. Preventive measures include modifications in lifestyle such as following a proper diet, limiting smoking, restricting sodium or salt in the diet and following an exercise regimen. Steps should also be taken to reduce stress. Yoga and meditation are highly beneficial to control the condition. Sometimes intervention is needed in the form of PTRA and stenting.

Related Tip: Kidney Stones and Homeopathy