Dialysis is a very important and life-saving procedure. It is performed to replace kidney function in case of renal failure. Wastes and extra fluids in the blood are filtered out during this process. To be able to perform Dialysis, the connection between the patient s bloodstream and the equipment for performing Dialysis (dialyzer) outside the body is established. This connection is created through Dialysis Access Surgery. It is a type of Vascular Surgery which forms the vascular opening for access during Dialysis. Thus, Dialysis Access Surgery is the lifeline for the survival of the patient.

Types of Vascular Access for Dialysis- 
There are three types of Vascular Access for Dialysis: Arteriovenous (AV) Fistula, Arteriovenous (AV) Graft, and Venous Catheter.

  Arteriovenous (AV) fistula is a surgical connection of an artery to a vein. An AV fistula is usually placed in the upper arm or in the forearm. It causes extra blood to flow into vein making it grow large. A larger vein hence provides easy access to blood vessels. An AV fistula is preferred over other methods as it lasts longer than other methods of access and provides a good flow of blood. Moreover, it is less prone to infection and blood clots than other methods. Before an AV Surgery, a Vessel Mapping Test is sometimes performed for assessing the blood vessels most suitable for Dialysis. An AV fistula is performed under local anaesthesia and requires two to three months for maturation before hemodialysis. If it fails to mature, the procedure is repeated.

  Arteriovenous (AV) graft is performed when AV fistula fails to mature. It is hence the second most preferred choice for long-lasting access to vascular tissues for Dialysis. An AV graft is a looped plastic tube which establishes a connection between an artery and a vein. Like AV fistula, AV graft is also performed under local anaesthesia. It is slightly more difficult to maintain than an AV fistula.

  A venous catheter is used for short- term hemodialysis. It is a tube which is inserted into chest, neck, leg, or near groin for vascular access. After exiting the body, the tube splits into two halves. In the case where a renal disease has made quick progression leaving little or no time for the AV fistula or AV graft to mature, a venous catheter is used to establish the required vascular connection. This procedure is also performed under local anaesthesia. It is a tool for emergencies but is not suited for long- term use. It can cause narrow vein due to an infection,
scarring, or blood clot. If long- term venous catheter is used, it is tunnelled under the skin which has fewer problems associated with it and is more comfortable. 

How to Care for a Vascular Access?
  Get checked for infections and other problems before each hemodialysis session;
  Use the operated site for access only for the intended use;
  Always keep the access clean;
  Prevent cutting or bumping the access;
  Check for thrill/ vibration in the access and inform the doctor if any;
  Do not put pressure on the access site;
  Do not put blood pressure cuff around the access arm;
  Do not wear jewellery or tight-fitting garments over the site;
  Do not lift a weight.

Take Away-
Vascular Surgery for Dialysis is performed to provide vascular access for the procedure. AV fistula is the most preferred type followed by an AV graft. A venous catheter is recommended to be used only in case of an emergency when there is not much time left for the other two options to mature.

Vascular Surgery - Can It Help For Dialysis?

There are two primary factors that are more likely to cause a stroke in a person i.e age and a family history. While both are inevitable, this necessarily doesn t have to be the fate of a person. Brain stroke is entirely preventable as with the case of other diseases. By working on the potential health risk factors, a stroke can be prevented. Here is a list of few such steps which, when followed can pay rich dividends to a person facing the risk of a brain stroke:

Blood Pressure: Blood pressure is the single most important factor that can increase the chance of a brain stroke. If a perfect blood pressure reading seems too difficult to achieve, a more realistic blood pressure target of 140/190 should be aimed for. Some of the common steps in order to achieve an acceptable blood pressure figure include reducing salt in the diet, exercising on a daily basis, regular intake of fresh fruits & vegetables and fast processed food containing processed fats. Finally, quitting drinking and smoking goes a long way in ensuring that a person is safe from strokes.

Losing Weight: Obesity increases the risk of diabetes and blood pressure subsequently increasing the risk of a stroke. Being overweight, therefore greatly increases the odds of a stroke. A BMI of 25 should be maintained by engaging in activities such as walking, running and playing on a daily basis.

Regular Exercise: Exercise is a clear mandate for people facing an increased risk of brain strokes. A moderate intensity exercise schedule for a minimum of 5 days per week is necessary. Some simple steps in order to achieve this include taking the stairs while climbing, joining a fitness club, 30 minutes of daily walk in a day etc.

Moderate Drink: Surprising as it may sound, moderate drinking on a daily basis can dramatically reduce the risk of a brain stroke. Red wine should be the choice of preference in this case. It should be ensured that the level of drinking does not surpass more than a glass. Regular drinking in excessive quantity can increase the chance of brain stroke.

Check For Atrial Fibrillation: This is a disease that is related to the heart due to an irregular heartbeat. There is a possibility of the clots travelling to the brain causing a brain stroke. Certain possible symptoms of this disease such as palpitation of heart and shortness of breath should be checked with a doctor to negate the chance of brain stroke. Certain blood thinners like warfarin and aspirin can shield against atrial fibrillation. A doctor has to be consulted before starting any medication related to the heart.

Top Ways To Prevent A Brain Stroke

With recent lifestyle changes, more and more people, younger in age, are falling prey to heart attacks. While some silently suffer the attack during their sleep and never wake up, others have symptoms which they dismiss as acidity or muscular pain and ignore them. There are multiple media programs that are trying to create awareness about how to identify a heart attack. If done at the right time, there is a good chance that the person can be saved.

What is a Heart Attack?

The blood vessels gradually narrow, reducing the blood flow to the target organs. This reduces the efficiency of the target organ, and if this happens to be the heart, it is known as a heart attack. The area that should ideally receive blood does not, leading to its  death.  If the damage is not severe, it can be reversed. However, if this attack happens in one of the critical areas of the heart, it can even be fatal.

Symptoms To Watch For: Very few attacks happen suddenly. Most start slowly and progress, and if identified on time, a life can be saved. The episode takes about an hour, and if you are well-versed with the symptoms, it could help identify the condition correctly and save a life. Most people use antacids and muscle relaxants to ease the situation, which does provide immediate relief, but not a proper cure.

There is a central pain which is constant, nagging, and has a squeezing like sensation. This causes discomfort and most often, this pain is in the center of the chest area, which lasts for just a few minutes. Sometimes the pain can go and come back. This pain radiates down into the arm, up into the neck area, and also into the jaw and is almost always indicative of a heart attack.

With chest pain, there is always shortness of breath which the person will experience. This is due to reduced oxygen levels in the body.

Associated symptoms include fatigue, exhaustion, nausea, dizziness, light-headedness.

There is almost always profused sweating where the person breaks into a cold sweat.

If the attack happens during sleep, the person may be snoring and may feel, as if something is choking his airway.

Due to reduced return of blood from the peripheral organs, there could be swelling of the feet and ankles.

If there is irregular heart beat (palpitations) very often, talk to your doctor about it.

When you suspect a person of having a heart attack, check for these signs. Very often, a heart attack is detectable and can be managed with timely intervention.

Signs Of A Heart Attack

Over the last few decades, the word cholesterol has assumed a different connotation. It has come to be known as a silent killer that spells doom for health. However, what we need to realize is that a certain amount of cholesterol is essential for the proper functioning of the body. The liver produces about 85% of the cholesterol that is required by the body normally. The ever changing food habits have introduced a lot of processed foods that are loaded with saturated fats. Along with this, reduced physical activity has led to accumulation of cholesterol in the blood.

The types of cholesterol are based on the density and we have 2 types of density that is Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). LDL is more dangerous than HDL, called as bad and good cholesterol respectively. In addition, the triglycerides and lipoprotein are also critical indicators of overall cholesterol levels. Depending on a person's age, height and weight, normal levels are derived for each of these four.

Because of their density of the cholesterol molecules, as they are circulating in the blood stream, they tend to get sluggish and settle down along the walls of the blood vessels, referred to as plaque. This plaque attracts more and more cholesterol from the blood and the layer gets gradually thicker. This reduces the thickness of the blood vessels and in severe cases even completely blocks blood flow to important organs like the brain and heart, leading to severe conditions like stroke and heart attack respectively.

However, it is not always that all cholesterol is bad. It is one of the essential things for the proper body functions with the main functions listed below.

1. Each cell in the body requires it to form the cell membrane, the protective layer around the cells
2. Synthesis of vitamin D is done with the help of cholesterol, which is very essential for skin health
3. It also helps in hormone formation. In addition to steroids, other hormones like testosterone, estrogen, cortisol require cholesterol as a main ingredient
4. Formation of neurotransmitters and overall nerve function requires cholesterol. This ensures optimal neurological functioning.

So, as noted above, there are, both good and bad aspects to cholesterol. It is not all that dangerous a thing that it is made out to be. The trick is to maintain a good level of cholesterol so that the body's requirements are met, and at the same time, the harmful effects are kept at bay. Some important parameters to manage, include the percentage of bad cholesterol in the blood and the ratio of triglycerides to HDL in the blood. These are considered fair indicators of heart health and if need be, lifestyle changes and/or medications can be undertaken to manage overall health and reduce risk of heart disease and stroke.

Cholesterol: Good and Bad of It

Peripheral Artery Disease (PAD) is caused by atherosclerosis or plaque build-up in the leg arteries. Mostly, individuals with PAD have mild or no symptoms. But with the extension of the blockages, individuals may experience disability and pain that restricts free walking. In more severe cases, individuals may develop a risk of losing their limb if the circulation is not improved. 

There are various ways to improve the flow of blood in the leg, especially for individuals with severe PAD. The objectives of improving the blood flow in the limb include improving functional ability, reducing pain, preventing amputation, and providing a better quality of life. 

Symptoms 

Symptoms of Peripheral Artery Disease may include gangrene, claudication or pain in leg muscle while walking, pain at night mainly in the feet and leg, and feet sores.

Bypass Surgery

There are a number of treating methods for PAD. Both invasive and traditional methods are used to treat Peripheral Artery Disease. 

Stenting and Angioplasty are invasive treatment methods. The traditional method includes bypass surgery. The best available treatment method for an individual depends upon various factors such as severity, location of the artery blockage in the leg, general health of the patient, history of any vascular problems, and previous treatments.

Surgical bypass in the leg or Lower Extremity Bypass Surgery is usually the last option for the patients with PAD. This method is used when all the other alternative treatment methods fail or are not suitable for the individual. During the Leg Bypass Surgery, the surgeon forms an alternative channel for blood flow to bypass or avoid the blocked area and restore the direct flow of blood to the lower leg and foot. 

The risks and benefits of the surgery are calculated prior to the surgery. For the best result of the surgery, surgeons try to use the patient s own saphenous vein, from inside the leg, to execute these grafts. Surgeons may also use veins from other leg or arms or use prosthetic or artificial graft, in case the required length of the saphenous vein cannot be achieved. 

The results of artificial and saphenous vein from other limbs are not as effective as the saphenous vein from the same leg. Thus, the availability of an appropriate vein to execute this method is an important consideration that is taken into account before the surgery. 

Takeaway

Leg Bypass Surgery is one of the medical procedures for the treatment of Peripheral Artery Disease. In PAD, the artery of the leg is blocked which can hinder the daily life of the individual. 

The symptoms can be mild or absent but, in the case, where symptoms are severe, and affecting the quality of life of the patient, treatment becomes a necessity. Bypass surgery is the last option used when other alternative methods fail to help the patient. 

Leg Bypass - Know More About It!

Coronary artery disease or CAD is the name given to the heart condition in which the major blood vessels that supply your heart with blood, oxygen and nutrients, also called coronary arteries, get blocked, damaged or diseased.

Blockages usually happen when cholesterol-containing deposits called plaque deposit in your arteries. Plaque narrows the lumen of your coronary artery which means your heart gets lesser and lesser oxygen and nutrients to function properly.
Inflammation is also to blame for coronary artery disease.
Common symptoms of CAD include

Angina or pain in the chest
Shortness of breath
If the blockage is complete, you can get a heart attack.
Common Diagnostic tests
When you go to a heart specialist, she will ask questions about your medical history and follow it up with a physical exam and order routine blood and diagnostic tests to confirm CAD like:

Electrocardiogram (ECG): An ECG records electrical signals as they travel through your heart revealing evidence of a previous heart attack or one that s happening. Holter monitoring is a type of ECG where you wear a portable monitor for 24 hours as you go about your normal daily activities. Abnormalities in the results suggest reduced blood flow to the heart signaling CAD.
Echocardiogram: This test uses sound waves to produce images of your heart. It helps your doctor determine whether all parts of your heart wall are contributing to your heart's pumping activity. If certain parts are moving weakly it can mean damage to muscle due to a heart attack or because of receiving too little oxygen- again signaling CAD.
Exercise Stress test: This test is done by making you do exercises like walking on a treadmill or riding a stationary bike during an ECG. Sometimes, medication to stimulate your heart may be used instead of exercise.
This again detects areas in your heart that receive less blood flow.

Cardiac catheterization or angiogram. A special dye is injected into your coronary arteries to observe blood flow through your heart in a test known as an angiogram.
The dye is sometimes also injected into the arteries through a long, thin, flexible tube called catheter that is threaded through an artery in your leg to the arteries in your heart. This procedure is called cardiac catheterization. This test is very good in diagnosing CAD as the dye outlines narrow spots and blockages on the X-ray images of your heart.
Heart scans. Computerized tomography or CT can help your doctor actually see calcium deposits in your arteries that can be narrowing your arteries. If a substantial amount of calcium deposits are found, coronary artery disease could be the reason.
MRI scans are also done to diagnose CAD.

Common Tests For Coronary Artery Disease!

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