Peripheral vascular disease (PVD) is a circulation issue that affects the veins and blood vessels outside of the brain and heart. PVD commonly strikes the veins that supply blood to the arms, legs, and organs situated beneath the stomach. These are the veins that are located away from the heart. They are known as peripheral vessels.

In PVD, the width of the veins get limited. Narrowing is normally created by arteriosclerosis. Arteriosclerosis is a condition where plaque develops inside a vessel. It is additionally called 'solidifying of the arteries'. Plaque acts towards reducing the amount of blood and oxygen that is supplied to the arms and legs. As the plaque development advances, clumps may develop, which may further affect the vessel.

There are two main types of PVDs:

    Functional PVD: This doesn't include physical issues in the veins. It causes accidental side effects. Typically,these fits happen suddenly.
    Organic PVD: This includes changes in the vein structure. This sort of PVD causes irritation, tissue harm, and blockages.

The most well-known reasons for functional PVDs are as follows:

    Emotional stress
    Smoking
    Cold temperatures
    Operating Vibrating machinery

The common causes of such natural PVDs are given below:

    Smoking
    High circulatory strain
    Diabetes
    High cholesterol

The symptoms include the following:

    Cramps
    Achiness
    Fatigue
    Burning

Diagnosis:

PVD can be diagnosed using interventional radiology (IR).

IRis a sub-claim of radiology that gives an image-guided diagnosis, and if required, includes treatment of the organs as well.It has developed as a first-line treatment in the administration of PVD.

Advantages:

IR medications are for the most part less demanding for patients than surgery, since they include no surgical cut.They are less painful and have shorter stays at the hospital. By and large, the patients are discharged on the same day the procedure is done. This mainly includes angioplasty and stenting. The procedure is as follows:

    Utilising imaging for direction, the interventional radiologist puts a catheter through the femoral artery in the crotch to the blocked vein in the legs.
    At that point, the interventional radiologist expands a balloon to open the vein that is blocked.
    Sometimes it is opened with a tiny metallic cylinder called astent.
    This is a treatment that does not require surgery; only a scratch in the skin the extent of a pencil tip.

Alternative measure:

Angioplasty and stenting have totally replaced invasive surgical methods. Early trials have proven IR to be as successful as surgery for some blood vessel and artery impairments. Earlier, extensive clinical experience demonstrated that stenting and angioplasty are favoured as first-line treatments for more procedures all through the body .

Doctors as well as patients who have been through the same, believe that IR is much better for PVD than invasive surgery, since it reduces the risk of infection.

Diagnosing Peripheral Vascular Diseases With Interventional Radiology

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?

Inguino-scrotal and Inguino-labial swellings are common in children during infancy. A common cause of an Inguino-scrotal swelling in children is the presence of a patent processus vaginalis. It presents in the form of an inguinal hernia or hydrocele. Male infants are often affected 3 to 6 times more than the female ones. Processus vaginalis is the outpouching of peritoneum that extends through the inguinal canal. It is first seen during the 3rd month of intrauterine life. It follows the gubernaculum and testes through the inguinal canal and reaches the scrotum by the 7th month of gestation. 

Differential diagnosis of inguino-scrotal swelling in children: 

Inguinal hernia and hydrocele 
Torsion testes, epididymorchitis 
Undescended testes 
Varicocele 
Enlarged inguinal lymph node 
Abscess or lipoma 
Normally after the testicular descent, the portion of processus vaginalis surrounding the testis becomes tunica vaginalis. The processus vaginalis gets obliterated, eliminating the communication between peritoneal cavity and scrotum. A patent processus vaginalis is seen up to 20% in adulthood. 

Hernia and Hydrocele: The testicles or ovaries form in the abdomen near the kidneys, between 3 to 4 months of fetal development. Further, they gradually move down into the lower part of the abdomen as the fetus continues to develop. On descending downwards, small part of the peritoneum (a layer of tissue lining the abdomen from inside) that attaches to the testicle is drawn with it into the scrotum. This forms a pouch or sac. A similar process occurs in females as the round ligament of the uterus descends into the groin at the labia. The sac formed is processus vaginalis. Any connection between the abdominal cavity and the scrotum or groin is eliminated. When closure of the processus vaginalis is delayed or incomplete, it may stretch and eventually become a hernia. Stretching of processus vaginalis creates the inguinal sac that allows organs an extension from abdomen and entry into the sac. If fluid, rather than organs, builds up and remains in the sac, the child has a hydrocele. Approximately 80 percent to 90 percent of inguinal hernias appear in boys. They are more common on the right side, but in about 10 percent of cases, they occur on both sides (bilaterally). 

Epididymorchitis: Epididymitis is the pain and swelling of the tube that attaches to each testicle called as the epididymis. Orchitis is pain and swelling of the testicle. Since epididymis and testis lie next to each other, differentiation of the inflamed part is difficult. Hence, the term epididymo-orchitis is often used. Infection with bacteria often causes these problems. Other causes are infections from surgery or from a catheter that drains urine. The mumps virus also can cause orchitis. Analgesics or anti-inflammatory medicines can reduce the pain. Antibiotics are used if the problem is caused by bacteria. 

Torsion testis: It is a painful condition that occurs in the boys. It is a twisting of the testicles and the spermatic cord (the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels). A decreased blood flow to the testes is caused by torsion of the testes. This torsion essentially strangles them of oxygen and nutrients. While it generally occurs in adolescent boys, it may also occur during fetal development or shortly after a baby is born. Urgent surgical procedure is undertaken if testicular torsion is confirmed in a child. The chance of survival for the testicle is best if surgery is completed within six hours of symptom onset.

Know The Types Of Inguinoscrotal Swelling In Children!

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:

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.
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.
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.
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.
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:

Traumatic, which occur after injury
Compressive, which occur when the pipes flatten
Occlusive, which occur when pipes are blocked
Tumors (growths) or malformations (deformed, tangled pipes), which may or may not be present at birth
Vessel spasms, which occur when abnormal control of vessels causes them to narrow
Symptoms
Symptoms of vascular disorders can include:

Pain
Abnormal color changes in the fingertips
Ulcers or wounds that do not heal
Hand problems when in cold temperatures or locations
Numbness or tingling of the fingertips
Swelling
Cool or cold fingers and/or hands

5 Common Vascular Disorders

Hereditary Angioedema is a rare skin related disorder and as the name suggests it is also a genetically inherited condition. This condition mainly afflicts the throat, abdomen and the limbs of the patient, with a certain kind of swelling. This swelling can become fatal if not treated on time. Here is everything you need to know about the condition and its treatment.

Causes: A rare genetic mutation of the SERPING1 gene can cause this condition. Usually, this gene is known to produce C1 esterase inhibitor, which is a kind of blood protein. This blood protein is an important element of one s immune system and is usually involved in the biochemical reactions that control the body s response to inflammation causing elements. This is done when the blood protein produces a hormone known as Bradykinin. If this blood protein does not function in a normal manner, then there is excessive production of this hormone, which leads to swelling and inflammation.

Type One: There are various types of Hereditary Angioedema that can affect various parts of the body. Type one is one of the most common kinds and can be found on the face, hands, abdomen, throat, as well as feet and genitals of the patient. The severity and frequency of attacks cannot really be predicted and the patient may suffer from attacks throughout his or her life. The best way to treat this type of Hereditary Angioedema is with the help of antihistamine drugs and prednisone which can fight allergic attacks.

Type Two: This kind of Hereditary Angioedema has the same symptoms as type one and is caused by a malfunction of the C1 inhibitor, rather than the Bradykinin hormone as one can see in type one. This condition can also be treated with anti-allergy drugs.

Type Three: This is very rare kind of Hereditary Angioedema. In fact, medical science is yet to find a conclusive body of knowledge that can point to the exact causes and symptoms of this condition. Coagulation is one of the main causes recognised so far. This condition is much more common in women than it is in men, and it usually shows up as facial swelling.

Timely Treatment: While there is no cure for this condition, one can prevent a flare up of the symptoms by taking C1 inhibitors and Bradykinin receptors as well as enzyme inhibitors. It is important to get early treatment for the symptoms and to have constant access to a hospital and its emergency unit. One should also keep track of attacks and symptoms and get regular check-ups done by a doctor to detect the earliest signs of the same to avoid fatalities.

What is Hereditary Angioedema and How Can it be Treated?

An abnormal swelling in the neck can be symptom of various problems. While it can be something as non-threatening as a swollen gland due to a cold that can be cured with simple medication, a swollen neck can also turn out to be a cancerous lump in the neck. When faced with an irregular swelling in the neck, it is best to not panic or jump to conclusions until you consult with an Ear-Nose-Throat Specialist. The possible problems that a swelling in the neck can indicate are:

Swelling or enlargement of the salivary glands: The salivary glands may become enlarged due to an infection or due to foreign materials getting stuck in them. While foreign objects or formation of stones in the salivary glands might require surgical removal, they can often be dissolved with medication and other non-invasive treatments. And infection in the salivary glands is often treated with antibiotics or other medication. These treatments can be prescribed and administered by ENT Specialists.
Thyroid disease: The thyroid gland may swell up and cause a swelling of the neck. These are often called goiters in colloquial language and are a result of thyroid diseases such as hypothyroidism and hyperthyroidism. They usually require a series of medication and treatment and are not considered an ENT problem despite the swelling of the neck.
Benign cysts: Benign cysts can form in any part of the neck or in the glands, much like it can form in any part of the body. An ENT Specialist can prescribe a surgical removal of the cyst lest it turns cancerous later in life. It should also be removed in case it grows or relocates, going on to cause other problems.
Lumps in the muscles: Lumps in the neck muscles are formed by injury or torticollis. These usually aren t considered ENT problems and can be treated by general physicians and sometimes chiropractors.
Cancerous cysts or growths: One of the most daunting problems posed by a swelling of the neck is the possibility of cancer. While thyroid cancers as well as cancerous growths in the salivary glands are slow to develop, a swelling in the neck should immediately be investigated by an ENT Specialist in order to rule out all possibilities.

Neck Swelling - When It's An ENT Disease!!

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