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!

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?

In our bodies, the vascular system is composed of vessels. This system is comprised of a complex network of veins and arteries. The arteries transport oxygenated blood away from the heart and spread it throughout our bodies and veins brings the deoxygenated blood (oxygen-poor) back to the heart for purification. Whenever this complicated process gets disturbed, pain, dysfunction of the system, and other complications may occur.

Most common complications among all are:
1. Abdominal Aortic Aneurysm: This condition is when there is a  bulge  formed in the weak area of the largest artery in the abdomen and keeps on increasing with each pressure flow of blood from that artery. This condition weakens the artery further and massive internal bleeding may occur.

2. Carotid Artery Disease - Stroke: This condition arises when the main blood vessels flowing blood to the brain develops a plague caused due to hardening of the arteries (atherosclerosis). The continuous increase of plague can cause a stroke.

3. Peripheral Arterial Disease: This condition occurs when the flow of oxygen-rich blood is insufficient to the lower limbs of the body due to hardening of the arteries in that area. This can cause difficulty in walking, foot ulcers, infections and can even lead to amputation.

The complication of these types are corrected by the vascular surgeon with the process is commonly known as vascular surgery. However, this condition is sometimes medically managed by an innovative, less invasive procedure called Endovascular surgery. 

Vascular Surgery-
Vascular surgery is generally the traditional surgery that corrects the diseases outside of the heart and the brain. This procedure is more invasive as it involves incisions that are surgical in nature. Vascular surgery comprises of the surgery of the aorta, carotid arteries, and other small diametric arteries. This surgery also involves surgery of veins for treating various conditions such as varicose veins and May-Thurner syndrome.

Endovascular Surgery:
However, this type of surgery is an innovative way to treat medical conditions related to the vascular system. For instance, during the procedure of treating the Abdominal Aortic Aneurysm, it involves making a small cut near the hip area and inserting the endovascular graft through the arteries and is positioned inside the aorta, in a catheter, which is a flexible, long, and narrow tube. The endovascular graft is a tube device made up of special fiber and is framed within stainless steel self-expanding stents. The grafts expand and seal off the aneurysm. This stops the internal bleeding the system and the graft remain in the aorta permanently.

This method has a short recovery time, smaller incisions, less discomfort, less stress on the heart and has fewer risks. This surgery is appropriate for the patient who is at high
risk of complications. 

Take Away-
Diseases related to artery and veins are now being treated with various methods such as angiography, stenting, sclerotherapy in various countries. These days vascular surgeons have become proficient with the endovascular surgical methods. Endovascular surgery is durable and less painful and stressful when viewed with the context of vascular surgery. However, the cost of staying longer at the hospitals is somewhat got balanced by the high cost of imaging equipment and other high financial expenses in the endovascular surgery.

Endovascular VS Vascular Surgery - Know The Difference!

Phimosis, Paraphimosis are the two major issues which occur in males In Phimosis, the foreskin is not easily pulled back from the tip position of the penis. Normally, this problem takes place in younger children and this is not a serious condition. With spontaneous erections and natural manipulations, more than 90% of foreskin becomes retractable by age 3 to 4 years. Few require Preputioplasty and Circucision is reserved for Balanitis Xerotica Obliterans. Paraphimosis, is quite a painful condition which needs to be treated urgently. Paraphimosis is the condition in which the foreskin is pulled back or get stuck in the same position. Due to this the retracted foreskin, as well as the penis part, becomes swollen. 

In this condition, the fluid will build up, and thus the foreskin cannot be returned to its original position. If anyone ignores it then it can lead to major issues. This can have an effect on blood flow to the tip of a penis. And, if not treated on time then the tip of the penis can get damaged.

The insect bite is a condition which can cause swelling of the phallus and prepuce. This can be easily treated by medicine. Differential diagnosis Penile edema, which is related to insect bites, allergic reactions, and trauma. 

Causes of Phimosis and Paraphimosis: 

Scar tissue: Any kind of infections can create the scratch marks on the foreskin. This can also affect the penis. Thus because of tough tissues, it is somewhat difficult to pull it back.    Pull and stretch: It is important that one should not forcefully move the foreskin. Pulling it or stretching the tip of penis vigorously can cause inflammation. 
Medical conditions: If anyone is suffering from diabetes, then there are chances of having a infection known as balanitis. This is typically an infection which takes place at the tip of the penis. 
Thus, in this case, it is necessary to discuss the problem with your doctor. Therefore, after going through your complete medical history, he can suggest you the best treatment which can manage the swelling of the penis. 

Why Paraphimosis happens? 

Mishandled foreskin 
Piercing 
Treatment and cure for Paraphimosis: 
The manual reduction is the first treatment which is suggested by your doctor. In this procedure, analgesic is given as a pain killer through the mouth. Other than this local anesthetic block is applied to your penis. Or applying anesthetic jelly in a local area is quite helpful during manual reduction. Injections of hyaluronidase are also effective to decrease the swelling.

How Surgery Can Help Manage Swelling Of Penis?

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!

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

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