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!

Many people know that smoking causes several problems including cancer, heart disease, and respiratory disease. However, there are other diseases occur because of smoking and chewing tobacco. Buerger's Disease is one such disease in which the blood vessels in legs and arms get blocked. This blockage will interfere in blood flow and results in forming blood clots. These clots will affect both legs and
hands.
Buerger's Disease is also known as Thromboangitis Obliterans. It is a type of vasculitis which causes inflammation in the blood vessels including thickening, narrowing, weakening, or scarring.
Buerger's Disease cannot be cured easily. However, by quitting the use of tobacco and smoking, one can limit the symptoms from getting worse. If a person is not able to quit smoking, he/she might end up
suffering from severe tissue damage. One can also even lose toes, fingers, or other parts of the limbs. This is why quitting all type of tobacco or smoking is the only way to treat Buerger's Disease.

What Causes Buerger's Disease?
As discussed earlier, smoking cigarettes or cigars and chewing any form of tobacco is one of the main causes of Buerger's Disease. Still, the exact cause of this disease is unknown, but in most cases of Buerger's Disease, the sufferer has consumed tobacco products. It is an assumption that chemicals present in tobacco, cigarettes, and cigars may affect the lining of blood vessels, causing them to swell. According to experts, the genes in the body may also cause this disease. It is suspected that this disease is caused by an autoimmune response in which the immune system of the body attacks healthy tissues mistakenly. According to this theory, some people are prone to this disease.

Symptoms of Buerger's Disease-
Some of the most common symptoms of Buerger's Disease are:
  Pain in the hands and feet while exercising
  Stiffness due to reduced blood flow
  Pain at Rest
  Skin ulcerations
  Gangrene of the fingers and toes in severe cases
  Numbness, coldness, or tingling of the feet and hand
  Pale, reddish, or blue-tinted hands or feet.

Diagnosis of Buerger s Disease-
There is a set of tests that can diagnose Buerger s disease. Doctors first ask a person about his/her lifestyle, use of tobacco, and symptoms. After seeing a few symptoms, doctors may perform a test to check the blood flow. He may also look for other diseases that cause similar symptoms. Some of the common test to diagnose Buerger s Disease are:


  Allen Test: The Allen test is a blood flow test. In this type of test, patients squeeze their hand into a firm fist, which pushes out blood from hand. The doctor presses the arteries to slow down the
blood flow of the hand. At this stage, the normal color of the skin gets pale. After that, patients open his/her hand and doctors release the pressure from both sides of the wrist one by one. If it takes a longer time to go back to the normal skin color, it may be an indication of Buerger s disease

  Angiogram: It is a type of X-ray that will help to check the blockage of the blood vessels in the legs and arms. In this test, doctor place catheter (thin tube) into an artery to pump the dye. After
that, he takes X-ray images. Doctors may also perform tomography (CT) or MRI scan for clear results.

  Blood Tests: The blood tests will help the doctor to check if there is any other disease that causes the same symptoms as most of the vascular diseases mimics the symptoms of Buerger s
Disease. The doctor may also perform tests to check for diseases like lupus, diabetes, and those that cause blood clots.

Treatment of Buerger' Disease-
Quitting smoking and use of tobacco will help a person to lower the symptoms of this disease. Doctors may also prescribe for pain killers or antibiotics to get rid of the pain in affected areas. If a person finds it difficult to quit smoking, doctors help him/her with the right program and rehabilitation techniques.

Take Away-
Buerger's Disease is one of the rare illness caused by intake of tobacco products, this is why quitting smoking is most important to treat this disease. It is also advisable to consult a doctor as soon as a person identify any of the above symptoms.

All You Need To Know About Peripheral Vascular Injuries!

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

Peripheral Artery Disease (PAD) is a disease of blood vessels that are located outside the heart and brain. The condition develops due to fatty deposits in the arteries and veins that stops the blood flow to the heart and mind as the case may be. It narrows the artery and restricts the blood flow, which causes problems to other organs of the body such as kidney, liver, and stomach.


Symptoms of Peripheral Artery Disease-
Peripheral Artery Disease is the most common type of condition in people. Some people may not even notice the symptoms. The symptoms include:

Pain in the hips and lower leg area.
Brittle toenails.
Short breath while taking stairs.
Pain in the calf.
Numbness and coldness in the leg around a calf
Hair loss on legs and feet
Erectile dysfunction in men
Repeated sores and ulcers in legs
Causes of Peripheral Artery Disease-
The most common cause of Peripheral Artery Disease is the deposit of fatty substances inside the arteries. The fatty deposits build in the arteries gradually with a process called Atherosclerosis. Most of the time people do not know that they are facing the problem of Atherosclerosis. With time deposits increase and the arteries become narrow. It restricts the blood flow and causes problems for other organs.
Another cause for Peripheral Artery Disease is clot created in the arteries due to diabetes. Also, this problem is common in diabetic patients and increases with old age.

The risk factors that contribute to the development of Peripheral Artery Disease are high blood pressure, bad cholesterol, obesity, and diabetes.

Diagnosis of Peripheral Artery Disease-
The primary way to test and diagnose Peripheral Artery Disease is to check the blood pressure in the arm and ankles. If the pressure is low as compared to arm in the ankles, one might be facing Peripheral Artery Disease. It is commonly known as the ankle-brachial index. Other ways to determine Peripheral Artery Disease are CT scans, angiography, and blood tests. Since the disease is prevalent and gradually progress, most of the time it remains undetected.

It is essential that Peripheral Artery Disease gets detected and treated well in time. If the condition persists for a more extended period of time, it may result in loss of leg, increased chances of coronary artery disease and carotid atherosclerosis.

Treatment for Peripheral Artery Disease-
The only way to treat Peripheral Artery Disease is to indulge in physical activity. A regular regime of exercise and physical work will help a person to burn fat and makes the arteries fat free. Doctors suggest that daily 30 minutes of walking or gyming will help treat Peripheral Artery Disease with significant effects. One may notice the signs in just a couple of months.

Along with exercise, one also needs to monitor the weight and eating habits. Foods that are rich in fats and bad cholesterol should be avoided. Make changes in the lifestyle and eat a healthy balanced diet. Include fruits and fresh vegetables in the diet and follow a low carb diet for regular food intake. If a person is addicted to smoking and alcohol, then he/she should consider leaving the bad habits for their own good health.

Take Away-
Above are some of the common and tried treatments. However, it is advisable to consult a doctor before opting for any of these options as these treatments are depended upon the condition of the patients.


Learning In depth About Peripheral Artery Disease!

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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