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?

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!

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!!

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!

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

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?

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