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?

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!!

Uncontrollable division of cells present in the tissue leads to the formation of a lump or mass of tissue. This mass of tissue is known as a tumor and when this condition is diagnosed in the bones of a human body, it is known as bone tumor. Most bone tumors are non-cancerous (benign) and cannot grow. However, it is still possible that the bones could be weakened and the condition could result in fractures and other such problems. The tumor replaces the normal and healthy tissue.

It is observed that cases of malignant bone tumors are much less as compared to benign tumors. Some examples of benign bone tumours include:
1. Giant Cell tumor: In this condition, the tumor affects the legs
2. Osteochondroma: This form is most common among teenagers
3. Osteoblastoma: A tumor which develops in young adults and affects the spine
4. Osteoid osteoma: A tumor that affects long bones
5. Enchondroma: Usually found in hand and feet.

As stated earlier, metastatic cancer is a form of cancer that spreads to the bone from other spots in the body. Cancers from other parts that commonly spread to the bones include breast cancer, prostate cancer and lung cancer.

It is common for bone tumors to bear no symptoms and they can only be diagnosed using an x-ray. However, a typical symptom of bone tumor is pain which:
1. Starts in the region of the bone tumor
2. Often feels achy
3. Worsens with activity

Other symptoms that might be related to bone tumors are:
1. Abnormal swelling around the bone
2. Fever
3. Limping, in rare cases

Treatment
1. Benign bone tumors can be treated by just using medications. However, the tumours might relapse even after treatment.
2. Treatment of malignant tumor might require a number of specialists. The stage of cancer plays a vital role in the treatment.

Common treatments for bone tumor are:
1. Amputation: It is the surgical removal of all or a part of the limb and is conducted only if the tumor is large.
2. Radiation therapy: High intensity X-rays are used to kill cancer cells and treat the tumors.
3. Chemotherapy: Tumor cells which have infiltrated the bloodstream are eliminated using cancer drugs.

Abnormal Swelling - Can it be a Sign of Bone Tumor

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

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!

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!

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