Angioplasty is the procedure of opening a coronary artery blockage with the help of wire balloon and stent. This procedure is done to open the blocked coronary arteries if they are causing symptoms or acute heart attacks.

HOW IT IS DONE?

The procedure is usually done in local anaesthesia. A wrist artery (radial) or a groin artery (femoral) is used to gain access to the coronary artery as is done in angiography. A hollow tube called a catheter is passed upto heart artery and through this, a guidewire is passed across the blockage and over this wire balloon is passed and blockage dilated.

After this balloon is removed and the metallic stent is passed over this wire. The stent is then inflated and it takes its shape of the hollow tube so that the flow in the coronary artery is restored.

WHAT ARE INDICATIONS OF ANGIOPLASTY AND STENTING:

An acute Heart attack is the most definite indication of angioplasty and stenting. At the time of the heart attack, there is an urgent need to restore the blood flow of block coronary artery which is usually not possible with medicines alone. Angioplasty is the most effective and definite way of opening the artery urgently in such situation.

SHOULD ALL BLOCKAGES BE OPENED UP BY ANGIOPLASTY AND STENTING?

NO, all blockages do not warrant this procedure. There is some amount of risk involved in the angioplasty procedure itself. When the risk of blockage is considered more than the risk of opening the artery then the procedure is indicated. Patients who are doing good on medicines may be followed up without angioplasty.

All About Angioplasty!

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?

Coronary artery disease is characterized by accumulation of plaque in the coronary artery that chokes blood supply to the heart. This plaque buildup usually starts with cholesterol accumulation and gradually other particles such as calcium and lipoproteins get deposited as well. Over time, the plaque accumulates, making the blood vessels narrow and choking the supply of blood. In some cases, if the plaque ruptures, it may lead to formation of blood clots resulting in stroke.

The symptoms of coronary artery disease are:

1. Breathing difficulties: This disorder may lead to shortness of breath as the blood pumping mechanism of the heart is impaired; this usually results in fatigue and exertion. It is advised to avoid advanced cardio exercises such as the high intensity interval training.

2. Chest pain: Stress related activities may cause intense pressure or tightness in your chest, resulting in pain in the middle or left portion of your chest. If you discontinue the activity, the pain would usually subside. In some cases, you may feel the pain in the arm and the neck.

3. Heart attack: If the level of plaque accumulation is excessive, then it may result in a heart attack. It is characterized by breathing difficulties, pain, tightness in the chest and sweating. You may also experience pain in the neck and the jaw.

The causes of coronary artery disease are:
1. Smoking and alcohol consumption
2. Leading a sedentary lifestyle ups the risk of coronary artery disease
3. Hypertension
4. High cholesterol levels in the body
5. Blood sugar problems

Treatment
1. Get your blood pressure under control: If you suffer from high blood pressure, then it is recommended to get it under control to prevent coronary artery disease.
2. Quit smoking: If you are a habitual smoker, then it is time to nip the habit in the bud. Smoking is known to constrict blood vessels as it is a vasoconstrictor.
3. Eat healthy: Eat a well balanced diet consisting of vegetables and fruits so that your body receives the essential nutrients to function well.
4. Beat stress: You need to control your stress levels through exercise or meditation. Take time off work and do activities that make you happy.

Coronary Artery Disease: Causes and Treatment

Varicose veins are a condition marked by enlarged or gnarled veins. This typically affects the veins in the feet and legs. In most cases, varicose veins are a mere cosmetic concern but in some cases, it can be quite uncomfortable and painful. If left untreated, it can also lead to further complications.

Varicose veins may be caused by a lack of elasticity in the veins causing blood to pool in them and flow back-wards. This blood is deoxygenated and hence the veins appear blue. Women have a higher risk of suffering from varicose veins as compared to men. This risk also increases with age and weight. Pregnancy can also cause varicose veins. The most common symptoms of this condition are:

visible veins just under the surface of the skin
veins that appear blue and gnarled
a dull ache in the legs
throbbing or burning sensation in the calves
pain in the legs that worsens after standing or sitting in the same position for a long time
itching around the veins
bleeding veins
inflammation of the skin or ulcers around the ankles
red or blue spider veins
Varicose veins can be treated with simple home remedies. Keeping the legs raised or wearing compression stockings can relieve the pain associated with varicose veins and prevent the condition from worsening. Exercise can also help improve blood circulation. If these home remedies are not effective, the patient may need to consult a doctor.

Varicose veins cannot be completely prevented. However, an individual can reduce the risk of suffering from this condition. Regular exercise and maintaining a healthy weight is crucial to do this as being overweight can increase the pressure on the legs and hence aggravate varicose veins. Women with a family history of varicose veins should also avoid wearing high heels and tight stockings.

Complications caused by varicose veins are rare. However, some people may experience bleeding on the surface of the skin. There are chances that the veins deep inside the muscle may get twisted which may lead to the swelling of the calf muscles. Varicose veins may also cause painful ulcers around the ankles and is a result of the buildup of fluid around the ankles.

All the complication must be reported to the doctor at the earliest to prevent the condition from worsening.

Varicose Veins - The Most Common Symptoms Your Should Know!

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

Blood flows through the tubes called as blood vessels. There are two networks of blood vessels   the arteries and the veins. The arteries carry pure or oxygenated blood from the heart to the various parts of the body. The veins, on the other hand, collect impure blood from all over the body and reach it to the heart. Blood flow in the veins is controlled via valves, which ensure blood does not flow in the reverse direction (against its desired direction of flow). The veins in the legs, which are farther from the heart, are quite thick and exert extra pressure to pump blood into the heart. They need to transport blood against gravity and so in people who are prone to stand for long hours, they can become thicker, swollen, twisted, and engorged. In severe cases, there could even lead to bleeding.

Some common causes for varicose veins are:

Damaged valves which are not able to control the flow of blood in the required direction.
Veins with a thin wall that are unable to control blood flow.
Risk factors: Though these are the suspected causes, there are specific risk factors which aggravate the condition of varicose veins.

Family history
Smoking
Occupations which require prolonged standing (construction jobs, painters, etc.)
Pregnancy
Obesity
Age, which reduces the elasticity of the veins
Surgery in the leg, which could have hampered the values or veins
There are quite a few symptoms of varicose veins. These are quite distinct and present as:

Swollen, ropy leg veins which can be blue
Pain, especially with prolonged standing
Tenderness on touching the veins
Itching and heaviness along the veins
Skin changes like scaling and dryness
Night cramps around the area
Susceptibility to bleed from these veins
While varicose veins are easy to diagnose given their distinct clinical presentation, some additional testing can involve the following:

Doppler ultrasound
Scanning
MRI
As said, prevention is better than cure; here are some preventive measures that can be really helpful:

Elevate legs as much as possible. When working, take short breaks to reduce stagnation and promote blood circulation
Quit smoking
Avoiding alcohol, as it causes venous dilation
Weight management
Avoid tight clothing and sitting with cross-legs for prolonged periods as they put a lot of pressure on the veins and valves
Follow a regular exercise regimen to improve blood flow in the legs, like walking or running
Starting from the least invasive to the most, this condition can be treated by:

Compression stocking (Ted hose or Jobst stocking) which improves circulation and reducing pain
Surgical options include sclerotherapy, laser treatment, and stripping off the vein. These are done in very severe cases, but quite rare.

Varicose Veins - How Best It Can Diagnosed?

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