Understanding vascular access for dialysis

A vascular surgeon assesses and treats diseases of the arteries and veins, other than the heart itself and the vessels inside the brain. This includes varicose veins, peripheral arterial disease, aneurysms, deep vein thrombosis, dialysis access problems, vascular injury, and many complications of poor circulation, including diabetic foot disease.

Arrange a consultation for leg pain on walking, varicose veins with aching or skin change, a foot or leg wound that is not healing, new leg swelling, or a known circulation problem. Sudden severe limb pain, a cold pale limb, heavy bleeding, chest pain, or sudden breathlessness needs emergency care, not a routine clinic visit.

Common symptoms are twisted visible veins, aching, heaviness, itching, ankle swelling, and cramps. Some people have few symptoms. Skin darkening, hard patches of skin, bleeding from a vein, or an ulcer near the ankle should be assessed.

Warning signs include calf or thigh pain on walking that eases with rest, cold feet, pale or shiny skin, and wounds that heal slowly. Pain in the foot at rest, or a toe that becomes blue or black, needs prompt medical assessment.

A diabetic foot ulcer should be evaluated as soon as it is noticed. Do not wait to see whether it closes on its own. Fever, spreading redness, a foul smell, black tissue, or a suddenly cold foot needs same-day emergency care.

Peripheral arterial disease is narrowing of the arteries that supply the limbs, most often the legs. It is commonly related to fatty deposits in the artery wall. It may cause pain on walking and, when more severe, pain at rest or tissue loss.