There has been an immense emphasis on the development and adoption of innovative minimally invasive techniques to treat various medical conditions in recent years, vascular disorders being no exception. At the Vascular and Interventional Centre, we take pride in providing a range of high-end procedures. This is a comprehensive overview of the disease processes that necessitate these procedures and various minimally invasive therapies that we offer. They encompass an array of techniques, all sharing the philosophy of frailty-averse solutions to cure a disease process with the minimum use of resources and time, thereby providing maximum comfort. These innovative, multi-disciplinary, and often high-precision treatments are concepts built upon the long-nurtured traditional philosophy of treatment. However, the shift in approach appears in the ‘how to do it’ rather than in ‘what to do’ and ‘why do it.’ The primary understanding of the disease process is mandatory for any successful course of treatment.
Understanding Vascular Conditions
A number of vascular conditions such as varicose veins can occur at any age and in any segment of human vasculature and lead to dangerous or fatal complications. However, these diseases are still relevant not only for their pathophysiology, diagnosis, and treatment, but also for the specifics of medical care. There are several initial groups of diseases: cerebrovascular diseases, coronary artery diseases, and chronic obstructive diseases of the arteries primarily affecting the lower extremities. Arterial diseases develop at the place of maximal anatomic deformity, including the neck and abdominal aorta, celiac trunk, superior mesenteric artery, renal arteries, and arteries of the upper and lower extremities.
Many diseases of the vessels are a chronic process and are often asymptomatic for a long time. Such diseases are called ‘silent killers.’ Since it is challenging to diagnose these diseases when patients do not have symptoms, to date, imaging vascular diagnostics is increasingly important for the timely identification of vascular abnormalities in the majority of patients or the healthy population at risk, such as the elderly and children, in all segments of the vascular system. Symptoms can also occur in these groups but are generally far from the most common. The prevalence of such diseases in patients with underlying vascular diseases is also difficult to calculate for the same reasons as silent killers; therefore, up to 30–40% of patients may suffer from both pathologies, in all vascular beds, including the brain, extremities, and circulatory system.
Minimally Invasive Procedures in Vascular Treatment
Vein disease treatment is available for patients in Singapore. Minimally invasive procedures are an innovative way of treating vascular abnormalities, which are deviations from a normal, disease-free vascular system. These procedures are at the cutting edge of technology with patient comfort in mind. For vascular conditions, the most traditional way of treatment was open surgeries, which have been replaced by interventional procedures. A minimally invasive procedure can be categorized based on the technology used, such as endovascular, laparoscopic, thoracoscopic, or robotic, and the newer advances include particle kinetic energy versus laser energy. These aim to fix the abnormality from inside the vessel, from simple blockage to complex endovascular aneurysm repair of abdominal and thoracic aneurysms. The primary advantages of minimally invasive procedures are (1) no or less cut in the skin, (2) faster recovery, usually immediately or overnight, (3) shorter hospital stay, if any, (4) less or no infection, and (5) lower rate of any complications.
Some of the most common minimally invasive procedures are venous ablation and angiography, peripheral angiography in arteries, carotid and cerebral angioplasty, and stenting, among others. Venous diseases are very active right now due to the change in lifestyle that people have adopted during the new norm. There are different options, including prevention and early treatment before symptoms begin in complicated venous disease. There are many treatment options that give hope to patients who are suffering from different degrees of vascular conditions. There are different patient testimonials about the usefulness, pain alleviating properties, and success of these procedures. These procedures are well established and proven for patient satisfaction, safety, and improved quality of life.
Key Services Offered by Vascular and Interventional Centre
The services that will be offered by all sixty of these centres will vary, but the Vascular and Interventional Centre will open with a truly comprehensive package of care. The centre has been designed to provide patients with a broad array of services encompassing the arterial, venous, and lymphatic systems, covering vascular conditions from top to toe.
The centre provides a comprehensive assessment service for all types of vascular conditions. Most patients will be seen initially in our outpatient facility and may undergo further investigations on the same day. We use advanced digital technology, including a wide range of non-contrast ultrasound techniques and CT angiography examinations. We offer a very wide range of minimally invasive intervention techniques to treat vascular conditions in veins, arteries, and lymphatic diseases. We make sure that all our procedures have been evaluated rigorously, and all of our proceduralists have taken many hours of practicing techniques in our state-of-the-art virtual simulators and in our industry-sponsored masterclasses to ensure that we only offer safe and effective treatments.
We complement this approach with the services offered by our surgical and medical colleagues in our Mortality and Morbidity Multi-disciplinary Teams, which can offer the gamut of surgical and medical non-operative techniques to treat the most complex conditions. We are committed to making sure that patients who get discharged from our services are returned to their fishing or golf as quickly as possible, and without the inconvenience of coming into the hospital again and again for a protracted program of painful dressing changes and checks. Only a patient-centered approach will yield excellent outcomes.
Innovative Approaches to Vein Disease Treatment
Over the past several years, the treatment of vein diseases using minimally invasive approaches has seen some remarkable innovations. New procedures and technologies have been developed and are currently receiving investigative scrutiny, leading the way to more efficient and effective treatments in a variety of disease states. Conditions such as deep vein thrombosis, chronic venous insufficiency, and venous disease secondary to arterial occlusion are being treated with techniques that were not available just a few years ago.
One of the most active areas of research in venous disease today involves the use of intravascular ultrasound. This technique, which is not constrained by body habitus, can provide a remarkable level of accuracy in the diagnosis and follow-up of venous occlusions and insufficiency. The devices can be used to identify areas that require therapy and provide objective evidence of the success of the procedure. It appears that intravascular ultrasound will contribute to a new understanding of venous disease.
Methods for protecting patients during procedures are also being given priority. The ability to filter clots to prevent the migration of material has been the subject of large studies. Case studies conducted at the Vascular and Interventional Centre highlight successful techniques using many of these innovations. Importantly, research into these techniques and technologies is ongoing and has been presented at scientific meetings. Studies being conducted through the Centre promise to redefine the way physicians treat acute and chronic vein disorders. These numerous efforts reflect the Centre’s commitment to an innovative approach and ensuring the best care for patients with chronic venous disease.
Aortic Aneurysm Management
An aortic aneurysm is an abnormal local dilatation affecting the aortic wall, potentially leading to a deadly complication. The aorta, the largest arterial blood vessel in the body, can develop an aneurysm due to several reasons, including advanced age, male sex, family history, or concurrent cardiovascular diseases such as high blood pressure or atherosclerosis. Aortic aneurysms are initially asymptomatic, and many patients may not be aware of their aneurysm until it is detected incidentally. When symptomatic, patients can present with vague or sudden-onset back or chest pain, hypotension or cardiovascular collapse, shortness of breath, and difficulty swallowing, among others. If left untreated, aortic aneurysms will continue to expand in size, with an increased probability of complications, including aneurysm rupture with deadly consequences or embolization of the blood clot downstream. Patients treated by vascular and interventional radiologists will mostly undergo computed tomography surveillance or guided treatment for the aortic aneurysm. In our center, state-of-the-art minimally invasive management of aortic aneurysms includes an endovascular aortic procedure, endovascular aneurysm repair. Endovascular aneurysm repair is associated with significantly improved perioperative outcomes compared to the traditional aortic open surgical repair approach.
The specialists primarily involved are interventional radiologists and cardiac surgeons. Our multidisciplinary model is based on cooperation with interventional and vascular surgeons, anesthetists, nurses, and radiographers. At the hospital after discharge, the patient is supported by a dedicated fast long-term outpatient service – a seamless service at the vascular center. The center has a major research background and is currently conducting some surveillance-based, minimally invasive treatment protocols but also assessing the role of 3D aortic modeling and aneurysm flow analysis in determining treatment decision-making and estimating aortic aneurysm growth. The latest expert consensus has also been endorsed by the center’s specialists. The minimally invasive endovascular aneurysm repair strategy has been incorporated in the center’s updated, multidisciplinary management protocol for managing the aortic aneurysm.
