Vascular & Endovascular Centre
The Vascular and Endovascular Centre at CVSKL is a one stop centre for screening, diagnosis, surveillance and treatment for all vascular diseases.
What are Vascular diseases?
The vascular system or the circulatory system is made up of vessels that carry blood and lymph through the body. Blood vessels are tubes and there are 3 types of blood vessels:
- The arteries carry blood from the heart to the whole body, delivering oxygen and nutrients to the body tissues.
- The veins carry the deoxygenated blood back to the heart taking with them the tissue waste matter.
- The lymph vessels carry lymphatic fluid.
Vascular diseases are conditions that affect the arteries, veins or lymphatics. Depending on the disease and which arteries or veins are affected, the resulting consequence will be different.
- In conditions where the lumen of the arteries are narrowed or completely blocked, the blood flow to the affected organs or other body structures, eg the legs, may be compromised. If it is the vessels to the heart (coronary arteries) the patient will have a ‘Heart attack’ and if it is blood vessels to the brain, a stroke will result. If it is blood vessels to the legs, the patient can experience pain, ulceration and gangrene of the leg (critical limb ischemia).
- If the arterial wall is weakened, it will result in bulging (aneurysm) and eventually rupture of the artery resulting in blood loss.
- In the veins, blockages in the blood flow results in thrombosis (deep vein thrombosis) and damages in the valves (within the veins) will lead to dilated veins (varicose veins).
There are many vascular diseases, the commoner vascular diseases are listed below:
- Abdominal Aortic Aneurysms (AAA)
- Peripheral Arterial Disease (PAD)
- Carotid Artery Disease
- Carotid Body Tumour
- Varicose Veins
- Deep Vein Thrombosis (DVT)
- Vascular Access (AV Fistula)
- Hyperhidrosis (Sweaty palms)
- Endovascular Aneurysm Repair
○ Endovascular Aneurysm Repair for AAA (EVAR)
○ Thoracic Endovascular Aneurysm Repair (TEVAR)
○ Custom-made Devices (CMD) – Fenestrated & Branched Stent Grafts for Thoracoabdominal aneurysm / Aortic Arch aneurysm
- Open Repair
- Endovascular Repair
- Open Repair
Peripheral Arterial Diseases
- Bypass Procedures
- Hybrid Procedures
Acute Limb Ischaemia
- Carotid Endarterectomy
- Carotid Angioplasty/Stenting
- Excision of Carotid Body Tumour
Renal & Visceral Arteries
- Open Surgery
- Thermal ablation – Radiofrequency / Endovenous Laser
- Glue closure
- Open surgery
- Injection Sclerotherapy
Deep Vein Thrombosis
- Venogram & Stenting
Vascular Access for Haemodialysis
- Creation of Arteriovenous Fistula
- Creation of Arteriovenous Graft
- Angioplasty for Failing Arteriovenous Fistula
- Solution for Multiple Access Failures
Angioplasty & Stenting of Central Vein Occlusion
Thoracoscopic Sympathectomy for Hyperhidrosis
CVSKL has a Emergency Department to receive emergency cases:
- Ruptured Aortic Aneurysms
- Acute Aortic Dissection
- Acute Limb Ischemia
- Vascular Trauma
The Vascular & Endovascular team consists of:
- 2 Vascular & Endovascular surgeons
- 2 Vascular Technologists / Ultrasonographers
- 2 Radiographers
- 6 Vascular nurses in the Hybrid OR
The team works closely with our Anaesthesiologists, Cardiothoracic surgeons, Cardiologists and Nephrologists.
Non-Invasive Vascular Laboratory (Vascular Lab)
Situated at the Outpatient Department next to our doctors’ clinics, the Vascular Lab specialises in several tests that look at the condition of arteries and veins and how well blood flows in these vessels. The tests are performed by 2 qualified ultrasonographers who work closely with our doctors.
Tests are done to examine the blood vessels throughout the body. These tests help to diagnose and plan the treatment of many vascular disease, including peripheral arterial disease (PAD), carotid artery disease, aneurysms, varicose veins, deep vein thrombosis (DVT) and vascular access (AV fistula). These tests are also used for surveillance and post-operative follow-up to monitor the
success of surgery or endovascular procedures.
The Non Invasive Vascular Tests
- The ankle-brachial index (ABI) is a test that uses inflatable pressure cuffs to assess blood flow in the legs and arms.
- The difference between the blood pressure from the ankle and the arm form the ABI ratio. The ABI ratio tells the doctors how the circulation in your legs is performing.
The duplex ultrasound evaluates the condition and the blood flow through your arteries and veins. There are several types of ultrasound tests:
- Carotid ultrasound – ultrasound of the carotid arteries in the neck to identify or rule out blockages that can lead to a stroke
- Abdominal ultrasound – ultrasound of the abdominal aorta to identify and evaluate aneurysmal disease or blockages of the aorta and its branches.
- Lower limb ultrasound – ultrasound of the arteries to the legs to evaluate blockages that may be contributing to pain in the legs, ulceration or gangrene.
Most of these tests are done at the Vascular Lab, but Duplex ultrasound is also increasingly being used in our Hybrid Operative Theatre pre-operation for planning of procedures, intraoperative and post-operative assessments.
Computed tomography Angiography (CT angiogram)
Done in our Radiology Department, a CT scan is a type of X-ray that uses a computer to make cross-sectional images of your body. CT angiography combines a CT scan with an injection of a special dye to produce pictures of blood vessels and tissues in a part of the body. The dye injected to perform CT angiography is called a contrast material because it “lights up” blood vessels and tissues that are being studied. These images are reconstructed to give 3D images of the arteries that are studied. These images will help the surgeons to plan the best treatment for the patient’s condition. CT angiography is frequently used to assess the aorta (chest and abdomen) and its branches for aneurysms and occlusions. It may also be used to assess the carotid arteries and the arteries to the lower limbs.
Hybrid Operating Theatre
A Hybrid Operating Theatre (Hybrid OT) is a room that combines a traditional Operating Theatre with an image guided Interventional Suite. This combination allows us to do complex open surgery or advanced intervention procedures as well as a combination of both (Open surgery + Intervention procedures, also called Hybrid surgery) as a single procedure in the same patient. The Hybrid OT helps us to provide the optimal treatment and the best outcome for the patients.
Like a traditional Operating Theatre, our Hybrid OT is an aseptic room, equipped with a surgical table, operating lights and anaesthetic machine. In addition, there is a state of art imaging system. Our imaging system is highly mobile. Using laser-guided technology, it is parked at a corner of the room when not in use. When it is needed, it will move to the required position beside the operating table to obtain the best imaging.
This state-of-art system is equipped with advanced imaging tools such as Fusion imaging and Rotational angiography. Fusion imaging is a novel technique that allows for integration of highly detailed computed tomographic (CT) images with fluoroscopy. Images from a previous CT scan is loaded and processed in a workstation to produce a 3D model of the vasculature which is then merged with the live fluoroscopic images. Unlike conventional angiography which gives us 2D images, Rotational angiography gives us CT -like 3D images. The C-Arm rotates around the patient and acquires a series of x-ray images. These images are then reconstructed through software algorithms into 3D images.
- The Aortic Programme
- The PAD & Diabetic Foot Programme
- The Vein Centre
- The Vascular Access Programme