Level 2
Tan Tock Seng Hospital
Tel: 6357 8911
Fax: 6357 8917
| |
|
Monday to Thursday:
Friday:
Saturday, Sunday & Public Holiday:
|
8am to 5:30pm
8am to 5pm
Closed |
- Vascular Ultrasound (Duplex)
- Non-invasive Investigation of:
- Arterial, Venous Diseases
- Deep Venous Thrombosis
- Ankle Brachial Pressure Index
- Digit Phlethysmography
- Varicose Veins
- Carotid Artery Disease
- Thoracic Outlet Syndrome
- Aortic Aneurysms
- Endovascular Surgery of Aortic Aneurysms
- Management of Arterio-occlusive Disease in:
- Lower Extremity Amputation Prevention
- Carotid and Extracranial Circulation
The section of Vascular Surgery has had its inception in Tan Tock Seng Hospital since the early 80’s when a succession of trainees returned from their overseas training to take up the position of the Vascular Surgery Consultant. The section of Vascular Surgery was formally created in 1998 with the formation of a dedicated Vascular Surgical Team.
The Vascular Surgery team is actively involved in managing the whole range of vascular disorders in Singapore and we are a tertiary referral center for the management of patients with vascular disorders. This includes managing patients with peripheral arterial disease and limb ischaemia, varicose veins, abdominal and thoracic aortic aneurysms, vascular trauma, renal transplantation, creation of vascular access for dialysis in patients with end-stage renal failure and providing complementary skills to the practice of oncological surgery. The Vascular Surgical team functions as the lead team in coordinating and organizing multidisciplinary holistic care for vascular patients. Other specialties involved in the care of vascular patients include Interventional Radiologists, Cardiologists, Endocrinologists and paraclinical specialties including physiotherapy, occupational therapy, podiatry and speech therapy.
Management of Peripheral Arterial Disease
One of the foremost programs launched by the Ministry of Health in studying the treatment of patients with peripheral arterial disease was conducted in TTSH by the Vascular Surgery team. The Lower Amputation Amputation Prevention program, also known as the LEAP for Life program was first proposed by the late Dr Alexandre Chao who successfully managed to institute a 4 year program in TTSH. The program began in 2001 and was completed in 2005. During this period, a total of 413 patients were enrolled. These patients were assessed and treated with a combination of modalities including bypass surgery, limb angioplasty, pneumatic compression therapy or hyperbaric oxygen therapy. Early analysis of the results has shown successful prevention of lower limb amputations with successful limb salvage in 81.3% of patients. Patients have also managed to retain their functional status following successful intervention, with at least 80% of patients being able to resume their premorbid daily activities.
In this day and age of a rapidly aging population and increasing prevalence of chronic diseases such as diabetes mellitus, hypertension, hyperlipidaemia and hypercholesterolaemia, the incidence of peripheral arterial disease is definitely on the rise. Early identification of the presence of peripheral arterial disease allows the institution of simple non-invasive interventions such as lifestyle modifications and exercise therapy conducted by dedicated physiotherapists in our hospital as well medications or pharmacological therapy. Patients at risk include patients with risk factors of diabetes mellitus, hypertension, hyperlipidaemia, hypercholesterolaemia, smokers or past history of tobacco use, family history of peripheral vascular disease.
Assessment of patients with peripheral vascular diseases will include a detailed history-taking and physical examination and non-invasive vascular tests including Ankle-Brachial Pressure Index, which is a measure of the blood pressure in the legs and Toe Pressure Index which measures the blood circulation in the peripheries. Duplex scanning of the arteries in the lower limb provides a picture of the arteries of the lower limb and may demonstrate areas of narrowing (stenosis) or blockage (occlusion). These non-invasive tests are performed in-house in our dedicated Vascular Diagnostics Laboratory.
Management options for patients with significant or critical ischaemia include bypass surgery or percutaneous angioplasty. Bypass surgery involves open surgery and creating a new conduit to channel blood to the leg and foot using either the patients’ own vein as a graft or using a prosthetic graft. Percutaneous angioplasty, for suitable patients, obviates the need for open surgery. Guidewires and catheters are inserted into the artery in the groin from a needle puncture. Balloons are passed to segments of narrowed arteries and expanded to try to increase the flow of blood past the narrowed segments. Close cooperation with our skilled colleagues in Interventional Radiology enables us to offer this option to salvage patients with peripheral arterial disease.
Management of Varicose Veins
The problem of varicose veins continue to plague many patients in the general populace, especially in women. Surgical interventions are not only indicated purely for cosmesis but also in preventing progression of the disease to the stage of developing venous ulcers and treating the often disturbing ‘bursting’ pain due to congestion in the varicose veins.
In recognizing the scope of the problem, we have proposed the setting up of the “Vein Centre” specifically targeted to the treatment of this disorder. We propose to employ cutting-edge technology to be able to better treat patients with varicose veins. This includes the use of EndoVenous Laser Therapy (EVLT) to reduce the pain and discomfort associated with open surgery. This involves passage of a laser fibre from a needle puncture near the knee and application of laser energy to cause fibrosis of the long saphenous vein. Other treatment modalities include injection sclerotherapy for treating fine “spider” veins in the skin and Trivex Transilluminated Phlebectomy for recurrent varicose veins.
Management of Thoracic and Abdominal Aortic Aneurysms
Aortic aneurysms occur when the walls of the aorta become thinned and the aorta starts to balloon out becoming prone to rupture, leading to death. Patients at risk include patients with history of smoking and tobacco use, hypertension and positive family history of aneurysms.
The standard of treatment has been open surgery with replacement of the aneurysmal segment of aorta. This involves major thoracic or abdominal surgery and is associated with significant morbidity and mortality. A recent innovation is the use of endovascular stent-grafting of aneurysmal aorta where a stent-graft is delivered into the aorta via incisions in the groins, obviating the need for a long surgical incision in the chest or abdomen.
In the section of Vascular Surgery in TTSH, we have successfully instituted the Prevention of Aneurysm Rupture program from 2001 to 2005. A total of 39 patients with either thoracic or abdominal aortic aneurysms were enrolled in the program and had endovascular stent-graft repair performed with less morbidity and mortality compared to open surgery.
Vascular Trauma
In close cooperation with the Tan Tock Seng–National Neuroscience Institute Trauma (TNT) Team, the Vascular Surgery is also involved in the management of acute vascular trauma, most commonly following motor vehicle accidents, fall from height or work-related injuries. We also work closely with our colleagues in Orthopaedic Surgery in managing complex limb injuries with vascular compromise and in complex limb reconstruction.
Transplantation Surgery and Dialysis Access
The Vascular Surgery team works with the Renal Physicians in providing a surgical service for the creation of arterio-venous fistulas for long-term haemodialysis. This includes the use of both native veins for fistula creation and prosthetic grafts in patients who have no suitable veins. We are also involved in the national kidney dialysis program where Dr Chia Kok Hoong is a registered renal transplant surgeon and Dr Cheng SC is a registered assistant transplant surgeon.
Oncological Surgery
The Vascular Surgical Team is also involved in oncological surgery in conjunction with other surgical disciplines. Our involvement includes surgery for complex tumours requiring vascular control or vascular reconstruction. We also have an interest in surgery for retroperitoneal tumours.
Carotid surgery for prevention of stroke
One common cause of stroke is due to narrowing of the arteries leading to the brain. One correctable cause of narrowing is stenosis of the Internal Carotid Artery which is the main artery supplying the brain. Carotid endarterectomy surgery involves removing the atherosclerotic plaques causing the narrowing and repairing the artery and this has been shown to reduce the incidence of stroke.
The Vascular Surgical Team
The Vascular Surgical team comprises of one Senior Consultant and 2 Associate Consultants. The team is led by Dr Chia Kok Hoong, Senior Consultant, Vascular and General Surgery. The two Associate Consultants are Dr Lee Chee Wei, who has completed his HMDP training in Australia and Dr Sanjay Nalachandran, who is currently doing his HMDP training in the United Kingdom. Dr Cheng Shin Chuen is currently completing his Advanced Specialty Training in General Surgery in TTSH.
Vascular Diagnostics Laboratory
The support from a dedicated Vascular Diagnostics Laboratory cannot be overemphasized. Our in-house Vascular Diagnostic Laboratory, led by our chief vascular ultrasonographer, Ms. Vivien Ling has been crucial to the success of the vascular team in providing timely and accurate non-invasive imaging of vascular pathology. The Vascular Lab employs state of the art Duplex Ultrasonography for vascular imaging and other adjunct investigative modalities to assist us in the workup of a vascular patient.
<< BACK TO TOP 
