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Chan KS, Arunaachalam M, Hong Q, Yong EM, Lingam P, Zhang L, Chandrasekar S, Tan GWL, Lo ZJ. Outcomes of incisional negative pressure wound therapy following brachiobasilic transposition arteriovenous fistula creation: A 1:2 propensity score matched study. Int Wound J 2020; 17:1231-1238. [PMID: 32347016 DOI: 10.1111/iwj.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
Incisional negative wound pressure therapy (iNPWT) use on closed incisions has been shown to improve wound outcomes, but no studies have evaluated the use of iNPWT following brachiobasilic transposition arteriovenous fistula (BBT-AVF). We aim to investigate the efficacy of iNPWT vs conventional wound therapy in reducing surgical site infections (SSIs) for BBT-AVF incisions. This is a retrospective cohort study of patients who underwent BBT-AVF creation between January 2010 and December 2017. A 1:2 propensity score matching (PSM) was performed to reduce selection bias and address for confounding factors. Study outcomes included SSI and haematoma incidence, 30-day readmission, and 30-day mortality. A total of 154 patients were reviewed in this study: 47 (30.5%) had iNPWT and 107 (69.5%) had conventional wound therapy. The overall median age was 60.5 (interquartile range 54-69). PSM with a 1:2 ratio resulted in a total of 117 patients (39 iNPWT and 78 conventional wound therapy). In the unmatched cohort, SSI incidence was lower in the iNPWT group (n = 1/47 [2.1%] vs n = 14/107 [13.1%], P = .035). However, incidence of SSI was comparable between iNPWT and conventional wound therapy after matching (n = 1/39 [2.6%] vs n = 9/78 [11.5%], P = .102). There was no significant difference in 30-day readmission and 30-day mortality. Within our study population of patients with BBT-AVF incisions, there is a non-statistically significant reduction in SSI incidence for patients who received iNPWT as compared with conventional wound therapy. Further prospective randomised controlled studies should be conducted to validate these findings.
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Leong Tan GW, Chandrasekar S, Lo ZJ, Hong Q, Yong E, Lingam P, Zhang L, Quek LHH, Pua U. Early experience in the COVID-19 pandemic from a vascular surgery unit in a Singapore tertiary hospital. J Vasc Surg 2020; 72:12-15. [PMID: 32305387 PMCID: PMC7162742 DOI: 10.1016/j.jvs.2020.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
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Leong SW, Lo ZJ, Hong Q, Yong E, Zhang L, Chandrasekar S, Leong Tan GW. LEA 5. Use of Disposable Negative Pressure Wound Therapy on Split-Thickness Skin Graft Recipient Sites for Peripheral Artery Disease Foot Wounds—Two Case Reports. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chan WK, Lo ZJ, Hong Q, Yong E, Zhang L, Chandrasekar S, Leong Tan GW. AAA 16. Systematic Review of Prevalence of Abdominal Aortic Aneurysms in Asians. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Le Hua Soh Z, Li JY, Han Ng DW, Lo ZJ, Hong Q, Yong E, Zhang L, Chandrasekar S, Leong Tan GW, Selvaganapathi N. MISC 8. Effectiveness of Multidisciplinary Perioperative Geriatric Surgical Service Consultation for Vascular In-Patient Population. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ho XN, Lo J, Hong Q, Yong E, Zhang L, Leong Tan GW, Chandrasekar S. LEA 16. Peripheral Vascular Disease in a Multicultural Diabetic Asian Population: A 10-Year Experience in a Tertiary Center. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lau L, Lo ZJ, Hong Q, Yong E, Zhang L, Chandrasekar S, Leong Tan GW. LEA 18. Systematic Review on the Use of Artificial Intelligence in Peripheral Vascular Diseases. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lo ZJ, Huang IK, Pua U, Quek L, Hong Q, Yong E, Zhang L, Chandrasekar S, Leong Tan GW. VC 4. Asian Iliac Vein Disease and Stenting Outcomes. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tay WL, Lo ZJ, Hong Q, Yong E, Chandrasekar S, Tan GWL. Toe Pressure in Predicting Diabetic Foot Ulcer Healing: A Systematic Review and Meta-analysis. Ann Vasc Surg 2019; 60:371-378. [DOI: 10.1016/j.avsg.2019.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
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Pua U, Tan GWL, Kolvenbach RR, Quek LHH. Use of Multilayer Stent and Fenestrated Endograft in a Single Session to Treat Long-Segment Aorta. Ann Vasc Surg 2019; 61:471.e17-471.e21. [PMID: 31394240 DOI: 10.1016/j.avsg.2019.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/27/2022]
Abstract
A 72-year-old man with suprarenal aneurysm and 2 large penetrating ulcers (PAUs) in the descending aorta was referred for endovascular treatment. To avoid long-segment aortic coverage and the attendant risk of spinal ischemia, combination of 2 different stent technologies was used. A multilayer flow modulator was implanted in the thoracic aorta for the PAU, followed by implantation of a customized 4-vessel fenestrated stent graft for the suprarenal aneurysm. The patient remained well at 2 years with computed tomography evidence of exclusion of the suprarenal aneurysm and involution of the PAU.
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Quek LHH, Tan TSM, Tan GWL, Pua U. Salvage of exhausted neck access using a novel inside‐out device in dialysis‐dependent patients. Hemodial Int 2019; 23:E111-E114. [DOI: 10.1111/hdi.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/06/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
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Chong RC, Lo ZJ, Chandrasekar S, Leong Tan GW. AVA 1. Salvage of Failing Native Arteriovenous Fistula by Interwoven Nitinol Stenting: A Review of Early Experience. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lee J, Lo ZJ, Hong Q, Leong Tan GW, Chandrasekar S. AA11. Laparoscopic Retroperitoneal Washout of an Infected Aortobifemoral Graft: A Novel Technique. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Loke Y, Ng I, Lo ZJ, Hong Q, Leong Tan GW, Chandrasekar S. LEA 11. Implementation of a Multidisciplinary Team Approach in Lower Extremity Amputation Prevention Program for Diabetic Foot Ulcer Referral from Primary Health Care to a Tertiary Center Vascular Surgery Clinic: Initial Experience in an Asian Population. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mak WZ, Chandrasekar S, Leong Tan GW, Lo ZJ. LEV 6. Klippel-Trénaunay Syndrome: A Case Report and Literature Review. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ling TW, Lo ZJ, Hong Q, Chandrasekar S, Leong Tan GW. LEA 24. Toe Pressure in Predicting Diabetic Foot Ulcer Healing: A Systematic Review and Meta-Analysis. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lim K, Hong Q, Leong Tan GW, Chandrasekar S, Lo ZJ. LEA 10. Use of Home Negative Pressure Wound Therapy in Peripheral Artery Disease and Diabetic Limb Salvage. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lo ZJ, Hong Q, Huang HJ, Leong Tan GW, Chandrasekar S. LEO 8. Diabetic Foot Limb Salvage: A Series of 809 Attempts and Predictors for Endovascular Limb Salvage Failure. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yu H, Huang B, Yau JWK, Chandrasekar S, Tan GWL, Lo ZJ. Review of Patency Rates between One-Stage and Two-Stage Brachial-Basilic Transposition Arteriovenous Fistulae Creation in an Asian Population. Ann Vasc Dis 2018; 11:318-323. [PMID: 30402182 PMCID: PMC6200625 DOI: 10.3400/avd.oa.18-00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To compare patency rates between one- and two-stage (first-stage arteriovenous anastomosis followed by second-stage superficialization) creation of brachial-basilic transposition arteriovenous fistula (BBT-AVF) in an Asian population. Methods: A retrospective review of BBT-AVFs was conducted between July 2008 and March 2015. Kaplan–Meier survival analysis and log-rank test were used to evaluate patency. Results: In total, 103 BBT-AVFs were created in 86 patients (mean age, 61 years; men, 57%). The overall primary, assisted primary, and secondary patency rates at 12, 24, 36, and 48 months were 70%, 48%, 38%, and 35%; 86%, 70%, 62%, and 59%; and 90%, 77%, 70%, and 63%, respectively. There was no significant difference in demographics and preoperative vessel caliber between the groups. The primary failure rate was 24% in the one-stage group, compared with 21% in the two-stage group (p=0.803). There were no statistically significant differences in primary, assisted primary, and secondary patency rates between the groups. Conclusion: There was no significant difference in primary failure and patency rates between the two groups. Both one-stage and two-stage procedures conferred good outcomes with overall 12-month primary patency, secondary patency, and primary failure rates of 70%, 90%, and 23%, respectively.
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Tan GWL, Quek L, Tan BP, Pua U. Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population. Cardiovasc Intervent Radiol 2017; 41:544-553. [DOI: 10.1007/s00270-017-1858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
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Ong DY, Tan GWL, Chan MSL, Pua U. Common Femoral Artery Caliber Changes after Percutaneous versus Surgical Access in Endovascular Aneurysm Repair in the Asian Population. Ann Vasc Surg 2017; 47:266-271. [PMID: 28943488 DOI: 10.1016/j.avsg.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/23/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Western studies showed vascular caliber changes post-endovascular aneurysm repair (EVAR). This study aims to evaluate for postoperative changes of the common femoral artery inner diameter (CFA ID) in the Asian population. METHODS From January 2011 to June 2016, 202 patients who underwent EVAR were reviewed. CFA IDs were evaluated at 3 fixed levels on computed tomography (CT) aortograms. Preoperative and postoperative measurements were compared. Per-groin analysis was carried out after division into percutaneous access endovascular aneurysm repair (PEVAR) and surgical access endovascular aneurysm repair (SEVAR) groups. Independent sample t-test compared for differences in overall CFA ID changes between PEVAR and SEVAR groups. Paired sample t-test evaluated CFA ID changes in each group. P value < 0.05 was considered significant. RESULTS One hundred and twenty patients were included, with 200 groins subsequently analyzed. The PEVAR and SEVAR groups have no significant demographic differences, except in sheath size and duration of CT aortogram follow-up. No significant differences in overall CFA ID changes comparing PEVAR and SEVAR groups (-0.12 ± 1.05 mm, -0.10 ± 0.81 mm, P = 0.36). No significant overall CFA ID changes in both PEVAR (7.92 ± 1.23 mm, 7.80 ± 1.38 mm, P = 0.34) and SEVAR groups (7.47 ± 1.44 mm, 7.36 ± 1.64 mm, P = 0.15). CONCLUSIONS No significant differences in CFA caliber changes comparing PEVAR and SEVAR. No significant CFA caliber changes in either group.
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Wu JT, Wong M, Lo ZJ, Wong WE, Narayanan S, Tan GWL, Chandrasekar S. A Series of 210 Peripheral Arterial Disease Below-Knee Amputations and Predictors for Subsequent Above-Knee Amputations. Ann Vasc Dis 2017; 10. [PMID: 29147164 PMCID: PMC5684163 DOI: 10.3400/avd.oa.17-00046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To review patient characteristics and outcomes after peripheral arterial disease (PAD)-related below-knee amputation (BKA), and identify risk factors predicting subsequent above-knee amputation (AKA). Materials and Methods: A retrospective study of 210 BKAs between May 2008 and December 2015. Results: The mean age of the study population was 66 years. Most of the patients had cardiovascular comorbidities, and 33% had end-stage renal failure (ESRF); 89% were American Society of Anesthesiologists 3 or 4. Previous ipsilateral lower-limb minor amputation was present in 49% and previous contralateral lower-limb major amputation was present in 20% patients. Limb salvage revascularization via angioplasty prior to BKA was performed in 73%, while 27% had extensive tissue loss that was not suitable for limb salvage. Postoperatively, 20% had BKA wound infection, with 3% requiring further surgical debridement, and 9% (19 patients) required subsequent AKA within 1 month. Overall survival analysis at 1–5 years was 75%, 66%, 64%, 59%, and 58%, respectively. Multivariate analysis showed ESRF (Odds Ratio [OR]=3.85; p=0.01) and preoperative non-ambulatory status (OR=5.58; p=0.01) to be independent risk factors in predicting for subsequent AKA. Conclusion: Patients with underlying ESRF or preoperative non-ambulatory status may benefit from direct AKA if major amputation is required.
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Tan KW, Lo ZJ, Hong Q, Narayanan S, Tan GWL, Chandrasekar S. Use of Negative Pressure Wound Therapy for Lower Limb Bypass Incisions. Ann Vasc Dis 2017. [PMID: 29515700 PMCID: PMC5835432 DOI: 10.3400/avd.oa.17-00052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective: The use of negative pressure wound therapy (NPWT) for post-surgical cardiothoracic, orthopedic, plastic, and obstetric and gynecologic procedures has been described. However, there are no data regarding its use for lower limb bypass incisions. We aimed to investigate the outcomes of NPWT in preventing surgical site infection (SSI) in patients with lower limb arterial bypass incisions. Materials and Methods: We retrospectively used data of 42 patients who underwent lower limb arterial bypass with reversed great saphenous vein between March 2014 and June 2016 and compared conventional wound therapy and NPWT with regard to preventing SSI. Results: Twenty-eight (67%) patients underwent conventional wound therapy and 14 (33%) underwent NPWT. There were no statistical differences regarding patient characteristics and mean SSI risk scores between the two patient groups (13.7% for conventional wound therapy vs. 13.4% for NPWT; P=0.831). In the conventional group, nine instances of SSI (32%) and three (11%) of these required subsequent surgical wound debridement, whereas in the NPWT group, there was no SSI incidence (P=0.019). Secondary outcomes such as the length of hospital stay, 30-day readmission rate, and need for secondary vascular procedures were not statistically different between the two groups. Conclusion: The use of NPWT for lower limb arterial bypass incisions is superior to that of conventional wound therapy because it may prevent SSIs.
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Pua U, Kwan J, Tan GWL. The IR Point of View: Action Cameras for IR Action. Cardiovasc Intervent Radiol 2016; 40:639-641. [PMID: 27999915 DOI: 10.1007/s00270-016-1542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
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Pua U, Tan GWL. Plug Closure of an Arteriovenous "Fish-tula" for Lymphedema. J Vasc Interv Radiol 2016; 27:1777. [PMID: 27926424 DOI: 10.1016/j.jvir.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 11/15/2022] Open
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