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Lim X, Lee N, Zhang L, Hong Q, Mak M, Chong RC, Tan GWL, Pua U, Wu YW, Yong E, Kwan J. Snuffbox distal transradial access (dTRA) for arteriovenous fistuloplasty in Singapore: Going distal is safe. J Vasc Access 2024:11297298241250246. [PMID: 38708823 DOI: 10.1177/11297298241250246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
AIM Arteriovenous fistula (AVF) dysfunction resulting from stenosis or occlusion, is a prevalent issue in end-stage renal failure patients reliant on autogenous AVFs for dialysis. Recently, a distal transradial approach (dTRA) has emerged, offering advantages such as diminished access site complications, better patient comfort and reduced risk of radial artery occlusion. Our study seeks to assess the effectiveness, outcomes and complication rates of employing dTRA for arteriovenous fistuloplasty in Singaporean patients. METHODS A retrospective review of all dTRA fistuloplasties performed on dysfunctional or slow to mature AVFs from 2017 to 2023 in our institution was performed. Patients with a distal radial artery measuring 2 mm or more with no evidence of occlusion or thrombosis were included. Patients who required central venoplasty or cutting balloon angioplasty were excluded. Outcome measures included technical success, mean procedure duration, complications and post-intervention primary patency at 1, 3 and 6 months. Patients were followed up for 12 months post-intervention. RESULTS A total of 37 patients were included. 97.3% of patients undergoing dTRA fistuloplasty had radiocephalic fistulas while 2.7% had brachiobasilic fistulas. There was 100% technical success (defined as success in radial artery cannulation, sheath insertion and crossing of stenotic lesions) in our study as all patients successfully underwent fistuloplasty via dTRA approach. One-month patency rate was 97.4%, 3-month patency rate was 92.1% and 6-month patency rate was 86.8%. There were no immediate complications (haematoma, infection, bleeding, pseudoaneurysm, occlusion) of the radial artery post-intervention. CONCLUSION Our paper illustrates the safety and efficacy of utilising dTRA for arteriovenous fistuloplasty. This approach offers distinct benefits in addressing non-mature or dysfunctional distal forearm arteriovenous fistulas and should be taken into account in anatomically suitable cases.
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Affiliation(s)
- Xuxin Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Naomi Lee
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Malcolm Mak
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Rhan Chaen Chong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Yi-Wei Wu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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Ong DY, Yong E, Huang IKH, Loy LM, Lee ZY, Tan GWL, Quek LHH, Lim GHT, Kwan J, Chan G, Hui TCH, Wu YW, Pua U. The Utility of Ultrasound Guidance to Improve the Safety of Closure of Antegrade Common Femoral Artery Access after Lower Limb Revascularization. J Vasc Interv Radiol 2023; 34:2208-2212. [PMID: 37652297 DOI: 10.1016/j.jvir.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
This study aimed to investigate the feasibility of ultrasound (US)-guidance in reducing adverse event (AE) rates when using Angioseal device during antegrade lower limb angioplasty via common femoral artery access. From December 2016 to November 2022, 1,322 patients were identified, including 1,131 (85.6%) patients who underwent US-guided closure and 191 (14.4%) who underwent non-US-guided closure. Moderate AEs were encountered in 10 (5.2%) patients in the non-US-guided closure group compared to 38 (3.4%) patients in the US-guided closure group (P = .208). Severe AEs were encountered in 4 (2.1%) patients in the non-US-guided closure group compared to 3 (0.3%) patients in the US-guided closure group (P = .010). Overall AEs occurred in 14 (7.3%) patients in the non-US-guided closure group compared to 41 (3.6%) patients in the US-guided closure group (P = .029). Binary logistic regression showed that only non-US guidance was an independent risk factor for the occurrence of severe AEs (P = .008).
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Affiliation(s)
- Daniel Yuxuan Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Liang Meng Loy
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Zhong Yun Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | | | | | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Gabriel Chan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Yi-Wei Wu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
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Mak MHW, Tan GWL, Wu YW, Quek LHH. Use of Wallstent device as an embolic protection device during stenting of aortic thrombus. J Vasc Surg Cases Innov Tech 2023; 9:101340. [PMID: 37965113 PMCID: PMC10641675 DOI: 10.1016/j.jvscit.2023.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023] Open
Abstract
Blue toe syndrome can occur due to distal embolization from proximal lesions such as an aortic thrombus. We describe the case of a patient who presented with chronic limb threatening ischemia due to a flow-limiting infrarenal aortic thrombus, with gangrene from distal embolization to the left fifth toe, and was successfully treated with endovascular aortic stent graft insertion. Distal embolization during instrumentation was successfully prevented by using a partially deployed Wallstent (Boston Scientific) as an embolic protection device. The reconstrainable Wallstent device can be considered for distal thromboembolic protection during aortic stenting, in particular, when distal embolization is a concern and commercial devices are not readily available.
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Affiliation(s)
- Malcolm Han Wen Mak
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yi-Wei Wu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Lim C, Kwan J, Lo ZJ, Hong Q, Zhang L, Chong L, Huang IKH, Lim GHT, Quek LHH, Pua U, Punamiya S, Chandrasekar S, Tan GWL, Yong E. Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts. J Vasc Access 2023; 24:965-971. [PMID: 34844461 DOI: 10.1177/11297298211060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access. METHODOLOGY A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. RESULTS A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4-31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months. CONCLUSION Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.
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Affiliation(s)
- Cheryl Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Justin Kwan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Lester Chong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Ivan Kuang Hsin Huang
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Gavin Hock Tai Lim
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sundeep Punamiya
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Yong E, Gong H, Liew H, Chan YM, Neo S, Pan Y, Pua U, Lo ZJ, Zhang L, Mak M, Chong L, Hong Q, Tan GWL, Chua MJ, Bin Mohd Fadil MF, Chandrasekar S. Getting a Foothold on Diabetic Foot Disease-Outcomes of a Multidisciplinary Clinical Pathway for Inpatient Diabetic Foot Care: A 17-Year Institutional Review. INT J LOW EXTR WOUND 2023:15347346231183740. [PMID: 37376875 DOI: 10.1177/15347346231183740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Diabetes foot disease (DFD) contributes to poor quality of life, clinical and economic burden. Multidisciplinary diabetes foot teams provide prompt access to specialist teams thereby improving limb salvage. We present a 17-year review of an inpatient multidisciplinary clinical care path (MCCP) for DFD in Singapore. METHODS This was a retrospective cohort study of patients admitted for DFD and enrolled in our MCCP to a 1700-bed university hospital from 2005 to 2021. RESULTS There were 9279 patients admitted with DFD with a mean of 545 (±119) admissions per year. The mean age was 64 (±13.3) years, 61% were Chinese, 18% Malay and 17% Indian. There was a higher proportion of Malay (18%) and Indian (17%) patients compared to the country's ethnic composition. A third of the patients had end stage renal disease and prior contralateral minor amputation. There was a reduction in inpatient major lower extremity amputation (LEA) from 18.2% in 2005 to 5.4% in 2021 (odds ratio 0.26, 95% confidence interval 0.16-0.40, P < .001) which was the lowest since pathway inception. Mean time from admission to first surgical intervention was 2.8 days and mean time from decision for revascularization to procedure was 4.8 days. The major-to-minor amputation rate reduced from 1.09 in 2005 to 0.18 in 2021, reflecting diabetic limb salvage efforts. Mean and median length of stay (LOS) for patients in the pathway was 8.2 (±14.9) and 5 (IQR = 3) days, respectively. There was a gradual trend of increase in the mean LOS from 2005 to 2021. Inpatient mortality and readmission rate was stable at 1% and 11%. CONCLUSION Since the institution of a MCCP, there was a significant improvement in major LEA rate. An inpatient multidisciplinary diabetic foot care path helped to improve care for patients with DFD.
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Affiliation(s)
- Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Haiqing Gong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yam Meng Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shufen Neo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ying Pan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Malcolm Mak
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lester Chong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Min Jia Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Ong DY, Yong E, Quek LHH, Tan GWL, Pua U. Kissing Balloon-Augmented Intravascular Lithotripsy of Calcified Aortic Stenosis. J Vasc Interv Radiol 2023:S1051-0443(23)00173-2. [PMID: 36812985 DOI: 10.1016/j.jvir.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Daniel Yuxuan Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Glenn Wei Leong Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Lim YT, Tay WM, Lo ZJ, Pua U, Quek LHH, Tan BP, Chandrasekar S, Tan GWL. Endovascular repair of mycotic aortic aneurysms confers good medium-term outcomes and aneurysmal sac resolution. Singapore Med J 2022; 63:263-267. [PMID: 36043296 PMCID: PMC9297181 DOI: 10.11622/smedj.2020165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mycotic aortic aneurysm (MAA) is a life-threatening condition. Endovascular repair (EVAR) of aortic aneurysms has been found to be a safe and effective alternative to open repair. We aimed to present the short- to medium-term outcomes for EVAR of MAA in our cohort. METHODS We conducted a retrospective study of 23 consecutive patients with MAA who underwent EVAR in our hospital from January 2008 to July 2017. RESULTS The mean age of our study population was 62 years. The mean aneurysmal size was 3.2 cm. Abdominal MAAs (n = 16, 70%) were the most common, followed by thoracic MAAs (n = 4, 17%). There was no 30-day mortality in our cohort. Endoleak (Types 1, 3, 4) was detected in 3 (13%) cases. At the one-month surveillance computed tomography aortogram, all patients had a reduction in aneurysmal size and 5 (22%) had complete aneurysmal sac resolution. 7 (30%) patients had sac resolution at six months and 8 (35%) patients, at 12 months. The overall survival was 91%, 80% and 61% at one, 12 and 60 months, respectively. CONCLUSION EVAR is a feasible and durable method for the repair of MAA, with a five-year overall survival of 61%. All patients in our study had a reduction in aneurysmal size at one month, with 65% having complete aneurysmal sac resolution by 12 months.
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Affiliation(s)
- Yi Ting Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Wee Ming Tay
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Bien Ping Tan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Sivapragasam N, Matchar DB, Zhuang KD, Patel A, Pua U, Win HH, Chandramohan S, Venkatanarasimha N, Chua JME, Tan GWL, Irani FG, Leong S, Tay KH, Chong TT, Tan BS. Cost-Effectiveness of Drug-Coated Balloon Angioplasty Versus Conventional Balloon Angioplasty for Treating Below-the-Knee Arteries in Chronic Limb-Threatening Ischemia: The SINGA-PACLI Trial. Cardiovasc Intervent Radiol 2022; 45:1663-1669. [PMID: 35237860 DOI: 10.1007/s00270-022-03073-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Drug-coated balloon angioplasty (DCBA) has been studied as a potentially superior option compared to conventional percutaneous transluminal angioplasty (PTA) in treating below-the-knee (BTK) arteries in chronic limb-threatening ischemia (CLTI). The aim of this study is to examine the cost-effectiveness of DCBA versus PTA in BTK arteries based on a randomized controlled trial. MATERIAL AND METHODS A prospective economic study was embedded in a randomized controlled trial of 138 patients with CLTI. Resource use and health outcomes were assessed at baseline, and at 3, 6 and 12 months post-intervention. Costs were calculated from a societal perspective and health outcomes measured using quality-adjusted life years with probabilistic sensitivity analysis performed to account for subject heterogeneity. RESULTS Compared with participants randomized to receive PTA, participants randomized to DCBA gained an average baseline-adjusted quality-adjusted life years (QALYs) of .012 while average total costs were USD$1854 higher; this translates to an incremental cost-effectiveness ratio (ICER) of US$154,500 additional cost per QALY gained. However, the estimate of ICER had substantial variance with only 48% of bootstrap ICERs meeting a benchmark threshold of US$57,705 (the average gross domestic product (GDP) per capita of Singapore). CONCLUSION The use of DCBA in BTK arteries in CLTI patients was not cost-effective compared with PTA. LEVEL OF EVIDENCE 2, Randomized trial.
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Affiliation(s)
- Nirmali Sivapragasam
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - David B Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Ankur Patel
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Hlaing Hlaing Win
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Sivanathan Chandramohan
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Nanda Venkatanarasimha
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Jasmine M E Chua
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Glenn Wei Leong Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Farah G Irani
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences, Singapore General Hospital, Radiological Sciences Academic Clinical Programme, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
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Lim X, Zhang L, Hong Q, Yong E, Neo S, Chandrasekar S, Tan GWL, Lo ZJ. Novel home use of mechanical negative pressure wound therapy in diabetic foot ulcers. J Wound Care 2021; 30:1006-1010. [PMID: 34882000 DOI: 10.12968/jowc.2021.30.12.1006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Mechanical negative pressure wound therapy is an ultraportable, light weight and disposable single-use device that has been shown to promote wound healing. This study evaluated home use of a mechanically powered negative pressure wound therapy (NPWT) in diabetic foot wounds. METHODS Patients underwent revascularisation and/or debridement or amputation before starting mechanical NPWT. Wound outcomes and images of the wounds were recorded at each follow-up visit by the wound nurse. Patients were followed up until wound closure or end of therapy. RESULTS A total of 12 patients (each with one wound) were included in the study. Of the 12 wounds, 33.3% (n=4) of wounds achieved primary wound closure while the remaining 66.6% (n=8) of wounds demonstrated a mean wound size reduction of 37.5±0.13%. Of the closed wounds, mean time to healing was 4.75±2.50 weeks. There was 100% limb salvage with no further debridement or amputations, and no 30-day unplanned readmissions. Mean length of hospital stay before starting home NPWT was 9.75±6.31 days. Mean number of NPWT changes was 8.33±2.67 sessions, while mean duration of therapy was 4.0±1.54 weeks. Mean cost of home NWPT therapy was US$1904±731 per patient. CONCLUSION The home use of mechanically powered NPWT in diabetic foot wounds demonstrated excellent wound healing rates and 100% limb salvage, with no complications.
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Affiliation(s)
- Xuxin Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Shufen Neo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
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Ong DY, Hwee Quek LH, Leong Tan GW, Pua U. Endovascular repair of concomitant aortic arch and Kommerell aneurysms after failed surgical debranching. J Vasc Interv Radiol 2021; 33:348-350. [PMID: 34763087 DOI: 10.1016/j.jvir.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daniel Yuxuan Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Glenn Wei Leong Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Patel A, Irani FG, Pua U, Tay KH, Chong TT, Leong S, Chan ESY, Tan GWL, Burgmans MC, Zhuang KD, Quek LHH, Kwan J, Damodharan K, Gogna A, Tan BP, Too CW, Chan SXJM, Chng SP, Yuan W, Tan BS. Randomized Controlled Trial Comparing Drug-coated Balloon Angioplasty versus Conventional Balloon Angioplasty for Treating Below-the-Knee Arteries in Critical Limb Ischemia: The SINGA-PACLI Trial. Radiology 2021; 300:715-724. [PMID: 34227886 DOI: 10.1148/radiol.2021204294] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is a paucity of randomized trials demonstrating superior efficacy of drug-coated balloon angioplasty (DCBA) compared with conventional percutaneous transluminal angioplasty (PTA) for below-the-knee arterial disease in patients with -critical limb ischemia. Purpose To compare DCBA versus PTA for below-the-knee lesions in participants with critical limb ischemia through 12 months. Materials and Methods In this prospective, randomized, two-center, double-blind superiority study, participants with critical limb ischemia with rest pain or tissue loss with atherosclerotic disease in the native below-the-knee arteries were randomly assigned (in a one-to-one ratio) to DCBA or PTA after stratification for diabetes and renal failure between November 2013 and October 2017. The primary efficacy end point was angiographic primary patency at 6 months analyzed on an intention-to-treat basis. Secondary end points through 12 months were composed of major adverse events including death and major amputations, wound healing, limb salvage, clinically driven target-lesion revascularization, and amputation-free survival. Primary and binary secondary end points, analyzed by using generalized-linear model and time-to-event analyses, were estimated with Kaplan-Meier survival curves and hazard ratios (Cox regression). Results Seventy participants (mean age, 61 years ± 10 [standard deviation]; 43 men) in the DCBA group and 68 (mean age, 64 years ± 10; 50 men) in the PTA group were evaluated. The percentage of patients with angiographic primary patency at 6 months was 43% (30 of 70) in the DCBA group and 38% (26 of 68) in the PTA group (P = .48). Through 12 months, the percentage of deaths was similar: 21% in the DCBA group and 16% in the PTA group (P = .43). Amputation-free survival rate assessed with Kaplan-Meier curves differed through 12 months: 59% (41 of 70) in the DCBA group compared with 78% (53 of 68) in the PTA group (P = .01). Conclusion In participants with critical limb ischemia, the drug-coated balloon angioplasty group and the conventional percutaneous transluminal angioplasty group had similar primary patency rates at 6 months after treatment of below-the-knee arteries. Amputation-free survival rates through 12 months were higher in the percutaneous transluminal angioplasty group. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Ankur Patel
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Farah G Irani
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Uei Pua
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Kiang Hiong Tay
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Tze Tec Chong
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Sum Leong
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Edwin Shih-Yen Chan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Glenn Wei Leong Tan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Mark C Burgmans
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Kun Da Zhuang
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Lawrence Han Hwee Quek
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Justin Kwan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Karthikeyan Damodharan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Apoorva Gogna
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Bien Peng Tan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Chow Wei Too
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Shaun X Ju Min Chan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Siew Ping Chng
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Wei Yuan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
| | - Bien Soo Tan
- From the Department of Vascular and Interventional Radiology, Division of Radiological Sciences (A.P., F.G.I., K.H.T., S.L., K.D.Z., K.D., A.G., C.W.T., S.X.J.M.C., B.S.T.), and Department of Vascular Surgery, Division of Surgery and Surgical Oncology (T.T.C., S.P.C.), Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608; Departments of Diagnostic Radiology (U.P., L.H.H.Q., J.K., B.P.T.) and General Surgery (G.W.L.T.), Tan Tock Seng Hospital, Singapore; Department of Biostatistics, Singapore Clinical Research Institute, Singapore (E.S.Y.C., W.Y.); Duke-NUS Medical School, National University of Singapore, Singapore (E.S.Y.C., W.Y.); and Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands (M.C.B.)
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Chan KS, Liang S, Cho YT, Chan YM, Tan AHM, Muthuveerappa S, Lai TP, Goh CC, Joseph A, Hong Q, Yong E, Zhang L, Chong LRC, Tan GWL, Chandrasekar S, Lo ZJ. Clinical validation of a machine-learning-based handheld 3-dimensional infrared wound imaging device in venous leg ulcers. Int Wound J 2021; 19:436-446. [PMID: 34121320 PMCID: PMC8762571 DOI: 10.1111/iwj.13644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022] Open
Abstract
Chronic venous insufficiency is a chronic disease of the venous system with a prevalence of 25% to 40% in females and 10% to 20% in males. Venous leg ulcers (VLUs) result from venous insufficiency. VLUs have a prevalence of 0.18% to 1% with a 1‐year recurrence of 25% to 50%, bearing significant socioeconomic burden. It is therefore important for regular assessment and monitoring of VLUs to prevent worsening. Our study aims to assess the intra‐ and inter‐rater reliability of a machine learning‐based handheld 3‐dimensional infrared wound imaging device (WoundAide [WA] imaging system, Konica Minolta Inc, Tokyo, Japan) compared with traditional measurements by trained wound nurse. This is a prospective cross‐sectional study on 52 patients with VLUs from September 2019 to January 2021 using three WA imaging systems. Baseline patient profile and clinical demographics were collected. Basic wound parameters (length, width and area) were collected for both traditional measurements and measurements taken by the WA imaging systems. Intra‐ and inter‐rater reliability was analysed using intra‐class correlation statistics. A total of 222 wound images from 52 patients were assessed. There is excellent intra‐rater reliability of the WA imaging system on three different image captures of the same wound (intra‐rater reliability ranging 0.978‐0.992). In addition, there is excellent inter‐rater reliability between the three WA imaging systems for length (0.987), width (0.990) and area (0.995). Good inter‐rater reliability for length and width (range 0.875‐0.900) and excellent inter‐rater reliability (range 0.932‐0.950) were obtained between wound nurse measurement and each of the WA imaging system. In conclusion, high intra‐ and inter‐rater reliability was obtained for the WA imaging systems. We also obtained high inter‐rater reliability of WA measurements against traditional wound measurement. The WA imaging system is a useful clinical adjunct in the monitoring of VLU wound documentation.
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Affiliation(s)
- Kai Siang Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shanying Liang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yuan Teng Cho
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yam Meng Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Audrey Hui Min Tan
- Wound and Stoma Care, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Tina Peiting Lai
- Wound and Stoma Care, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | - Annie Joseph
- Skin Research Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lester Rhan Chaen Chong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Skin Research Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Chan KS, Chan YM, Tan AHM, Liang S, Cho YT, Hong Q, Yong E, Chong LRC, Zhang L, Tan GWL, Chandrasekar S, Lo ZJ. Clinical validation of an artificial intelligence-enabled wound imaging mobile application in diabetic foot ulcers. Int Wound J 2021; 19:114-124. [PMID: 33942998 PMCID: PMC8684856 DOI: 10.1111/iwj.13603] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022] Open
Abstract
There is a lifetime risk of 15% to 25% of development of diabetic foot ulcers (DFUs) in patients with diabetes mellitus. DFUs need to be followed up on and assessed for development of complications and/or resolution, which was traditionally performed using manual measurement. Our study aims to compare the intra- and inter-rater reliability of an artificial intelligence-enabled wound imaging mobile application (CARES4WOUNDS [C4W] system, Tetsuyu, Singapore) with traditional measurement. This is a prospective cross-sectional study on 28 patients with DFUs from June 2020 to January 2021. The main wound parameters assessed were length and width. For traditional manual measurement, area was calculated by overlaying traced wound on graphical paper. Intra- and inter-rater reliability was analysed using intra-class correlation statistics. A value of <0.5, 0.5-0.75, 0.75-0.9, and >0.9 indicates poor, moderate, good, and excellent reliability, respectively. Seventy-five wound episodes from 28 patients were collected and a total of 547 wound images were analysed in this study. The median wound area during the first clinic consultation and all wound episodes was 3.75 cm2 (interquartile range [IQR] 1.40-16.50) and 3.10 cm2 (IQR 0.60-14.84), respectively. There is excellent intra-rater reliability of C4W on three different image captures of the same wound (intra-rater reliability ranging 0.933-0.994). There is also excellent inter-rater reliability between three C4W devices for length (0.947), width (0.923), and area (0.965). Good inter-rater reliability for length, width, and area (range 0.825-0.934) was obtained between wound nurse measurement and each of the C4W devices. In conclusion, we obtained good inter-rater and intra-rater reliability of C4W measurements against traditional wound measurement. The C4W is a useful adjunct in monitoring DFU wound progress.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Yam Meng Chan
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Audrey Hui Min Tan
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Shanying Liang
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Yuan Teng Cho
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Qiantai Hong
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Enming Yong
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | | | - Li Zhang
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Glenn Wei Leong Tan
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Sadhana Chandrasekar
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
| | - Zhiwen Joseph Lo
- Department of General Surgery, Vascular Surgery Service, 11 Jalan Tan Tock Seng, Singapore
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14
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Yeo CB, Yong E, Hong Q, Kwan J, Quek LHH, Pua U, Punamiya S, Chandrasekar S, Tan GWL, Lo ZJ. Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today? Ann Vasc Dis 2021; 14:5-10. [PMID: 33786093 PMCID: PMC7991696 DOI: 10.3400/avd.oa.20-00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: To review the outcomes of catheter-directed thrombolysis (CDT) for salvage of thrombosed arteriovenous fistula (AVF) in a single centre in Southeast Asia. Methods: A retrospective study of CDT in AVF between January 2015 and July 2018 at a tertiary university hospital was carried out. Results: Within the study period, 85 patients underwent CDT for AVF thrombosis. Of these patients, 78% underwent CDT for 24 h and 12% required CDT for 48 h. Moreover, 14% of patients had bleeding during CDT and hence required a decrease in dosing or complete cessation. Incidence of intracranial haemorrhage was 1%, and technical success was 92%. Post CDT, primary patency rates at 12, 24 and 36 months were 87%, 62% and 36%, respectively; assisted primary patency rates at 12, 24 and 36 months were 96%, 82% and 69%, respectively; and secondary patency rates at 12, 24 and 36 months were 99%, 93% and 86%, respectively. Multivariate analysis did not identify any predictive factors for patency post CDT. Conclusion: Within our study population, CDT for AVF salvage conferred good technical results with low rates of complications. There was good primary patency at 12 months, and the results were sustained up to 36 months. It remains a useful modality for fistula salvage, avoiding surgical intervention.
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Affiliation(s)
- Clarice Biru Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Enming Yong
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Justin Kwan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sundeep Punamiya
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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15
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Huang IKH, Pua U, Quek LHH, Chong RCL, Tay WL, Hong Q, Yong E, Chandrasekar S, Zhang L, Tan GWL, Lo ZJ. Iliac vein pathology and short-term stenting outcomes in a South-East Asian population: A single-centre experience. J Med Imaging Radiat Oncol 2020; 65:46-53. [PMID: 33084219 DOI: 10.1111/1754-9485.13117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Current literature regarding iliofemoral intervention and stenting is mostly based on Western populations. We present our experience of iliofemoral stenting for chronic venous disease within a South-East Asian population. METHODS This is a single-centre retrospective review of a prospectively collected registry. Seventy-one patients with 105 limbs underwent iliac vein IVUS and stenting between 2016 and 2019. All patients underwent pre-procedure ultrasound venous scan and MRI venogram. Pre- and post-operative CEAP classification, Villalta score and Venous Clinical Severity Score (VCSS), technical results, stent patency rates and complication rates are documented. RESULTS Seventy-six per cent of the cases are non-thrombotic iliac vein lesion, and 68% of patients have C4 to C6 disease. Ten percentage of patients had acute thrombosis on presentation. There was 100% technical success. A 6- and 7-point reduction in the mean VCSS and Villalta score, respectively, were noted post-stenting (baseline of 10 points and P < 0.001 in both categories). Post-stenting ulcer healing rate was 91% at 6 and 12 months. One-year ulcer recurrence and cellulites recurrence were at 8% and 7%, respectively. One unplanned 30-day readmission (not related to procedure) and no 30-day mortality were noted. Bleeding complication from anticoagulation was 3%. There was 10% in-stent non-flow limiting stenosis on surveillance. One-year primary patency was 91%, and secondary patency was 100%. CONCLUSION Within our series, iliofemoral stenting has 100% technical success, with statistically significant reduction in VCSS and Villalta score, good wound healing rates, low ulcer and cellulites recurrence and good primary and secondary patency rates at 1 year.
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Affiliation(s)
- Ivan Kuang Hsin Huang
- Vascular and Interventional Radiology, Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Rhan Chean Lester Chong
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Wei Ling Tay
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Qiantai Hong
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Enming Yong
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Li Zhang
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore City, Singapore
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16
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Chan WK, Yong E, Hong Q, Zhang L, Lingam P, Tan GWL, Chandrasekar S, Lo ZJ. Systematic review and meta-analysis of the prevalence of abdominal aortic aneurysm in Asian populations. J Vasc Surg 2020; 73:1069-1074.e1. [PMID: 32987145 DOI: 10.1016/j.jvs.2020.08.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The prevalence of abdominal aortic aneurysms (AAAs) is well reported in Western countries and AAA screening programs are well-established. However, although individual studies have reported that the prevalence of AAAs is lower in Asian populations, high-quality data on the prevalence of AAA in Asians are relative lacking. The present study aimed to systematically synthesize the data available in the literature and report the prevalence of AAAs in Asians. METHODS An electronic search was performed using two major databases (PubMed and EMBASE) with no limitations imposed on the year of publication. The review conformed to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies that reported the prevalence of AAAs in Asians were selected, and the population characteristics, AAA definition, method of screening, target population, and total number of patients screened were recorded. RESULTS Our search yielded 157 unique articles. After a full-text review, 17 articles were included in the present study. All 17 studies of fair quality. The overall AAA prevalence was 1.30% (95% confidence interval [CI], 1.01%-1.59%) in Asian populations. The prevalence of AAAs was 2.56% (95% CI, 1.81%-3.31%) in Asian populations selected for cardiovascular risk factors and 0.61% (95% CI, 0.37%-0.85%) in Asian populations not selected for cardiovascular risk factors. CONCLUSIONS The prevalence of AAAs in the general Asian population is low. However, the prevalence in Asian populations selected for cardiovascular risk factors approaches the prevalence of AAAs in Western populations. As such, screening for AAAs in carefully selected Asian male populations with cardiovascular risk factors could potentially yield benefits. Opportunistic screening for AAAs during ultrasound examination of the abdomen or transthoracic echocardiography for other indications could also be considered. However, further studies are needed to evaluate the potential benefits of screening for AAAs in carefully selected Asian populations.
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Affiliation(s)
- Wai Kiu Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Pravin Lingam
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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17
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Yong E, Tan GWL, Huang IKH, Wu YW, Pua U, Quek LHH. Pressed for time: Implications of a delayed presentation of venous thromboembolism precipitated by COVID-19 and May-Thurner Syndrome. Br J Surg 2020; 107:e550-e551. [PMID: 32845512 PMCID: PMC7461540 DOI: 10.1002/bjs.11908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Enming Yong
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Ivan Kuang Hsin Huang
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Yi-Wei Wu
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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18
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Ong CW, Yong E, Hong Q, Chandrasekar S, Quek LHH, Pua U, Tan GWL, Lo ZJ. Transradial access for arteriovenous fistuloplasty in Singapore. J Vasc Access 2020; 22:555-560. [PMID: 32847465 DOI: 10.1177/1129729820946643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Endovascular balloon angioplasty is standard therapy for dysfunctional arteriovenous fistula in end-stage renal failure patients on hemodialysis. Venous antegrade or retrograde puncture of the fistula is typically performed to gain access for fistuloplasty. Transradial approach for brachiocephalic or brachiobasilic arteriovenous fistulas offers an alternative method of access with the advantage of addressing multi-focal juxta-anastomotic and venous stenosis from the same approach. We aim to review the efficacy, outcomes and complication rates of transradial access for arteriovenous fistuloplasty among patients in Singapore. METHODS A retrospective review of 195 endovascular fistuloplasties from September 2017 to August 2019, at a tertiary university hospital Vascular Surgery unit. RESULTS Of 195 fistuloplasties, 43 (22%) were transradial approach (23 brachiocephalic arteriovenous fistulas, 20 brachiobasilic arteriovenous fistulas) in 33 patients (67% male and mean age = 65 years). Of these 43 procedures, 11 (26%) were performed as balloon-assisted maturation fistuloplasties while 32 (74%) were performed for mature arteriovenous fistulas with multi-focal juxta-anastomosis and venous stenosis. Technical success rate was 95% with mean procedure duration at 43.5 ± 14.6 min. Mean pre- and post-fistuloplasty dialysis access flow rates increased from 502 to 952 ml/min (p < 0.001). Post-intervention primary patency was 100%, 66% and 20% at 1, 6 and 12 months, respectively. There were four patients with non-limb-threatening radial artery thrombosis (9.3%) while there was no radial artery pseudoaneurysm or post-procedural bleeding. CONCLUSION Transradial approach for arteriovenous fistuloplasty is a safe and feasible option in patients requiring balloon-assisted maturation or with multi-focal juxta-anastomotic and venous stenosis.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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19
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Ryu SW, Tan GWL, Pua U. Percutaneous Deep Vein Arterialization in Buerger's Disease. J Vasc Interv Radiol 2020; 31:1897-1900.e1. [PMID: 32807614 DOI: 10.1016/j.jvir.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Seung Wook Ryu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - Glenn Wei Leong Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
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20
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Goh SSN, Yong EM, Hong QT, Lo JZ, Chandrasekar S, Ng JJ, Chia YW, Fan EB, Ling LM, Wong PMP, Wee NKX, Punamiya S, Quek HHL, Pua U, Tan GWL. Acute aortic thrombosis presenting as acute limb ischemia in two young, non-atherosclerotic patients. Br J Surg 2020; 107:e565-e566. [PMID: 32776523 DOI: 10.1002/bjs.11897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S S N Goh
- Department of General Surgery, Tan Tock Seng Hospital
| | - E M Yong
- Department of General Surgery, Tan Tock Seng Hospital
| | - Q T Hong
- Department of General Surgery, Tan Tock Seng Hospital
| | - J Z Lo
- Department of General Surgery, Tan Tock Seng Hospital
| | | | - J J Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital
| | - Y W Chia
- Department of Cardiology, Tan Tock Seng Hospital
| | - E B Fan
- Department of Haematology, Tan Tock Seng Hospital
| | - L M Ling
- Department of Infectious Diseases, National Centre of Infectious Diseases
| | - P M P Wong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - N K X Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - S Punamiya
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - H H L Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - U Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - G W L Tan
- Department of General Surgery, Tan Tock Seng Hospital
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21
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Pua U, Quek LHH, Yong E, Tan GWL. Intravascular Ultrasound-Guided Revascularization of Chronic Juxtarenal Aortoiliac Occlusion. Ann Vasc Surg 2020; 69:441-446. [PMID: 32736023 DOI: 10.1016/j.avsg.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
Chronic juxtarenal aortoiliac occlusion (JRO) represents the most severe form of aortoiliac occlusive disease, classified under Trans-Atlantic Inter-Society Consensus (TASC II) as a TASC II D lesion with surgical treatment as the main recommendation. Although endovascular revascularization of other TASC II D lesions are routinely performed, JRO is often considered a contraindication for endovascular treatment due to the extensive nature, extending from the level of the renal arteries down to the iliac arteries. We hereby illustrate an intravascular ultrasound-guided re-entry based technique to facilitate endovascular reconstruction of a JRO. A 58-year-old man with JRO presented with an infected nonhealing forefoot ulcer. A transradial pigtail catheter was positioned at the level of the occlusion as an imaging catheter and landmark for re-entry. Subintimal wiring was performed through bilateral groin accesses to the level of the pigtail catheter. Intravascular-guided re-entry catheter was used to identify the true lumen guide firing of the needle catheter, allowing passage for a guidewire into the true lumen of the suprarenal aorta. The intimal fenestration was dilated using a 4-mm angioplasty balloon which allowed passage of the contralateral guidewire. Kissing stent grafts were deployed bilaterally, extending from the level of the infrarenal aorta down to the level of the distal external iliac arteries in overlapping fashion. Completion angiography showed brisk flow from the aorta through the stented portion into the femoral arteries. The patient underwent forefoot amputation 2 days later with successful wound healing and limb salvage at 6 months.
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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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22
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Fan BE, Chia YW, Sum CLL, Kuperan P, Chan SSW, Ling LM, Tan GWL, Goh SSN, Wong LH, Lim SP, Lim KGE, Tan HT, Ang MK, Lau SL, Ong KH, Ng J. Global haemostatic tests in rapid diagnosis and management of COVID-19 associated coagulopathy in acute limb ischaemia. J Thromb Thrombolysis 2020; 50:292-297. [PMID: 32474758 PMCID: PMC7261037 DOI: 10.1007/s11239-020-02165-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore. .,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Singapore, Singapore. .,Yong Loo Lin School of Medicine, Singapore, Singapore.
| | - Yew Woon Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Ponnudurai Kuperan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Stephrene Seok Wei Chan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Li Min Ling
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lai Har Wong
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shu Ping Lim
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kian Guan Eric Lim
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hwee Tat Tan
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mui Kia Ang
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Soon Lee Lau
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kiat Hoe Ong
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jensen Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
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23
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Goh SSN, Yeo DXW, Kaushal SA, Yeong HK, Tan GWL. Surgical and endoscopy protocols for general surgeons during the COVID-19 pandemic: an institutional experience in Singapore. Br J Surg 2020; 107:e249. [PMID: 32418201 PMCID: PMC7276907 DOI: 10.1002/bjs.11696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Affiliation(s)
- S S N Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - D X W Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - S A Kaushal
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - H K Yeong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - G W L Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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24
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Quek LHH, Tan GWL, Pua U. Managing Endovascular Workload during COVID-19 Outbreak-The Singapore Experience. Ann Vasc Surg 2020; 66:3-5. [PMID: 32437919 PMCID: PMC7211577 DOI: 10.1016/j.avsg.2020.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/30/2022]
Abstract
At the outset and during the throes of the COVID-19 pandemic, as valuable resources are channeled to combat the pandemic, challenges in timely delivery of non-COVID-19-related health care services such as endovascular service arise. As such, this article looks at a tertiary institution's experience in managing its endovascular workload-referenced to the American College of Surgeons' triage of vascular surgery patient acuity-based case classification.
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Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Glenn Wei Leong Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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25
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Cheng EL, Hong Q, Yong E, Chandrasekar S, Tan GWL, Lo ZJ. Validating the use of contrast-induced nephropathy prediction models in endovascular aneurysm repairs. J Vasc Surg 2020; 71:1546-1553. [DOI: 10.1016/j.jvs.2019.07.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/20/2019] [Indexed: 10/25/2022]
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Muthaiah Arunaachalam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - En Ming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Pravin Lingam
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Zhiwen Joseph Lo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Pravin Lingam
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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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: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - Ralf R Kolvenbach
- Department of Vascular Surgery and Endovascular Therapy, Catholic Hospital Group, Duesseldorf, Germany
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technologicial University, Singapore, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/06/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic RadiologyTan Tock Seng Hospital Singapore Singapore
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
| | - Tracy Suet Mun Tan
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
- Department of Renal MedicineTan Tock Seng Hospital Singapore Singapore
| | - Glenn Wei Leong Tan
- Lee Kong Chian School of MedicineNanyang Technological University Singapore Singapore
- Department of General SurgeryTan Tock Seng Hospital Singapore Singapore
| | - Uei Pua
- Department of Diagnostic RadiologyTan Tock Seng Hospital Singapore Singapore
- Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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38
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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40
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Hongyan Yu
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Baoxian Huang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joachim Wen Kien Yau
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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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] [What about the content of this article? (0)] [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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46
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Daniel Yuxuan Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Glenn Wei Leong Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Uei Pua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
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47
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Jing Ting Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maggie Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Wei-En Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sriram Narayanan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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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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Affiliation(s)
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sriram Narayanan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 309199, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 309199, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
Affiliation(s)
- Uei Pua
- Departments of Diagnostic Radiology, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Glenn Wei Leong Tan
- General Surgery, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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