1.Improving medical adherence and antithrombotic management for patients with chronic limb threatening ischaemia in Singapore.
Tjun Yip TANG ; Ankur PATEL ; Shereen Xue Yun SOON ; Sze Ling CHAN ; Charyl Jia Qi YAP ; Sivanathan CHANDRAMOHAN ; Tze Tec CHONG
Annals of the Academy of Medicine, Singapore 2021;50(10):795-797
2.Cascade of Complications Following Carotid Body Tumor Excision
Pawan K GARG ; Sarbesh TIWARI ; Tushar S GHOSH ; Surendra PATEL ; Ankur SHARMA ; Pushpinder S KHERA
Neurointervention 2021;16(3):298-302
Carotid body tumor excision can lead to various complications including vascular injury and pseudoaneurysm formation. Here we describe a case of carotid body tumor excision followed by series of complications including pseudoaneurysm formation, failure of primary surgical repair, carotid stump syndrome following parent artery occlusion, and persistent hypotension.
3.Percutaneous Endovascular Treatment to Salvage Non-Maturing Arteriovenous Fistulas in a Multiethnic Asian Population.
Wei Ping THAM ; Mark C BURGMANS ; Bien Soo TAN ; Kiang Hong TAY ; Farah G IRANI ; Apoorva GOGNA ; Ankur PATEL ; Richard Hg LO ; Siew Ping CHNG ; Hui Lin CHOONG ; Shaun Xjm CHAN
Annals of the Academy of Medicine, Singapore 2017;46(2):64-71
INTRODUCTIONAn arteriovenous fistula (AVF) is the preferred method for haemodialysis in patients with end-stage renal failure. Previous studies have shown value in attempting percutaneous transluminal angioplasty (PTA) to salvage AVFs that fail to mature, but they are relatively small in size and mainly reported in Western populations. We reviewed our data of PTA in non-maturing AVFs to establish whether this technique is translatable to our local multiethnic population.
MATERIALS AND METHODSWe retrospectively reviewed the medical records and procedural images of 105 patients who had PTA for non-maturing AVFs performed at our department from January 2008 to January 2011. Technical success was defined as ≤30% residual stenosis after angioplasty. Clinical success was defined as at least 1 successful haemodialysis session within 4 weeks after PTA.
RESULTSAll 105 patients underwent angioplasty for at least 1 haemodynamically significant stenosis. Six (5.7%) had additional embolisation of accessory veins. Technical success was achieved in 95.2% of cases. The clinical success rate was 76.2%. Primary patency rates at 3, 6 and 12 months were 83%, 45% and 28%, respectively. Secondary patency rates at 3, 6 and 12 months were 90%, 79% and 70%, respectively. The minor complication rate was 18.1%. No major complications were encountered. An average of 1.7 interventions per access-year was required to maintain AVF patency. Patients with a preoperative vein size >2.0 mm and age <55 years were more likely to achieve clinical success, although not statistically significant.
CONCLUSIONPTA is a viable option to help salvage non-maturing AVFs in a multiethnic Asian population.
Angioplasty ; methods ; Arteriovenous Shunt, Surgical ; Constriction, Pathologic ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Kidney Failure, Chronic ; therapy ; Male ; Middle Aged ; Renal Dialysis ; Reoperation ; Retrospective Studies ; Singapore ; Veins
4.Distribution of Peripheral Arterial Disease in Patients Undergoing Endovascular Revascularization for Chronic Limb Threatening Ischaemia: Insights from the Vascular Quality Initiative in Singapore
Shereen X. Y. SOON ; Ankur PATEL ; Tze Tec CHONG ; Charyl J. Q. YAP ; Hsien Ts’ung TAY ; Kiang Hiong TAY ; Chandramohan SIVANATHAN ; Tjun Y. TANG
Vascular Specialist International 2021;37(2):13-
This study aimed to examine the distribution of lower limb atherosclerotic lesions in a multi-ethnic Asian cohort with chronic limb threatening ischemia (CLTI) from Singapore. The Society for Vascular Surgery Vascular Quality Initiative registry database was used to identify 265 CLTI patients who underwent percutaneous angioplasty between June 2019 and December 2019, of whom 171 (64.5%) were male, and the mean age was 67.9±11.0 years. The majority were diabetic (84.5%) and 145 (54.7%) had chronic kidney disease (CKD). The majority of the lower limb atherosclerotic lesions were de novo lesions (598/797, 75.0%), predominantly TransAtlantic Inter-Society Consensus II C/D (451/797, 56.6%), and were moderately to severely calcified (76.3%). The anterior tibial artery and femoral-popliteal artery were the most commonly affected vessels. The mean length of the treated lesions was 14.5±13.7 cm. There was a tendency, albeit insignificant, of multi-level disease in those who were diabetic or had CKD.
5.Distribution of Peripheral Arterial Disease in Patients Undergoing Endovascular Revascularization for Chronic Limb Threatening Ischaemia: Insights from the Vascular Quality Initiative in Singapore
Shereen X. Y. SOON ; Ankur PATEL ; Tze Tec CHONG ; Charyl J. Q. YAP ; Hsien Ts’ung TAY ; Kiang Hiong TAY ; Chandramohan SIVANATHAN ; Tjun Y. TANG
Vascular Specialist International 2021;37(2):13-
This study aimed to examine the distribution of lower limb atherosclerotic lesions in a multi-ethnic Asian cohort with chronic limb threatening ischemia (CLTI) from Singapore. The Society for Vascular Surgery Vascular Quality Initiative registry database was used to identify 265 CLTI patients who underwent percutaneous angioplasty between June 2019 and December 2019, of whom 171 (64.5%) were male, and the mean age was 67.9±11.0 years. The majority were diabetic (84.5%) and 145 (54.7%) had chronic kidney disease (CKD). The majority of the lower limb atherosclerotic lesions were de novo lesions (598/797, 75.0%), predominantly TransAtlantic Inter-Society Consensus II C/D (451/797, 56.6%), and were moderately to severely calcified (76.3%). The anterior tibial artery and femoral-popliteal artery were the most commonly affected vessels. The mean length of the treated lesions was 14.5±13.7 cm. There was a tendency, albeit insignificant, of multi-level disease in those who were diabetic or had CKD.
6.Drug Eluting Stents in Infrapopliteal Arterial Disease: A Pilot Safety Study in an Asian Population.
Karthikeyan DAMODHARAN ; Ankur PATEL ; Farah Gillan IRANI ; Mark Christiaan BURGMANS ; Apoorva GOGNA ; Kiang Hiong TAY ; Richard Hg LO ; Chow Wei TOO ; Sum LEONG ; Nanda VENKATANARASIMHA ; Shaun CHAN ; Hlaing Hlaing WIN ; Chandramohan SIVANATHAN ; Bien Soo TAN
Annals of the Academy of Medicine, Singapore 2017;46(4):155-159
7.Single centre experience of transjugular liver biopsy in 152 patients.
Ankur PATEL ; Apoorva GOGNA ; Farah Gillan IRANI ; Terence K B TEO ; Tow Non YEOW ; Deepak JAIN ; Richard H G LO ; Kiang Hiong TAY ; Bien Soo TAN ; Rafay AZHAR ; Jason P E CHANG ; Manish TANEJA
Annals of the Academy of Medicine, Singapore 2014;43(3):160-165
INTRODUCTIONLiver biopsy is considered the definitive investigation in the diagnosis and management of liver disease. This study describes the experience of performing transjugular liver biopsy (TJLB) over the last 9 years in a local single centre.
MATERIALS AND METHODSA retrospective review of consecutive TJLB procedures performed at our institution was conducted. A total of 152 patients (74 males and 78 females), with a mean age of 47.4 years (range, 13 to 83 years) underwent a total of 154 TJLB procedures at our institution between March 2003 and November 2011. The principal indication for TJLB was severe coagulopathy in over 80% of patients. The technical success, number of passes, histological adequacy and complication rates were analysed.
RESULTSThe procedural success rate was 98.7% (152 out of 154 procedures). Adequate material for diagnosis was obtained in 149 out of 152 (98.0%) technically successful procedures. There was procedure related morbidity in 8 patients (5.2%) of which all but one were self-limiting requiring no further intervention. We also performed hepatic venous pressure gradient (HVPG) measurements in 19% of patients at the time of TJLB.
CONCLUSIONTJLB performed at our institution is a safe and reliable technique in patients in whom traditional percutaneous liver biopsy may be hazardous. TJLB has a high technical success rate as well as a high diagnostic yield with a low complication rate. TJLB also has the added benefit of performing HVPG, which is of increasing importance in management and prognostication of chronic liver disease.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; methods ; Female ; Humans ; Jugular Veins ; Liver ; pathology ; Liver Diseases ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult
8.Mid-Term Outcomes of Patients with Central Venous Occlusive Disease Undergoing Surveillance Venography and Intervention.
Hui Lin WONG ; Shaun Xavier Jm CHAN ; Satheesh RAMAMUTHY ; Kiang Hong TAY ; Tze Tec CHONG ; Chieh Suai TAN ; Ankur PATEL ; Chow Wei TOO ; Farah Gillan IRANI ; Lina Hl CHOONG ; Siew Ping CHNG ; Bien Soo TAN
Annals of the Academy of Medicine, Singapore 2020;49(6):360-366
INTRODUCTION:
To evaluate the mid-term outcomes of regular surveillance venography with or without percutaneous transluminal angioplasty (PTA) in haemodialysis patients presenting with central venous occlusive disease.
MATERIALS AND METHODS:
A single-centre retrospective analysis of haemodialysis patients who presented with central vein occlusion (CVO) and central vein stenosis (CVS) between January 2008 and December 2011 was performed. CVO and significant CVS were defined as 100% and >50% luminal narrowing, respectively. Upon successful angioplasty on first presentation, patients were followed up with regular surveillance venography within 3-6 months of the intervention and were re-treated when a significant stenosis or occlusion was demonstrated. Data on patient's demographics, comorbidities, presenting symptoms, type of upper limb dialysis access, lesion characteristics and complications were collected. Technical success, primary patency and primary assisted patency were analysed.
RESULTS:
Thirty-five patients with CVO and 77 patients with CVS were enrolled. The technical success of initial PTA was 77% and 73% for the CVO and CVS groups, respectively. The primary patency at 3 months was 65% and 55% for the CVO group and CVS group, respectively ( = 0.32). The primary assisted patency at 1 year was 88% and 99% for the CVO group and CVS group, respectively ( = 0.009). At 2 years, the primary assisted patency were 77% and 90%, respectively ( = 0.07). There was significant difference in the overall primary assisted patency ( = 0.048) between the CVO and CVS groups.
CONCLUSION
CVOs are more difficult to treat than CVS. High primary assisted patency rates can be achieved with surveillance venography, albeit at the expense of increased number of interventions. Further cost effectiveness studies need to be performed to study the true benefit of our surveillance programme.