Vascular health and Vascular intervention (treatment)

VASCULAR HEALTH

Vascular health is an essential part of your overall health but is often overlooked. It refers to the health of your vascular system, comprising arteries and veins that run throughout your body, carrying blood to your different organs. As such, your vascular health can have an impact on many areas of your body.

In order to protect your vascular health and even improve it, have a healthy diet to maintain low blood cholesterol, exercise regularly to encourage good circulation, maintain a healthy weight and avoid smoking. These are just a few ways that you can allow yourself a happier, more comfortable life.

VASCULAR CONDITIONS/DISEASES

Vascular diseases are any abnormal state of your blood vessels, applying to both arteries and veins. [1] Vascular conditions can be divided into 3 main categories, arterial diseases, vein diseases, and vascular malformations. Listed below are examples for each of these categories.

Arterial diseases

• Stroke
• Brain aneurysm
• Carotid artery disease
• Peripheral arterial disease
• Aortic aneurysm
• Aortic dissection

Vein diseases

• Deep vein thrombosis
• Varicose veins

Vascular malformations

•  Arteriovenous malformations (AVM)
• Venous malformations (VM)
• Lymphovenous malformations (LVM)
• Dural Arteriovenous Fistula
• Hemangioma

These conditions range from causing slight discomfort to posing a possible threat to your life. Should you be suffering from any of the above conditions, vascular intervention could be an option for you to regain your vascular health and give you back the quality of life.

VASCULAR INTERVENTION/TREATMENTS

The field of vascular intervention has evolved to consist of minimally-invasive day procedures that involve the vascular system. There are two main types of treatment approaches and desired outcomes: firstly improving blood flow (remove blockages/atherosclerosis) and reducing blood flow (embolisation, radiofrequency ablation).

• Coiling: a technique where a small incision is made in the groin to access a blood vessel, through which small catheters and wires are put, and are ultimately coiled in the aneurysm. This blocks off the aneurysm and stops blood flow to it.

The recovery period from this procedure is short (1-2 days if the aneurysm is unruptured). The procedure is also safer than the traditional open surgery method of clipping the aneurysm to cut off the blood supply.

• Angioplasty & Stenting: Used to widen the blood vessel and restore good circulation through it.  The procedure involved inserting a catheter into the blood vessel, and then inserting a balloon through it. When the balloon is inflated, it widens the arteries, and the stent can then be placed into the artery to prevent it from narrowing again.

Angioplasty and Stenting are used in conjunction with many other vascular surgical procedures, and can be used to treat conditions like stroke, ministrokes (Transient Ischemic Attack), Carotid artery disease, and Peripheral Artery Disease.

• EndoVascular Aortic Repair (EVAR): Very similar to stenting, except that the stents are covered with an impermeable fabric. Hence, this is also known as covered stents-grafts. Because it is a minimally invasive procedure, EVAR can be done under local anaesthesia or mild sedation.

EVAR can be used to treat an aortic aneurysm. A covered stent is inserted through a small incision into the site of the aneurysm under guidance by x-rays (fluoroscopy). This excludes the aneurysm from the blood circulation, relieving blood pressure and minimising the chances of the aneurysm rupturing.

• Thrombolysis: Refers to the removal of blood clots by the combined use of mechanical devices and certain medicine to dissolve the clots. This procedure is performed for deep vein thrombosis if the condition has been present for less than 2 weeks. Stenting may be used with thrombolysis to keep the blood vessels open.

• Embolisation: This is a procedure commonly used to treat uterine fibroids and osteoarthritis. Although these are both not vascular diseases, the treatment is vascular in nature. During arterial embolisation, small particles are injected into the target blood vessel to block it.

• Radiofrequency Ablation: Radio waves are used to heat up and damage the wall of the blood vessel. In the case of varicose veins, this is to cause scarring on the walls of the veins. The scar tissue closes the vein and blood is diverted to other healthy veins, thus causing the varicose veins to disappear. This procedure can also be used on nerves as a pain management treatment.

• Venseal^TM/VenaBlock Glue Closure: This is a medical adhesive product that also helps to close the varicose veins, rerouting the blood to healthy veins nearby, relieving you of the pain caused by the varicose veins.

• Clarivein^TM/Mechanochemical Ablation: This procedure involves a combination of mechanical and chemical closure of the vein when used to treat varicose veins. A catheter is inserted to damage the inner layer of the vein. Simultaneously, a sclerosant (chemical that seals off veins) is also injected. There is no risk of damage to surrounding blood vessels with this technique.

• Cryo-Laser and Cryo-Sclerotherapy (CLaCs): This procedure is used to treat both vascular malformations and varicose veins. It combines transdermal laser and injection sclerotherapy using a chemical sclerosant, while keeping the skin cool at a temperature of -20℃.

For certain conditions, once it has progressed to become very severe, the only option available may be an open surgery. These are 2 vascular open surgeries, but the list is non-exhaustive.

• Endarterectomy: This is the traditional treatment method for Carotid Artery Disease. An incision is made in the neck to directly access the carotid artery, and the plaque or build-up in the artery is surgically removed to restore unobstructed flow through the artery again.

• Bypass surgery: General term that refers to using one of your native blood vessels or an artificial graft to direct the blood flow around the blocked blood vessel, such that circulation improves. This is used to treat peripheral artery disease, if stenting and angioplasty are not successful.

The Vascular & Interventional Centre has two in-house vascular interventional physicians, Dr. Benjamin Chua and Dr. Manish Taneja, who has specialised in vascular radiology and vascular surgery.

If you are looking for vascular interventional treatments in Singapore, feel free to book an appointment at the Vascular and Interventional Centre today! Dr. Benjamin Chua and Dr. Manish Taneja will be happy to give you a consultation.

Contact us with the details below:

+65 6694 6270 (Call)

+65 9898 3595 (WhatsApp)

en*****@sg***********.com (Email)

Novena Specialist Centre #06-08, 16-19

8 Sinaran Drive, Singapore 307470

REFERENCES

¹https://vascularcures.org/what-is-vascular-disease/