Vascular surgery is a type of surgery that focuses on the blood vessels and their related conditions, such as blocked arteries, aneurysms, and varicose veins. In Singapore, the need for a vascular surgeon has been increasing over the years as the population ages and diseases such as aortic aneurysms, peripheral arterial disease, varicose veins and kidney failure needing dialysis, increases in incidence.

(https://www.kch.org/vascular-surgery)

Vascular surgery is a type of surgery that focuses on the diagnosis and treatment of diseases that affect the arteries, veins, and lymphatic vessels outside of the heart and the brain. It is a complex field of surgery that requires specialized skills, knowledge, and experience.

There are many approaches and devices available to open or bypass blocked arteries or veins, or to repair damaged aneurysmal vessels. Thus, it is wise to choose a Vascular surgeon with expertise in a wide range of surgical techniques, and who can advise on the best approach for your particular condition. An experienced surgeon may make the difference between a successfully salvaged leg or an amputated leg, and even between life and death in high risk conditions such as aortic aneurysms or carotid artery disease.

What type of conditions require Vascular Surgery for Patients in Singapore?

Vascular surgeons treat a wide range of conditions that afflict the arteries or veins located outside of the heart and the brain. These include:

1.Carotid artery disease – opening up narrowed arteries which supply the brain can reduce the risk of stroke.

2.Peripheral arterial disease (PAD) – restoring blood flow to arms or legs affected by PAD will reduce pain in the limbs, help any wounds to heal, and ultimately avoid a major amputation.

(https://my.clevelandclinic.org/health/diseases/17357-peripheral-artery-disease-pad)

3.Deep vein thrombosis (DVT) – Vascular surgeons can use minimally invasive methods to remove abnormal blood clots which may develop in the deep veins of the arms and legs and prevent complications such as pulmonary embolism or post-thrombotic syndrome.

(https://www.drugwatch.com/health/cardiovascular-health/deep-vein-thrombosis/)

4.Varicose veins – varicose veins are a very common problem, and if left untreated may lead to irreversible skin hardening, skin darkening and ultimately chronic wounds. There are many minimally invasive devices available to treat this condition to prevent these debilitating complications.

(https://provascularmd.com/stages-of-venous-insufficiency/)

5.Aortic aneurysms – This is an abnormal enlargement of the largest blood vessel in the body (the aorta) which is at risk of sudden rupture and death if allowed to increase past a certain size. This is also known as a ‘silent killer’ as most times, there are no symptoms until it is too late. An experienced Vascular surgeon can help to perform screening for the presence of this condition in at risk individuals, and institute preventive surgery early to reduce the risk of rupture and death.

(https://medlineplus.gov/ency/article/000162.htm)

6.Arteriovenous malformations – This is usually an inborn disease where the arteries and/or veins develop abnormal connections. Vascular surgeons can use minimally invasive embolization techniques to prevent the growth of these blood vessel lesions.

7.Embolization surgery – This is a minimally invasive technique which utilizes wires, coils and embolic agents to selectively block off certain blood vessels in the body. It is used to treat a wide range of conditions ranging from uterine fibroids, to benign prostatic hyperplasia, to even erectile dysfunction.

This list is in no way exhaustive, and if you suspect you have a condition related to the blood vessels in your body, do not hesitate to consult an experienced Vascular surgeon for advice.

The Latest Advances in Vascular Surgery in Singapore

Gone are the days of long large incisions on the neck, arms, abdomen or legs to treat Vascular diseases. These days, most conditions can be treated using minimally invasive techniques (aka endovascular surgery). Endovascular surgery involves inserting a small catheter into the artery or vein to access the affected area, and thru which balloons, stents, coils and medications can be infused to treat most Vascular conditions. This type of surgery is less invasive than open surgery and can help reduce the risk of complications. Most patients can now have their surgery performed as a day case and go home the very same day.

(https://www.coastalvascular.com/blog/what-is-endovascular-surgery)

Not all conditions are best suited for endovascular surgery however, and it is prudent to choose a Vascular surgeon with experience in both open and endovascular surgery so that you can be given all possible options available and choose the most appropriate one.

Understanding the Different Types of Vascular Surgery

There are two main types of vascular surgery: open surgery and minimally invasive endovascular techniques. Open surgery is the traditional approach to treating vascular conditions and involves making an incision in the skin to access the affected area. This type of surgery is more invasive and can involve a longer recovery period. Minimally invasive endovascular techniques, involve inserting a small catheter into the artery or vein to access the affected area. This type of surgery is less invasive and can help reduce the risk of complications [3].

What to Expect During a Vascular Surgery Procedure

As seen from the above list (see “What type of conditions require Vascular Surgery for Patients in Singapore?“), Vascular surgery involves a wide range of diseases and a wide range of surgical approaches, devices and techniques to achieve good outcomes. In general however, prior to any Vascular surgery procedure, imaging tests will be performed to outline the anatomy of the affected vessels. Common imaging tests performed include ultrasound scanning, computer tomography (CT) scanning or magnetic resonance imaging (MRI).

As most conditions can now be treated via minimally invasive endovascular approaches, only a small incision in the arm or the groin is required to complete the operation. Most surgeries also do not require general anaesthesia and can be safely performed just with some light sedation owing to its minimally invasive approach.

Upon completion of the surgery, a small pressure dressing will be applied to the puncture wound to prevent bleeding and most patients can usually return home on the evening of the operation, after a couple of hours of recuperation in a recovery bay.

The Cost of Vascular Surgery in Singapore

The cost of vascular surgery in Singapore can vary depending on the type of procedure performed and the complexity of the condition. Much of the cost is contributed by the various stents, balloons, catheters and wires used during endovascular surgery. Endovascular surgery also requires the use of an operating theatre with fluoroscopy (X-ray) availability, of which may contribute somewhat to the cost, as these are specialized operating rooms designed to accommodate the fluoroscopy machine and reduce radiation leakage.

(https://uniqarehospital.com/best-vascular-surgeon-in-pcmc/)

Owing to these various factors, it is not possible to give an accurate general guide as to the cost of Vascular surgery in Singapore, so do speak with your chosen Vascular surgeon about the estimated cost of your particular surgery. Most Vascular conditions are considered medically necessary and most good insurance policies should cover the cost of the surgery.

The Risks and Potential Complications of Vascular Surgery

As with any surgery, there are risks and potential complications associated with vascular surgery. These risks can include infection, bleeding, nerve damage, and blood clots. In rare cases, the surgery can lead to stroke, heart attack, and other cardiovascular complications. It is important to discuss the risks and potential complications of the procedure with your doctor before proceeding [5].

Preparation, Post-Surgery Care, and Recovery Tips for Vascular Surgery

General advice before undergoing any operation include eating a healthy diet, avoiding smoking and alcohol, and following a regular exercise regimen. In addition, do let your doctor know if you are on any regular medications and if you have any drug allergies so that they can advise which medications need to be discontinued prior to the surgery, and they know which medications to avoid.

It is always prudent to follow your doctor’s instructions regarding post-operative care, take all medications as they are prescribed, and do not miss the follow up appointment. If in the event you really cannot attend the scheduled follow-up appointment, please do call in to reschedule one at your convenience.

Specific things to pay attention to for certain Vascular surgeries include:

1. Surgery for peripheral arterial disease (PAD) or deep vein thrombosis (DVT) – Your doctor will typically prescribe a course of blood-thinning medications to prevent the artery from narrowing/blocking up again. While on such medications, do avoid any contact sports or activities which may expose you to trauma/injury, such as riding a motorbike.
2. Surgery for varicose veins – If endovenous heat ablation techniques are used for the surgery, your affected leg will have a compression bandage applied at the end of the operation. When at home, avoid getting the compression bandage wet or taking it off prematurely. The bandage is removed 1-2 days after the operation and a light stocking needs to be worn for a further 2 weeks to achieve the best possible outcomes from the operation.

(https://medisistsurgicals.com/product/compression-bandage/)

3.Aortic aneurysm and carotid artery surgery – Good blood pressure control is imperative to reduce complications after the operation. Do take all prescribed blood pressure medications as recommended, and monitor your blood pressure daily to ensure it remains within a healthy range.

The Role of Vascular Surgery in Treating Cardiovascular Disease and Overall Quality of Life

Vascular surgery involves treating the blood vessels located outside the brain and the heart, and it involves:

1. Opening or bypassing blocked vessels
2. Repairing damaged aneurysmal vessels
3. Blocking (embolizing) vessels which are causing disease symptoms

Many vascular conditions are either limb or life threatening and by undergoing successful vascular surgery, most patients can avoid a major limb amputation and return to their usual lifestyle. Please refer to “What type of conditions require Vascular Surgery for Patients in Singapore?” section above for more details on the various disease conditions treated by Vascular surgeons.

Minimally Invasive Techniques & The Latest Technologies in Vascular Surgery

In recent years, minimally invasive techniques, aka endovascular surgery, have become standard practice in Singapore. This type of surgery involves inserting a small catheter into the artery or vein to access the affected area. It is less invasive than open surgery and can help reduce the risk of complications. In addition, improvement in 3D imaging technology has contributed to the improvement in outcomes by helping doctors diagnose and treat vascular conditions more effectively.

Endovascular techniques have also made vascular surgery less invasive. This has reduced the risk of complications and has allowed more operations to be performed under sedation as a day case.

Vascular Surgery and its Long-Term Role in Preventing Chronic Disease

Vascular surgery can have a profound impact on preventing chronic disease. By improving blood flow to the lower extremities, it can help reduce the risk of blockages in the arteries and reduce the risk of complications, such as aneurysm rupture. In addition, it can also help reduce the risk of deep vein thrombosis and other blood clotting disorders. By reducing the risk of these conditions, vascular surgery can help reduce the risk of chronic disease.

The long-term benefits of vascular surgery can vary depending on the condition and the type of procedure. Generally, vascular surgery can help improve blood flow to the lower extremities and reduce the risk of amputation. It can also help reduce the risk of stroke, and other cardiovascular diseases. In addition, it can help improve the quality of life for many patients.

The Impact of Vascular Surgery on the Elderly Population in Singapore

Vascular surgery can have a positive impact on the elderly population in Singapore. By improving blood flow to the lower extremities, it can help reduce the risk of amputation and improve the quality of life for many elderly patients. In addition, it can help reduce the risk of stroke and other cardiovascular diseases. Vascular surgery can also be used to treat aneurysms, which can help reduce the risk of serious complications, such as aneurysm rupture.

FAQs:

Dr Chen Min Qi profile

Dr. Chen Min Qi is a fellowship-trained Vascular and Endovascular Surgeon who graduated from the National University of Singapore in 2005. He subsequently completed his basic and advanced training in General and Vascular Surgery while obtaining the Member of Royal College of Surgeons of Edinburgh (MRCSed) qualification in 2010, and the Master of Medicine (General Surgery) qualification in 2015. Dr Chen was subsequently successful at the fellowship exams obtaining the Fellow of Royal College of Surgeons of Edinburgh (FRCSed) qualification in 2016.

Upon completion of his advanced surgical training, Dr Chen Min Qi joined the newly opened Ng Teng Fong General Hospital (NTFGH) as a specialist in the Vascular Surgery division. In 2018, Dr Chen was awarded the Health Manpower Development Plan (HMDP) grant from MOH to undergo further subspeciality Vascular training at the internationally renowned St Mary’s Hospital in London, United Kingdom. There Dr Chen gained further experience in surgeries on complex abdominal and thoracoabdominal aortic aneurysms, redo open repair of abdominal aortic aneurysms following failed EVAR surgeries as well as carotid endarterectomy surgery and lower limb revascularization surgeries.

Upon his return in 2020, Dr Chen Min Qi joined the newly formed Woodlands Health as head of their Vascular service, before joining his current practice at the Vascular and Interventional Centre in January 2023.

References

[1] https://www.sgvascularctr.com/dr-benjamin-chua-on-vascular-disease-and-surgery/

[2] https://www.mayoclinic.org/tests-procedures/minimally-invasive-surgery/about/pac-20384771

[3] https://www.sgvascularctr.com/cover-interview-dr-benjamin-chua-on-the-fast-changing-field-of-endovascular-surgery/

[4] https://www.sgvascularctr.com/all-things-vascular-singapore-guide/

[5] https://www.sgvascularctr.com/treatment-of-peripheral-artery-disease-pad-in-singapore-a-comprehensive-guide/