In recent years, Singapore has proposed plans to overhaul its healthcare system in response to its swiftly aging population. This monumental change seeks to cater to the distinct healthcare requirements of the elderly demographic, improve preemptive medical services, and offer enhanced assistance for a variety of health conditions. The government’s strategy involves creating innovative care frameworks, harnessing technological advancements, and reinforcing community-based healthcare to ensure top-notch medical services for individuals of all age brackets, considering the shifting demographics. In response to this, healthcare providers are undergoing a comprehensive transformation to better address the specific needs of the elderly population.

(https://ctvstexas.com/common-vascular-questions-answered/)

The Role of Vascular Surgeons in Singapore’s Ever-Changing Landscape

Vascular surgery stands as a critical medical specialty that specializes in diagnosing and treating diseases affecting blood vessels, arteries, veins, and lymphatic vessels outside the heart and brain. As Singapore’s population undergoes a significant aging trend, the demand for skilled vascular surgeons has seen a notable upswing. This surge is attributed to the rising prevalence of conditions like aortic aneurysms, peripheral arterial disease, varicose veins, and kidney failure necessitating dialysis. The complex nature of vascular surgery mandates a specialized skill set and deep expertise to ensure the successful management of such intricate cases.

With an array of innovative approaches and medical devices available for interventions, the selection of an adept vascular surgeon is pivotal. This choice can be the deciding factor especially in life and death cases of high-risk conditions like aortic aneurysms or carotid artery disease. As the realm of vascular surgery continues to evolve, experienced surgeons become the bridge between medical interventions and optimal patient outcomes.

Types of Procedures Performed by Vascular Surgeons

Vascular surgery is a specialized medical field dedicated to addressing issues concerning the blood vessels and circulation that play a crucial role within our bodies. This encompasses the intricate network of arteries and veins, which are responsible for transporting blood throughout the body. Unlike cardiac surgery that focuses on the heart, vascular surgery primarily concentrates on blood vessels situated outside the heart and, for the most part, the brain. This branch of surgery employs an array of techniques to address various vascular conditions.

Vascular surgeons are trained extensively to manage these complex conditions with precision and expertise. Their training involves a comprehensive understanding of the intricate anatomy and physiology of blood vessels, enabling them to diagnose and treat a diverse range of vascular conditions. Through rigorous education and hands-on experience, vascular surgeons acquire the skills necessary to perform intricate procedures, utilizing both traditional open surgical approaches and innovative minimally invasive techniques. This training equips them to handle conditions such as aortic aneurysms, peripheral artery disease, venous insufficiencies, and more, ensuring that patients receive tailored care that addresses their unique vascular challenges. As the field continually advances, vascular surgeons stay up-to-date with medical developments, allowing them to provide patients with optimal outcomes in a rapidly evolving medical landscape.

Types of Vascular Conditions Treated by Vascular Surgeons in Singapore

1. Peripheral Arterial Disease (PAD) occurs when arteries supplying blood to limbs narrow due to cholesterol and calcium deposits in arterial walls, leading to inadequate oxygen and nutrient supply. This results in pain in affected areas, as limbs can’t function properly.

(https://www.cdc.gov/heartdisease/PAD.htm)

2.Erectile Dysfunction (ED) is the inability to maintain a firm erection for sexual activity. Blood must stay in the penis during arousal, achieved through vein constriction. If veins don’t constrict enough, an erection can’t be sustained, causing difficulty in sexual performance.

3.Pelvic Congestion Syndrome (PCS) is a chronic condition affecting women due to weakened valves in lower abdomen veins. This causes blood to flow backward, pooling in pelvic and leg veins, leading to discomfort and pain.

(https://www.astraveinvascular.com/pelvic-congestion-syndrome-pcs-treatment/)

4.Uterine Fibroids (UFE) are growths in the uterus, common among women. They are classified by their location within the uterus and can impact reproductive health and cause various symptoms.

5.The aorta, body’s largest artery, weakens and balloons outward, forming an Aortic Aneurysm (AA). This can disrupt blood supply to essential organs and pose a serious health risk, demanding medical attention to prevent potential rupture.

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

6.Varicose Veins (VV) are dilated veins predominantly affecting the legs and which results in pooling of blood in the lower limbs. This causes an increase in the venous pressure in the lower parts of the legs leading to dry itchy skin, hardening and darkening of the skin, and even chronic wounds.

(https://www.yarravascular.com.au/condition/varicose-veins/)

Diagnostic Procedures

Doppler ultrasound: Non-invasive, no radiation exposure; however, its performance reduces in the absence of sufficient acoustic windows, such as in degenerative arterial diseases of the neck.

CT angiography: Non-invasive and rapid imaging, useful in conditions such as aortic pathologies, pulmonary embolism, and multi-territory vascular events.

MRI: Good soft-tissue imaging, useful in the visualization of carotid and vertebral arteries, aorta (including thoraco-abdominal aneurysms), renal arteries, mesenteric vessels, iliac arteries, and lower limb runoff. Outpatient setting without general anesthesia or iodine contrast, with less potential nephrotoxicity; however, the length of the imaging scan may not be suitable for all patients.

Cerebral and spinal digital subtraction angiography: Performed while injecting a contrast agent into selectively catheterized cerebral or spinal vessels, DSA typically provides the clearest visualization of blood vessels in the central nervous system. Accurate definitions of vascular disease are crucial, as these diseases guide treatment decisions. The timeliness of such diagnostic evaluations is increasingly shown to impact patient outcomes. Ongoing advances in diagnostic methodologies include the availability of high-quality cross-sectional computed tomography angiography and MR angiography in assessing the peripheral arteries and veins. MR is an excellent technique for disease evaluation and treatment planning, subsequent to which secondary effects of new or chronic disease as well as potential undiagnosed malignancy may also be evaluated and treated depending on the patient’s condition. All of these new technologies have to be interpreted by specialists in this field who can appreciate not only their sensitivity and specificity but also their limitations.

Various Treatments for Vascular Conditions

Vascular surgeons in Singapore provide a range of treatments to address these conditions. The treatment options can include:

1.An Angioplasty entails the insertion of a deflated balloon into a narrowed or blocked artery. Once in place, the balloon is inflated, causing the artery to widen. This process, known as dilation, helps to alleviate the blockage and enhance blood circulation. Angioplasty is especially effective for conditions like atherosclerosis, where arterial walls accumulate plaque deposits that hinder blood flow.

2.Endovascular Procedures are generally minimally invasive techniques used to treat diseased arteries or veins. Typically, a sheath is inserted into an artery, commonly located in the groin or arm area. Through this sheath, specialized medical instruments like balloons, stents, and catheters are introduced. These instruments allow medical professionals to perform intricate procedures without the need for extensive surgical incisions. Endovascular procedures are versatile and can target a variety of vascular issues.

(https://ourheartdr.com/vascular-services/abdominal-aortic-aneurysm-aaa/treatment-options-abdominal-aortic-aneurysm-aaa/what-is-endovascular-stent-grafting/)

3.Vascular Bypass Surgery involves a surgical intervention where a healthy vein or a synthetic graft is employed to circumvent a blocked segment of an artery. By creating an alternate pathway for blood flow, vascular bypass surgery effectively bypasses the blockage, restoring normal blood circulation. This procedure is typically conducted as an open surgery and is beneficial in cases where other treatment options might not be as effective.

(https://mwvascular.com.au/lower-limb-bypass-surgery/)

4.Certain medications are prescribed to prevent the formation of blood clots or to dissolve existing clots within the blood vessels. These pharmacological interventions play a critical role in preventing potentially life-threatening complications like deep vein thrombosis (DVT) or pulmonary embolism.

Open Surgery vs Minimally Invasive Endovascular Techniques

Vascular surgery encompasses two primary approaches: open surgery and minimally invasive endovascular techniques. Open surgery follows the conventional method, where an incision is made in the skin to reach the problem area. This approach is more intrusive and often requires an extended recovery period due to the nature of the procedure. On the other hand, minimally invasive endovascular techniques involve utilizing a small catheter inserted into the artery or vein to access the targeted region. This method is less invasive compared to open surgery, leading to reduced chances of complications. It generally involves smaller incisions, quicker recovery times, and often leads to less discomfort for the patient.

Recovery Times and Outcomes

Most surgical procedures require at least a few weeks for recovery to occur. The endovascular procedure usually causes less tissue trauma and has significantly shorter recovery times. After angioplasty, the patient is capable of ambulating almost immediately after the procedure. We recommend that after procedures, patients get up and walk around as soon as possible. The healing process and pain management will vary depending on the size of the access site and the caliber of the graft used. Ultimately, when the vessels heal fully, most do not have to be on any special activity or diet restrictions. We provide detailed post-procedure recovery instructions following your procedure. Immediately following the angiogram or endovascular procedure, the patient will be transferred to the recovery unit or to the special observation unit, which is dedicated to vascular procedures. The registered nurses and physicians will watch the patient carefully. Patients usually spend a night or more in the hospital following any type of procedure.

Several factors influence the recovery process, including the patient’s age, overall health, nutritional status, and whether there are any ongoing medical problems present prior to the procedure. There are also differences in outcomes observed with various treatment methods. In these pages, I will provide an overview of symptoms following vascular procedures that are common and can be expected in the majority of patients. We will illustrate the real world with testimonials from patients and their families; in particular, testimonials have been presented for open surgical AAA repair, EVAR, lower extremity bypass surgery, and angioplasty and stenting. We urge you to consider preparing for your recovery just as you did for the procedure itself. Rather than being fully focused on details, taking medications, or providing other care, it will be very beneficial for your overall recovery. The most powerful weapon we have is our minds. If you go into this with a positive attitude, you will have a good recovery; whereas if you go into it with a negative feeling, you quite likely will have a tough go of it. Please read on and let me help you prepare properly. In most cases, patients who undergo endovascular treatment can return to their daily routine shortly after the treatment. It is important to get back to normal activities as soon as possible. The exception to this is when the treatment included the placement of a stent graft and never includes activities that involve heavy lifting. There are risks with all procedures, and in some conditions, with all therapies. However, the placement of a stent graft in a favorable aorta due to a short abdominal aneurysm is the least invasive procedure available and thereby the least risky. Also, in most studies, the benefits of surgery are generally equivalent, regardless of the treatment received. As a result, the risk benefits for the least risky treatment may not be as convincing as for the high-risk procedures. In these low-risk situations, the quality of life issues are particularly important to consider, such as short- and long-term recovery times and the expected instrument durability. For example, the quality of life of an 80-year-old woman can be greatly hampered by a 1-year recovery period from an open surgical aneurysm repair.

Key Strategies for Preventing Vascular Diseases

Key strategies that could help in preventing vascular diseases are as follows:

Making Lifestyle Choices to Prevent Vascular Diseases: There are many risk factors that you have control over by making lifestyle changes. A healthy diet, which is low in saturated fats and cholesterol, high in fiber, and includes plenty of fruits and vegetables, helps to prevent arterial disease. A diet low in salt can help prevent high blood pressure. The amount of physical activity you need to prevent vascular diseases depends on your age. A good balance between a moderate increase in physical activity and adopting a heart-friendly diet is the most effective strategy for preventing vascular diseases. It can reduce blood pressure, atheroma, blood sugar, overweight, and depression.

Regular Health Screenings: Everyone should go for regular health screenings to detect any vascular abnormalities such as high blood pressure, high blood sugar, high cholesterol levels, and early signs of ischemic heart disease and peripheral arterial diseases. This will help to prevent stroke and heart attack, as treatment can be given to prevent the progression of the disease. Screening can also detect an AAA before it becomes life-threatening, and treatment can be offered to help prevent a person from dying from a ruptured AAA. Educational Initiatives: Efforts are always being made to raise public awareness about stroke, heart attack, PAD, and DVT. This will educate the public on the various signs, symptoms, and the importance of timely treatment for these vascular diseases so they may seek immediate help when needed. Healthcare Professionals: Health professionals play an important role in advising patients about risk factors for vascular disease (making lifestyle choices) and monitoring preventive measures. It is a shared responsibility between healthcare professionals and the individual in preventing vascular diseases.

Lifestyle Changes and Risk Reduction

Investigations have revealed that the risk of vascular disease can be halved by introducing certain lifestyle changes, some of which are: Quitting smoking, as smoking significantly enhances the healthcare risk. Increasing physical activity: Moderate physical activity for at least 30 minutes, most days of the week. Improving exercise capacity: Exercising with moderate intensity that enhances exercise tolerance or reduces symptoms such as excessive fatigability and breathlessness on routine activities. Dietary modification: Normally, diabetic patients do not need a special diet, just a normal healthy balanced diet. Reduce excessive intake of fat to lessen LDL cholesterol concentrations. Replacing it with mono or polyunsaturated fats can help lower cholesterol levels. Most of the calories should come from carbohydrates. Usually, diet counseling by a nutritionist will be arranged. Reducing body weight: Losing weight increases the efficiency of the medications and can reduce blood pressure and cholesterol levels.

Moreover, it has also been found that the known risk factors for the aforementioned diseases are common in the population and that for a given population and environment, the more risk factors a person has, the greater their likelihood of developing disease. Sustained behavioral changes are continually confirmed to be fundamental components in achieving healthy lifestyles, and professionals need to take consideration of key concepts that can directly influence individual behavior in practice. This can involve cognitive and rational processes, self-reflection, goal setting, and many others. Behavior is also influenced by environmental factors, but these links require further investigation. Evidence suggests that long-term, significant changes are more likely to be sustained if affected individuals are supported by structured programs that are influential in promoting short, medium, and long-term lifestyle improvements. Family and social networks can play a key role in providing support for such change, but the involvement of other significant people will also be necessary to ensure lifestyle modification is sustained over a longer period. For many at-risk people and patients, families and social networks will also need to be given accurate information about the risk of vascular disease. Ongoing motivation, support, and self-monitoring are crucial.

Final Words

As Singapore’s population ages, the healthcare system is undergoing transformation to cater to elderly needs, prompting a demand for skilled vascular surgeons. These surgeons play a critical role in diagnosing and treating diseases affecting blood vessels. With the advancement of minimally invasive techniques and complex interventions, choosing an adept vascular surgeon becomes pivotal. Their expertise in navigating innovative care frameworks and their ability to tailor surgical approaches to individual cases is crucial. A range of conditions like peripheral arterial disease, erectile dysfunction, and aortic aneurysms can be treated by these experts, often employing treatments such as angioplasty, embolization and stenting. Considering the potential risks and benefits of vascular surgery, consulting a qualified vascular surgeon ensures the best possible care in Singapore’s evolving medical landscape.

FAQs:

References:

[1] https://www.sgvascularctr.com/an-introduction-to-vascular-surgery-in-singapore/

[2] https://www.sgvascularctr.com/get-to-know-the-benefits-of-having-a-vascular-surgeon-in-singapore/

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.