Page 83 - HA Convention 2015

Masterclasses

MC5.1 Advances in Medical Technology 14:30 Convention Hall C

Interventional Radiology in Peripheral Vascular Disease: How Far Can We Go? Monday, 18 May
Cheng RLF
Department of Radiology, Princess Margaret Hospital, Hong Kong

Since the first paper on percutaneous transluminal angioplasty was published by Professor Charles T. Dotter in 1964,
endovascular treatment has become the most widely used and rapidly developed technique in treatment of peripheral
vascular disease.

Low-profile microguidewire and angioplasty balloon catheter are feasible for the treatment of the small vessels down to the
ankle and foot levels. Long chronic occlusion can be overcome by innovative techniques such as subintimal recanalisation
and re-entry devices. Improved stent design, together with drug eluting technology, has largely prolonged the vessel patency
after endovascular treatment. Atherosclerotic plaque on arterial wall can be removed by atherectomy devices. Preliminary
result of bioresorbable stent is promising, which may shift the paradigm in the treatment of peripheral vascular disease in
future.

MC5.2 Advances in Medical Technology 14:30 Convention Hall C

New Challenges in Endovascular Aortic Surgery HOSPITAL AUTHORITY CONVENTION 2015
Chan YC
Department of Surgery, The University of Hong Kong, Hong Kong

In the past few decades, the management of aortic diseases is rapidly evolving from the traditional open surgery to minimally
invasive methods with the advent of new endovascular techniques since early 1990s. From the standard endovascular
aneurysm repair (EVAR) for infrarenal aortic aneurysms and thoracic endovascular repair (TEVR) for aortic dissection and
aneurysm, other endovascular repair strategies have since emerged in the treatment of complex aortic disease, including
hybrid aortic repair, chimney graft techniques, physician-modified stent-grafts and custom stent-graft designs. Endovascular
repair strategies offer advantages over open repair, as they are minimally invasive and do not require hypothermic circulatory
arrest or rerouting of aortic blood flow. Several of these new techniques have proven technically successful with promising
early and midterm results, whereas others have been associated with long-term durability concerns.

These procedures are technically challenging, and often require upper limb and femoral access routes and extreme precision
in the placement of the stent-grafts. These devices are being delivered through relatively large delivery sheath and thus may
pose as access problem for those patients with small vessels. The peri-operative risks of end-organ ischaemia, paraplegia,
or stroke, still exist as these patients are often elderly and have significant comorbidity.

Like many new procedures, endovascular techniques present new challenges for vascular specialists who care for patients
with complex vascular pathologies. We draw inspiration from several inter-related disciplines, and work in a multidisciplinary
approach with vascular specialists (trained in both open and endovascular techniques), vascular anaesthetists, cardiothoracic
surgeons, and cardiologists all contributing to this exciting specialty. This talk gives an overview of the current status of
endovascular aortic surgery from a prospective of a highly specialised tertiary referral vascular centre.

81