Page 92 - Hospital Authority Convention 2018

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2018

M2.1 Advances in Vascular Intervention 13:15 Convention Hall A

Endovenous Therapy for Varicose Vein
Ting CW
Division of Vascular Surgery, Department of Surgery, Queen Elizabeth Hospital, Hong Kong
Varicose vein is a common problem which may lead to distending calf discomfort or even complications such as skin
changes, bleeding or ulceration. Sapheno-femoral incompetence with Great Saphenous Vein (GSV) reflux is the commonest
pathology. Traditional open sapheno-femoral flush ligation and stripping of the GSV has been the standard treatment for
decades. Less invasive therapy with endovenous ablative techniques have been introduced as an alternative treatment
for abolishing GSV reflux. This obviates the need for general or regional anaesthesia. Studies have shown comparable
efficacy with open surgery, while associated with less perioperative pain and earlier return to work. Thermal ablation with
radiofrequency (RFA) or laser (EVLA) are the most popular approaches. Some studies suggest that EVLA is associated with
greater perioperative pain and bruises when compared to RFA. With the introduction of 1470nm 2ring radial laser fibre, there
is decreased pain and quicker return to normal activities when compared to 940nm laser fibre. More recently, non-thermal
ablative methods including mechanochemical ablation and cyanoacrylate glue are also introduced. They show similar efficacy
in ablating GSV reflux with comparable outcomes to thermal approaches. These techniques further eliminate the need for
tumescent anaesthesia that is required for thermal ablation.

In summary, endovenous therapy with thermal ablation (RFA or EVLA) is the current first-line treatment for GSV reflux. Non-
Monday, 7 May 2018
thermal ablative methods including mechanochemical ablation and cyanoacrylate glue also show promising early results
although more long-term studies would be helpful.

M2.2 Advances in Vascular Intervention 13:15 Convention Hall A

Advances in Multidisciplinary Management of Vascular Anomalies: Surgeon’s Perspective
Lai E
Department of Surgery, Queen Elizabeth Hospital, Hong Kong

Vascular anomalies include various high flow and low flow vascular tumours and vascular malformations. Surgical excision
is the treatment choice for well-localised and functionally impaired lesions, while laser could be used to treat capillary
malformations for better quality of life. Many advances in microvascular surgery offer hope for those patients with large lesion
that require extensive resection resulting in complicated reconstructive procedure.
However surgical excision alone, especially in extensive disease, carries risk of massive haemorrhage which can be life-
threatening. In Queen Elizabeth Hospital, we have been using hybrid approach, combining embolization and immediate
surgical excision, to treat various high flow and low flow vascular malformations since 2011. The hybrid operation is carried
out in Endovascular Operating Room under general anaesthesia. Embolization and excision are performed in the same
session. It is an interactive procedure between surgeons and radiologists, which could minimise blood loss while increasing
the rate of complete resection.

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