Page 93 - Hospital Authority Convention 2018

Masterclasses

M2.3 Advances in Vascular Intervention 13:15 Convention Hall A

Advances in Multidisciplinary Management of Vascular Anomalies: Radiologist’s Perspective
Fung DHS
Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
Vascular anomalies are congenital diseases of blood and lymphatic vessels and are classified into vascular tumours and HOSPITAL AUTHORITY CONVENTION 2018
vascular malformations by the ISSVA classification. Vascular anomalies affect patients of all ages. Patients are stigmatised
socially due to their disfiguring appearances, and suffer from pain and functional loss. In severe cases, detrimental symptoms
and morbidity can occur, and profuse bleeding can sometimes be life-threatening.

Advances in diagnostic radiological technology improve the accuracy of diagnosis and facilitate decision making in
treatment. The use of portable ultrasound machine at the Joint Vascular Anomalies Clinic allows instant diagnosis at one-stop
consultation with various specialties. Magnetic resonance imaging and angiography, which are non-invasive and radiation-
free, allow better lesion characterisation and accurate blood flow assessment.
Advances in interventional radiology by image-guided sclerotherapy and embolisation result in optimal symptom control
and size reduction in the treatment of low-flow and high-flow vascular malformations. State-of-the-art imaging guidance
by ultrasound and digital subtraction angiography allows radiologists to accurately access the culprit vessel, where we can
inject sclerosant to shrink and occlude the diseased blood vessels without damaging adjacent normal structures. Various
sclerosants are now available, including dehydrated alcohol, sodium tetradecyl sulphate, doxycycline, and bleomycin.
Detachable metallic coils and permanent liquid embolic agents such as NBCA glue are adjuncts for safe and effective
embolisation, particularly in the treatment of huge arterio-venous fistula. For difficult cases with tortuous diseased vessels,
they can be accessed by micro-catheters and micro-guidewires for interventional procedures.

Endo-Vascular Operating Room (EVOR) refers to the setting of biplane digital subtraction angiography machine in the
operation theatre. This is a breakthrough in engineering and technology which provides a unique platform to combined Monday, 7 May 2018
surgical and interventional radiological operations.

M2.4 Advances in Vascular Intervention 13:15 Convention Hall A

Beyond Ascending Aorta, What are We Doing Now?
Total Arch Replacement and Frozen Elephant Trunk
Wong R
Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Hong Kong
Aortic surgery involving aortic arch has long been one of the most challenging areas of cardiac surgery. With the modern
hybrid operating theatre, it is possible to combine multimodalities evaluation and treatment including intra-operative 3D trans-
esophageal echocardiogram evaluation of true and false lumen flow, combining conventional open surgery with imaging
guided endovascular treatment as well as endoscopic visualisation of stent deployment and 3D printing application in pre-
operation planning. These multi-modalities approaches together with a multi-disciplinary team including cardiac surgeons,
vascular surgeons, interventional radiologists, cardiologists, anaesthetists and perfusionists greatly enhance the outcome of
our current aortic practice. In this presentation, the total aortic arch replacement with frozen elephant trunk series at Prince of
Wales Hospital Hong Kong will be shared.

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