Vascular Diseases
Introduction
The number of vascular patients in Hong Kong increases continuously in recent years. This is not limited to common diseases such as coronary heart disease and stroke, but also peripheral occlusion arterial disease, aortic aneurysm and lower extremity varicose veins. To enhance vascular surgical services, the KWH has set up the Acute Stroke Unit and the Cheung Tse Kwan Memorial Vascular Centre to provide accurate diagnosis and treatment to vascular patients with advanced medical equipment.
What is Stroke?
A stroke is when the blood vessels in the brain are blocked or ruptured, thus blood supply to part of the brain tissues is blocked, resulting in cell death. If a stroke occurs and blood flow can't reach the region that controls a particular body function, that part of the body won't work as it should. In minor cases the patient may lose certain bodily functions, while serious cases may lead to death. Strokes can be divided into infarction and haemorrhage, 70% of stroke cases are of the former and 30% the latter. Common causes of infarction include hardening of carotid arteries (arteries supplying blood to the brain) or blood clots from the heart blocked the blood vessels in brain. Other causes may include hardening of tiny vessels in the brain.
The consequence of a stroke is determined by the position and size of the dead brain tissues.
Strokes can be divided into ischaemic stroke and haemorrhagic stroke. Nearly 80% of stroke cases in Hong Kong are ischaemic, while the remaining are haemorrhagic.
Acute Stroke Unit
The KWH Acute Stroke Unit provides acute stroke patients with integrated specialist treatment, including specialist care, physiotherapy, occupational therapy, speech therapy, medical social service, dietetic service, and Chinese Medicine consultation. If necessary, patients will be referred to the Psychiatry or Clinical Psychology Department.
Founded in January 2001, the Acute Stroke Unit first operated in E3 and E10 Ward, with 4 beds each for male and female patients. In view of increasing demand, the Unit was moved to S10 Ward in September 2001 with a total of 10 beds. In January 2009 the Unit was moved again to N3 Ward with 24 beds (12 each for male and female patients).
Acute Stroke Unit – Professional Services
Specialist Care: aims at preventing complications, helping patients and their families to face difficulties, providing medication instructions and information on prevention of falls and strokes. Counselling education such as empowering carers with the ways, attitudes and techniques to take care of stroke patients.
Physiotherapy: aims at increasing the sense and cognition of the patients’ affected sides, avoiding joint stiffness of the affected sides, hence relieving and preventing muscle spasms. This can enhance patients’ mobility and self-care. Assistive devices such as wheelchairs, walkers, quad canes and walking sticks can also be tailored to patients.
Occupational Therapy: provides a range of services such as fitness recovery exercises, limb control exercises, household assistive device training, sensory impairment adaptation exercises, and cognitive exercises. These help recover the affected limbs’ mobility and thus enhance the patient’s self-care after stroke. With assessment on the patient's living environment, occupational therapists will recommend suitable assistive devices or provide advice on home setting. Stroke patients can then adapt to family and community life more easily after discharge, thus enhancing their quality of life.
Rehabilitation at Home: takes care of patient’s various needs after discharge and to continue rehabilitation efforts. Acute Stroke Unit refers suitable stroke patients to TWGHs Outreaching Home Care Services for the Elderly or Home Physiotherapy Services. Apart from related rehabilitation exercises and assistive devices, their living environment and home settings can also be improved. Valuable advice can be given to enhance their self-care ability and quality of life. Besides, the Unit’s Community Geriatric Assessment Services also provides outreaching healthcare services for stroke patients living in TWGHs residential care homes.
Integrated Chinese and Western Medical Services: In view of the recent Chinese medicine development in Hong Kong, the KWH Medical and Geriatric Unit cooperated with the Chinese Medicine Clinical Research and Services Centre to research on the effectiveness of Chinese acupuncture and herbal medicine on acute stroke patientsIn view of the ageing population and medical technology advancement, the Acute Stroke Unit will provide more specialised stroke treatments and more effective emergency services to the surging number of stroke patients.
Cheung Tse Kwan Memorial Vascular Centre
In 2000, TWGHs Board of Directors and Director Robert Chiu-yin Kwan allocated a special fund to found the Cheung Tse Kwan Memorial Vascular Centre . Located at 6/F, East Wing, KWH, the Centre uses advanced equipment to perform painless, non-invasive examinations on vascular patients for accurate diagnosis and treatment.
To coordinate with the KWH’s operation, the Vascular Centre has continued its service on 5/F, Tsui Tsin Tong Out-patient Building since April 2015.
Cheung Tse Kwan Memorial Vascular Centre – Professional Services
The KWH Vascular Surgeon and Nurse Team provides the following services to patients with peripheral occlusion arterial disease, abdominal aortic aneurysm, carotid artery stenosis and lower extremity varicose veins:
Pre-operative Evaluation: precise equipment is used for pre-operative evaluation; patients and their family are briefed with the conditions; counselling; and different surgery options are provided for reference.
Post-operative Follow-up: regular follow-ups to examine and monitor blood flow for early detection of abnormalities.
Medical Equipment
1. Duplex Ultrasound ScanningThrough Duplex Ultrasound, the Scanner can display the state of arteries and blood flow in various body parts. This helps diagnose the position and extent of blockage in the vessels.
Duplex Ultrasound Scanning is used for the following purposes:
Carotid Artery Stenosis is used to assess the extent of stenosis and estimate the risks of recurrent stroke.
Measuring the size of abdominal aortic aneurysm to evaluate the risks of rupture.
Examining the location and extent of peripheral occlusion arterial disease. With the help of angiography, more information about the disease can be obtained.
Evaluating varicose vein and chronic venous insufficiency, finding the causes behind varicose, the location of deep venous thrombosis and their severity.
Pre-operative mapping evaluates the condition of upper limbs vessels to locate arteriovenous fistulas for haemodialysis patients.
2. Ankle Brachial Index: ABIUltrasound is used to measure the blood pressure and blood flow of various parts of the legs. This is to diagnose the location and extent of lower extremity occlusion.
3. Exercise ABIExercise ABI evaluates the blood flow in the lower limbs under a specified amount of exercising.