No abstract

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

Introduction: Cystic adventitial disease (CAD) is a rare cause of claudication. We report a case of CAD involving the external iliac artery, with possible cyst rupture intramurally causing significant long segment stenosis of the external iliac artery. Case report: A 52-year-old female presented with sudden onset (over 1 day) lifestyle-limiting claudication affecting the left calf and thigh. CT angiography of the lower limbs revealed an eccentric low density wall thickening of the left external iliac artery (EIA) producing a 70% stenosis and a cystic lesion just distal to the stenosis. Discussion: A diagnosis of cystic adventitial disease was made and the patient proceeded to iliofemoral bypass.

ObjectivesEndovascular revascularisation is the mainstay of the treatment of lower extremity peripheral arterial disease. Improvement in perfusion after treatment is often quantified by a corresponding increment in ankle or toe brachial indices. These measurements are difficult to obtain in patients with foot wounds, and have to be performed at a separate time and setting after revascularisation. This preliminary study aimed to evaluate the use of parametric colour coding and analysis of time attenuation curves as a real time quantitative measure of perfusion after endovascular revascularisation.MethodsForty-seven consecutive patients with critical limb ischaemia were retrospectively enrolled and analysed. Parametric colour coding and generation of time attenuation curves in the main pedal vessel was performed for pre- and post-intervention digital subtraction angiograms of each patient. The change in time attenuation curve parameters was compared with the change in ankle or toe brachial indices before and after intervention.ResultsComparing before and after lower extremity endovascular intervention, there were significant changes in the washout parameters derived from the time attenuation curve. The percentage of contrast decay 4 seconds after peak (I4s) demonstrated the strongest correlation (R = .482) with the change in ankle or toe brachial indices.ConclusionsParametric colour coding and time attenuation curve analysis might be a helpful tool that can provide real time intra-procedural quantitative data on pedal perfusion which can improve clinical outcomes.