Dr Benjamin Chua, Consultant Vascular Surgeon and Director, Endovascular Surgery, Dept of General Surgery, Singapore General Hospital

Abdominal aortic aneurysms (AAAs) occur most commonly in individuals between 65‐75 years old. Risk factors include smoking, hypertension, atherosclerotic disease and rarer causes like connective tissue disorders. The biggest threat from AAAs is rupture, which is associated with more than 50% mortality before treatment. Most patients with AAA are asymptomatic and are diagnosed incidentally while being investigated for other disease conditions. This may be from clinical palpation of a pulsatile abdominal mass or findings from a CT scan or ultrasound. Symptomatic patients may experience severe persistent lower back pain that radiates to the flanks, lower limb pain/ tissue loss from aneurismal sac mural thrombus embolizing downwards and in ruptured aneurysms, severe pallor, pain and hypotensive shock. Once diagnosed, patients with aneurysms meeting criteria should be treated to prevent rupture. Traditional surgery for AAAs involved open surgery techniques through a laparotomy and in‐situ graft repair with significant morbidity and mortality risks.

The Singapore General Hospital now offers the latest minimally‐invasive techniques for treating AAAs before they rupture. These techniques, known as endovascular AAA repair with stent grafts or EVAR, have been shown to benefit patients significantly. Such benefits include lower peri‐operative risk of mortality, myocardial infarctions and strokes and faster post‐op recovery with minimal morbidity. In particular, patients with significant co‐morbid disease (e.g, ischaemic heart disease, respiratory diseases) that preclude high‐risk open surgery will benefit most from EVAR. Recent improvements in techniques and echnology for EVAR have now made it the first‐line preferred treatment for all patients with AAAs.

The Singapore General Hospital has developed a team‐based approach with a comprehensive programme towards treating patients with AAAs, using EVAR. Upon diagnosis, patients are further evaluated using advanced CT scan imaging to define aneurysm anatomy for EVAR planning. Surgery is then carried out in SGH’s Hybrid OT (the only facility in Singapore) where advanced fluroscopic imaging techniques are combined with operating theatre facilities and equipment. A team comprising an experienced Vascular Surgeon, Interventional Radiologist, Cardiovascular Anaesthetist, Radiographer and specialized OT Scrub nurses trained in endovascular techniques performs the EVAR surgery. Using the Hybrid OT and the latest endovascular surgery techniques, the team has managed to treat, with good outcomes, many patients with significant peri‐operative risks and whose AAAs have complex anatomies. Methods and techniques used include total percutaneous EVAR with patient under local anaesthesia through small groin puncture wounds, visceral artery chimney stent grafts in tandem with EVAR and special customized branched EVAR stent grafts. The latter techniques are especially useful for patients with short‐necked aneurysms that were previously deemed unsuitable for conventional open or EVAR techniques. Post‐surgery, the patients are monitored closely in clinics using the latest in CT and ultrasound‐contrast treatment and this surveillance will be for the patient’s lifespan.

We believe that the SGH team‐based approach to treat AAA will serve only to benefit patients as many talents are focused on delivering optimal care. We seek to further enhance our team‐based approach to AAA treatment by working closely with our GP partners to ensure early diagnosis of asymptomatic AAA patients as well as ensure continued care for AAA patients upon discharge postsurgery.

For referrals, a friendly chat or discussion, our GP partners can contact:

The Dept of General Surgery
Singapore General Hospital
Tel : 6321-4051 (Office), 6321-4377 (Appt Line)