Gan Chye Chung

Gan Chye Chung Consultant Interventional Nephrologist
Pakar Perunding Nefrologi Intervensi
介入性肾脏病学顾问

A lot of unnecessary catheter can be avoided. Patient was asked to rest the avf and get temporary access. At here, we sc...
25/07/2025

A lot of unnecessary catheter can be avoided. Patient was asked to rest the avf and get temporary access. At here, we scan to assess and we examine clinically. All we need to do is to mark and show the safe cannulation site.

Banyak kateter yang tidak perlu boleh dielakkan. Pesakit diminta untuk merehatkan avf dan mendapatkan akses sementara. Di sini, kami mengimbas untuk menilai dan kami memeriksa secara klinikal. Apa yang perlu kita lakukan ialah menanda dan menunjukkan tapak kanulasi yang selamat.



We had a very special left RC AVF endovascular thrombectomy last week. We found double cephalic arch and double SVC wher...
24/07/2025

We had a very special left RC AVF endovascular thrombectomy last week. We found double cephalic arch and double SVC where the left SVC drained directly to the right atrium! Imagine someone put at left hemodialysis catheter and review the cxr 🥶



See you at NKF ADC2025! 😅 Gonna be extreme busy 2 months. https://nkf.org.my/wp-content/uploads/2025/07/ADC2025_itinerar...
22/07/2025

See you at NKF ADC2025! 😅 Gonna be extreme busy 2 months.

https://nkf.org.my/wp-content/uploads/2025/07/ADC2025_itinerary-v1.pdf

I always check the sample of the kidney biopsy under microscope before dipping it into formalin for histopathological st...
13/07/2025

I always check the sample of the kidney biopsy under microscope before dipping it into formalin for histopathological staining to ensure adequate glomerulus. At times, we will go to lab to read the slide ourselves for urgent cases prior release of the report by the pathologist. This is how we clinician works here: we diagnose, we biopsy, we read, we treat and we see the outcome.

Saya sentiasa memeriksa sampel biopsi buah pinggang di bawah mikroskop sebelum mencelupkannya ke dalam formalin untuk pewarnaan histopatologi bagi memastikan glomerulus mencukupi. Ada kalanya, kami akan pergi ke makmal untuk membaca sendiri slaid untuk kes-kes yang mendesak sebelum laporan dikeluarkan oleh ahli patologi. Beginilah cara kami pakar klinik bekerja di sini: kami mendiagnosis, kami biopsi, kami membaca, kami merawat dan kami melihat hasilnya.


Back to back catheter related fibrin sheathIN flow good, OUTflow not good = Fibrin Sheath.Early detection = early interv...
11/07/2025

Back to back catheter related fibrin sheath

IN flow good, OUTflow not good = Fibrin Sheath.
Early detection = early intervention = lesser morbidity and mortality.

Do not off the catheter just because IN outflow is okay and OUTflow is not okay especially in patient with exhausted vascular access.

Save access = save lives


Back to back Fibrin sheath. Dont off the catheter just because the flow is poor especially exhausted vascular access and...
11/07/2025

Back to back Fibrin sheath. Dont off the catheter just because the flow is poor especially exhausted vascular access and the IN okay and OUT not okay. Just balloon fibrin sheath disruption and reload with new TCC.

Save the access = save lives.

Fibrin sheath at tunnelled cuff catheter (selaput mengeliling tiub dialysis). Sebab itulah perlu AVF. Selaputkan berulan...
10/07/2025

Fibrin sheath at tunnelled cuff catheter (selaput mengeliling tiub dialysis). Sebab itulah perlu AVF. Selaputkan berulang disebabkan tiub adalah benda asing badan.

Bila tiub flush boleh dan tarik tak boleh, inilah tanda-tanda fibrin sheath. Mai ke PPUM/UMSC, kami boleh selesaikan. Settle selaput dan kami usahakan untuk fistula baru.

After successfully recanalised a 3 mth old thrombosed RC AVF (another one was 3 days ago), we had another BC AVF with TC...
03/07/2025

After successfully recanalised a 3 mth old thrombosed RC AVF (another one was 3 days ago), we had another BC AVF with TCVO Type 2 case. No fancy CTO wire, just Terumo.

[Fistula berdarah berpanjangan selepas hemodialysis]Prolonged bleeding from fistula can be due to cephalic arch or centr...
26/06/2025

[Fistula berdarah berpanjangan selepas hemodialysis]

Prolonged bleeding from fistula can be due to cephalic arch or central vein occlusion. Not all bleeding AVF need to be ligated unless ruptured or ulcerated. Even if ulcerated (not infected), jump-graft is one of the option to preserve the AVF (replace the unhealthy native vessel with graft).

This is a case of recurrent BC AVF bleed and initial responded to balloon angioplasty (PTA). But it recurred. Hence one of the solution is stent with covered stent. Covered stent has proven to be superior than bare metal stent and also vs PTA.

The common culprit lesion according to fistula:
RC AVF = inflow (anastomosis or JA)
BC AVF = cephalic arch +/- subclavian
BB AVF = Distal swing segment, Subclavian +/- BCV
AVG = graft vein junction

[BM]
Pendarahan berpanjangan dari fistula boleh disebabkan oleh sempitan di gerbang cephalic atau oklusi vena pusat. Tidak semua AVF yang berdarah perlu diikat melainkan pecah atau ulser. Walaupun ulser (tidak dijangkiti), jump-graft adalah salah satu pilihan untuk memelihara AVF (menggantikan avf asli yang tidak sihat dengan graft - salur darah sintetik).

Ini adalah kes pendarahan BC AVF berulang dan tindak balas awal terhadap angioplasti belon (PTA). Tetapi ia berulang. Oleh itu, salah satu penyelesaian adalah rawatan dengan stent bertutup. Stent bertutup telah terbukti lebih unggul daripada stent logam kosong dan juga berbanding PTA.

Lesi penyebab biasa mengikut fistula:
RC AVF = aliran masuk (anastomosis atau JA)
BC AVF = gerbang cephalic +/- subclavian
BB AVF = Segmen ayunan distal, Subclavian +/- BCV
AVG = simpang urat cantuman

[CN]

瘘管长时间出血可能是由于头侧弓或中央静脉阻塞造成的。并非所有出血的动静脉瘘 (AVF) 都需要结扎，除非破裂或溃疡。即使出现溃疡（未感染），跳跃式移植也是保留动静脉瘘 (AVF) 的选项之一（用移植血管替换不健康的原生血管）。

本例为复发性动静脉瘘 (BC AVF) 出血病例，最初对球囊血管成形术 (PTA) 有反应。但复发了。因此，解决方案之一是使用覆膜支架。覆膜支架已被证明优于裸金属支架和 PTA。

瘘管常见的致病病变：
RC AVF = 流入（吻合口或 JA）
BC AVF = 头弓 +/- 锁骨下动脉
BB AVF = 远端摆动段，锁骨下动脉 +/- BCV
AVG = 移植静脉连接处



Thanks to MYSIR 2025 for your kind invitation. It is my honour to be able to share our Synergy team approach in the mana...
21/06/2025

Thanks to MYSIR 2025 for your kind invitation. It is my honour to be able to share our Synergy team approach in the management of dialysis access care. Let’s do this together, One for All and All for One, for better patient outcome💪🏻. Blessed to meet up again with one of my SGH IR trainer Dr Leong Sum (Jonah combo), my renal colleagues from UiTM, our celebrity nephrologist Renaluitm, my IR friends, colleagues who give strong supports endlessly.



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