手術演示醫師 - 台灣血管外科學會

第六屆第一次冬季學術研討會 2016/01/09-10 安南醫院 11 樓國際會議廳

手術演示醫師

PAOD 介入手術演示

Endovascular Treatment of TASC C/D Femoropopliteal Occlusion

Operator : 陳偉華/李明峰

血透通路介入手術演示

Endovascular Treatment of Central Vein Stenosis Operator : 陳偉華/鄭佳欣


Endovascular Treatment of Carotid Artery Stenosis Operator : 陳偉華/崔源生


Endovascular Salvage of Thrombosed AVG Operator : 陳偉華/楊智鈞


林暉翰醫師

學歷:

中國醫藥大學醫學系(1997~2004)

現職:

中國醫藥大學附設醫院外科部心臟血管外科主治醫師

（2012~迄今）

專長:

冠狀動脈繞道手術

心臟瓣膜置換手術及心律不整燒灼術

主動脈手術

胸、腹主動脈瘤傳統及支架置放手術

周邊動脈疾病、深部靜脈栓塞、下肢靜脈曲張之治療

洗腎用動靜脈廔管及洗腎用長期導管之建立

經歷:

中國醫藥大學附設醫院外科部住院醫師(2004~2007)

中國醫藥大學附設醫院外科部總醫師(2008)

中國醫藥大學附設醫院外科部心臟血管外科研究醫師(2009~2010)

中國醫藥大學附設醫院外科部心臟血管外科備任主治醫師(2010)

振興醫療財團法人振興醫院心臟血管外科總醫師（2010-2012)

證書:

外科專科醫師

胸腔及心臟血管外科學會專科醫師

心臟學會心臟血管外科專科醫師

血管外科學會專科醫師

血管外科學會專科指導醫師血管外科學會主動脈支架操作醫師

CMUH Experience with Frozen Elephant Trunk in Surgical Treatment of Acute Type A Dissection 中國醫大林暉翰 Acute aortic dissections of Stanford type A require emergency surgery repair and present challenges

to surgeons. The frozen elephant technique is one of several approaches used to treat aortic arch

dissection. The outcomes such as in-hospital mortality, rate of stroke, spinal cord injury, renal failure,

and reoperations for bleeding were similar compare with traditional ascending aorta replacement

surgery.

We present our experience and patient outcome in CMUH.


蘇大維醫師

Clinical positions:

Attending Surgeon, Vascular and Endovascular Surgery, Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

Academic positions:

Lecturer, Surgery department of Chang Gung Memorial Hospital, Linkou Medical Center

Specialty:

Vascular and Endovascular Surgery

Interest:

Vascular Surgery, Endovascular Treatment for Aortic Aneurysm,Dialysis Access and Peripheral Artery Disease, Venous Insufficiency Diseases

Honors:

Invited Speaker, iCON 2011, international congress for endovascular specialist, the Westin Scottsdale, Arizona, United States, 2011 Feb 13-17

LINC Asia Pacific, Live Demo Operator 2015 Mar

Invited Speaker, ISVS, Athens, Greece, 2015 Sep

CGMH Experience with Aortic Endograft in Treatment of Short Neck Abdominal Aortic Aneurysm 林口長庚蘇大維

Endovascular aneurysm repair (EVAR) has adopted by widespread community as the procedure of

choice for patients with infrarenal abdominal aortic aneurysms(AAAs).

EVAR for AAAs with unsuitable anatomy as defined in the instruction for use (IFU) of endografts is

always challenging to vascular interventionist.

To treat AAAs with short/hostile neck, we review the endovascular strategies, and share CGMH

experience of EVAR by currently available commercial endograft in Taiwan.


陳偉華醫師

EDUCATION AND QUALIFICATIONS Medical School：

National Taiwan University, Taipei, Taiwan , Sep 1995-Jun 2002 Residencies：

National Taiwan University Hospital , Jun 2002-Jun 2007 Board Certification：

Board of Cardiovascular Surgery of Tawain ROC Oct 2007 Board of General Surgery of Taiwan ROC Oct 2006 Board of Vascular Surgery of Taiwan ROC Oct 2009 RECORD OF EMPLOYMENT December 2013- now Director of Surgery Department , Tainan Municipal An-Nan Hospital- China Medical University March 2013- now Chief of Cardiovascular Surgery Department, Tainan Municipal An-Nan Hospital – China Medical University and China Medical University Beigang Hospital July 2007- March 2013 Chief of Cardiovascular Surgery Department , DaLin Tzu-Chi General Hospital Specialty 1. OPCAB and total artery OPCAB 2. Mitral valvuloplasty 3. Endovascular surgery (AV access, carotid , Venous ) 4. Peripheral artery occlusive disease Intervention 5. Complex EVAR/TEVAR

Annan Experience with Dissection Stent Graft in Treatment of Type B Aortic Dissection with Malperfusion 安南醫院陳偉華

Endovascular treatment of complicated Type B DAA at the acute and subacute setting had

been proved by several registries to lower periop morbidity and mortality with better

future aortic remodeling compared to traditional surgery, even lowerd aortic-related

death after two years of the procedure. In this case-based discussion session, we will

introduce updated result of endograft treating complicated type B DAA , techniques for

reperfusion of malperfused organs, mid-term outcome of dissection bare stent for aortic

remodeling and also future perspectives in treatment of type B DAA.


陳柏霖醫師

台北榮民總醫院外科部心臟血管外科主治醫師

學歷:國立陽明大學醫學系畢

經歷: 2012 迄今台北榮民總醫院外科部心臟血管外科主治醫師

2010-2012 苗栗市大千綜合醫院心臟血管外科主治醫師

兼台北榮民總醫院外科部心臟血管外科特約主治醫師

2006-2010 台北榮民總醫院外科部心臟血管外科住院醫師

2004-2006 台北榮民總醫院外科部一般外科住院醫師

2003-2004 台北市立聯合醫院仁愛院區一般內科住院醫師

VGH Experience with Fenestrated and Branched Graft in Treatment of TAAA 台北榮總陳柏霖 EVAR (endovascular aneurysm repair)已是腹主動脈瘤的標準治療，然而仍有其限制。在瘤頸

(aneurysm neck)極短的病人，或是腎動脈上腹主動脈瘤的病人，標準的腹主動脈瘤支架便不適合，

而新一代開窗支架 (fenestrated graft)或分支支架 (branched graft)可以解決一部份此類病人的問題。

台北榮總報告八例使用此類支架的經驗。


朱崧毓醫師

Education:

1990-1997 Chung-Shan Medical and Dental College, Taichung

Post-Graduate Education :

1-1997 Intern, National Taiwan University Hospital

1-1998 Military service, ROTC in the Army

1-2003 Residency in Department of Radiology, CGMH

2003- Visiting Stuff in Department of Medical Imaging and

Intervention, CGMH, Linkou

2012- Lecturer, CGMH, Linkou

Employment Record :

1999- Department of Medical Imaging and Intervention, CGMH, Linkou

Board Certification :

Radiological Society of the Republic of China, No.:0590

Research Interest:

Diagnostic Radiology

Interventional Radiology

CGMH Experience with Octopus Technique in Treatment of Complex TAAA 林口長庚朱崧毓

Endovascular intervention is popular treatment for abdominal or thoracic aortic disease. But

endovascular treatment for the aneurysmal disease or dissection involving both thoracic and

abdominal aorta is still a challenge. We will share the endovascular experience for thoracoabdominal

aortic aneurysm with Octopus procedure.


詹志洋醫師

學歷:

私立中國醫學大學醫學系畢業

國立臺灣大學生理研究所畢業

經歷:

台大醫院心臟外科主治醫師

台大醫院兼任助理教授

新光醫院主治醫師

亞東醫院主治醫師

台灣血管外科學會監事主席

個人專長:

主動脈手術、周邊血管手術、靜脈手術、血管腔內導管及支架手術

NTUH Experience with Treatment of Ruptured Thoracic Aorta DAA

緊急手術修補馬凡症病人復發胸腹主動脈破裂失敗經驗一例台北臺大詹志洋

一位 34 歲男性馬凡症病人因為胸腹主動脈破裂休克而至本院治療。期間發生多種

併發症，經過多次緊急手術以及處置，仍然處於敗血症，尚在努力治療中。

經過第一次緊急血管腔內修補胸腹主動脈破口後雖然暫時穩定，但是在三週後又發

生破裂且併發低氧現象、休克以及多種併發症，緊急 CT 發現大量縱隔血腫壓迫心臟

以及右側肺靜脈，引發右下肺葉實質化以及急性呼吸衰竭。我們緊急安裝上靜-靜葉克

膜系統 (veno-veno ECMO) ，並且再次緊急血管腔內修補第二個破口，並且開胸腹加

強修補以及清除中隔血腫以解除心臟壓迫，又因葉克膜系統相關性血凝障礙，隔日再

次進入胸腹腔止血。病人於術後第二日，右肺擴張，呼吸明顯改善，成功脫離葉克膜

系統。

意外在管灌飲食時發現食道下段有一破口，造成流質飲食及分泌物外流至中隔腔，

於是照會胸腔外科緊急置放食道覆膜支架覆蓋破口。並且於三日後接受影醫科協助順

利置放鼻腸管與鼻胃管，並且開始灌食。雖然經過多次努力手術治療，病人近來仍然

處於肺炎與敗血症。

我們期望分享這次失敗案例，提供各位專家指導，並且討論治療策略的錯誤以及可

能的改進選項。希望經由檢討，日後遇到類似病例時，可以提供更好的治療。


陳沂名醫師

Current Position : Attending Surgeon at Division of CardioVascular Surgery, Department of Surgery, Taipei Veterans General Hospital, July 2009~present Lecturer in Medicine Faculty of National Yang Ming University, Mar 2009~present Director of Taiwan Society of Vascular Surgery, Sep 2013~present Experience: Chief of Hybrid Operation Room, Department of Surgery, Taipei Veterans General Hospital, Jan 2011~Oct 2014 Awards: 1. Lillehei Award in annual meeting of Taiwan Association of Thoracic and CardioVascular Surgery (TATCS) in 2008 2. The 3rd place of best paper contest in annual meeting of Taiwan Association of Thoracic and CardioVascular Surgery (TATCS) in 2009 3. The 2nd place of best paper contest in annual meeting of Taiwan Society for Vascular Surgery (TSVS) in 2009 4. Best teacher of Taipei Veterans General Hospital in 2011 5. Winner of Record Case presentation contest of Taiwan Society for Vascular Surgery (TSVS) in 2012, 2013 6. Best abstract presenter award in Trans-Catheter Therapy Asia Pacific (TCTAP) in 2014 7. Best young scientist award in Trans-Catheter Therapy Asia Pacific (TCTAP) in 2015 8. Best teacher of National Yang Ming University in 2015 9. International Scholars of Society of Vascular Surgery in 2015 Medical Education: School of Medicine, National Yang-Ming University, Sept 1995 - June 2002,Degree: M.D. Internship: rotating internship at Taipei Veterans General Hospital, Nov 2000 - May 2002 Ph.D. candidates in Institute of Clinical Medicine of National Yang-Ming University Post-Graduate Training: Rotating Surgical Residency at Department of Surgery, Taipei Veterans General Hospital, Sept 2002 - June 2004 Cardiovascular Surgery Residency at Department of Surgery, Taipei Veterans General Hospital, July 2004 - June 2006 Chief Residency at Department of Surgery, Taipei Veterans General Hospital, July 2006 – June 2007 Clinical Fellowship at Department of Cardiac Surgery, Berlin Heart Center, German, Aug 2008 – Oct 2008 Clinical Fellowship at Division of Vascular Surgery, Epworth Hospital, Melbourne, Australia, Feb 2009 – March 2009 Fellowship at Department of Surgery, Taipei Veterans General Hospital, July 2007 – June 2009 Clinical Observer at Division of Vascular Surgery, NorthWestern Memorial Hospital, Chicago, U.S.A., June 2015 Clinical Observer at Division of Vascular Surgery, Mayo Clinic, Rochester Minnesota, U.S.A., July 2015


Experience with Abbott Supera in Treatment of Popliteal Lesion in PAD 台北榮總陳沂名


陳彥仰醫師

經歷：

新光醫院外科部住院醫師

新光醫院心臟血管外科住院醫師及總醫師

新光醫院心臟血管外科臨床研究員

Experience with DCB (Bard Lutonix) in Treatment of BTK Lesion in PAD 新光醫院陳彥仰 For patients with peripheral artery disease (PAD), balloon angioplasty (percutaneous transluminal

angioplasty [PTA]) remains the most common therapy for lesions of below-the knee (BTK) arteries.

However, the long-term patency of PTA is poor, which leads high re-intervention rate. Paclitaxel drug-

coated balloons (DCBs), delivering drug into arterial wall during angioplasty and inhibiting re-

stenosis, therapeutically increase the long-term patency. The Bard Lutonix® catheter, with an unique

peeling-away protector, is an European approved DCB for treating PAD, including BTK lesions. In this

speech, we will demonstrate the technique to deliver the Bard Lutonix® DCB, and also provide current

available clinical data and our short-term result of the Bard Lutonix® in treatment of BTK lesions.


張偉俊醫師 EDUCATION BACKGROUND July, 2002 M.D., China Medical University July, 2012 M.D., Institute of Clinical Medicine, National Yang Ming University

LICENSURE #035320

BOARD CERTIFICATION

Nov. 12, 1995 Board of Internal Medicine, (#7441) Nov. 01, 2009 Subspecialty, Cardiology, (#S1289) Nov. 2010 Interventional Cardiologist, (#0523)

PROFESSIONAL EXPERIENCE 2003- Resident, Internal Medicine- Taichung Veterans General Hospital 2006- Clinical professor, Department of Medicine - National Defense Medical Center 2009- Attending physician- Taichung Veterans General Hospital

ACADEMIC SOCIETIES The Society of Internal Medicine, Taiwan Taiwan Society of Cardiology Taiwan Society of Cardiovascular Intervention


Taichung VGH Experience with Transcollateral Technique and DCB (Boston Ranger) in BTK CTO Intervention 台中榮總張偉俊

While percutaneous recanalization appears equivaent to bypass surgery in the management of

patients with critical lower limb ischemia, standard percutaneous approaches and techniques are still

inadequate, as procedural failure can occur in up to one-fifth of the cases in BTK intervention, even in

experienced hands. In addition to the traditional controlateral approach, ipsilateral antegrade (i.e.,

femoral) and retrograde (e.g., pedal or posterior tibial) accesses and the ‘‘pedal-plantar loop

technique’’ have been shown to be beneficial in increasing success rates, especially in the most

challenging chronic occlusions. Nonetheless, even these strategies may fail or prove unfeasible (e.g.,

when the distal vessels are also diseased).

The ‘‘transcollateral’’ angioplasty technique in BTK CTO intervention is based on the creation of a loop

with the guidewire from the peroneal to tibial vessels (ie between different tibial arteries) by means

of guidewire tracking through collaterals. This loop can be used to directly open the artery from a

retrograde approach or also as a ‘‘roadmap’’ for further attempts to reopen antegradely the vessel. We

believe this technique may be of value specifically when a proximal occlusion stump is not evident,

when a dissection flap or a perforation in the proximal tract of the target vessel impairs guidewire

advancement, or when distal disease makes retrograde percutaneous puncture impossible.

In our experience, recanalization approach by means of collateral wiring loop is minimally invasive, as

no additional percutaneous accesses are employed (at odds with the retrograde pedal or posterior

tibial approaches), and the use of retrograde guidewire tracking minimizes the risk of ending up in a

collateral branch while tackling antegradely the total occlusion. On the other hand, the mechanical

properties of the guidewires and the balloons are stressed to their most extreme limits, as very

challenging angles and extreme tortuosity must be conquered to complete retrograde below-the-knee

recanalization using the ‘‘transcollateral’’ technique. Thus very low-profile balloons (e.g., the

Amphirion over-the-wire balloon), supporting catheter (1.7F Fincross) and exchange-length

guidewires are needed.

In conclusion, the ‘‘transcollateral’’ technique for percutaneous recanalization of below-the-knee

arterial disease appears to be a promising tool in the interventionist’s armamentarium, either on

a bail- out basis or or electively when traditional approaches are deemed unfeasible.


李明峰醫師

學歷 2000-2007 國立陽明醫學大學醫學系畢

經歷 2006-2007 台北榮民總醫院實習醫師

2007-迄今國家醫師考試及格

2009-2013 高雄榮民總醫院放射線部住院醫師

2013-迄今放射線醫師專科考試及格

2014-迄今高雄榮民總醫院放射線部主治醫師

2015-迄今國立陽明大學醫學系講師

2011-迄今英國醫學期刊(BMJ quality & safety)審稿人

2012-迄今中華民國放射線醫學會年輕放射線醫師委員會委員

重要

演講

2011 歐洲放射線醫學會論文發表

2011 國際醫療品質與安全論壇論文發表

2011, 2012 北美洲放射線醫學會論文發表

2012 高高屏心臟血管醫學會議受邀演講

2012 臺灣介入性心臟血管醫學會受邀演講

2013, 2014 亞培下肢血管介入性治療研討會受邀演講

2013 美國進階淺股動脈介入性治療研討會受邀演講

2014 台灣血管外科夏季會 Live Demo

2014 Peripheral vascular institute 辯論

2014 Viabahn for AV-Access Revision Symposium 2014 大林慈濟 TIPS 研討會 Live demo 及受邀演講

2014, 2015 美敦立南台灣血管介入會

2015 Global prospect and new innovations for best wound care and scar management 世界傷口癒合學會(WUWHS)受邀演講

2015 超音波醫學會受邀演講 (scrotal and penile ultrasound)

2015 Gore V3H symposium 受邀演講

2016 血管外科(TSVS)冬季會 Live demo 及受邀演講

專長介入性診斷及微創手術治療、主動脈疾病介入治療、周邊血管疾病治療、動靜脈管暢通

術、一般放射線診斷（超音波,電腦斷層,核磁共振）、醫療資訊學

得獎高雄榮民總醫院一 O 一年論文新人獎、高雄榮民總醫院一 O 一年優秀論文獎、高雄榮民總

醫院一 O 二年優秀論文獎、高雄榮民總醫院一 O 三年論文新人獎

Kaohsiung VGH Experience with BTA CTO Intervention 高雄榮總李明峰

The treatment options for patients with peripheral arterial disease (PAD) have increased largely

because of technical and technological advancements in endovascular techniques, namely the

introduction of extremely low-profile and dedicated devices and the development of subintimal

angioplasty. The development seen in the technologies used for angioplasty of the leg arteries and

increasing expertise allowed the feasibility of BTA angioplasty. Here, we report our

experiences in the BTA management.


陳偉華醫師





Experience with Medtronic Debulking Device Turbohawk in Severe Calcified Femoropopliteal Lesion 安南醫院陳偉華

Registry from single center showed worst outcome for DCB alone in severe calcified fempop lesion

with LLL up to 75% at 1 year with 50% Primary Patency.

Mechanical debukling device such as Turbohawk was proved in pilot study (DEFINITIVE AR), which

showed combined directional atherectomy and DCB improves both US and angiography patency and

also maximal luminal gain without increase of peri- and post-op MAE at 12 months follow-up. In this

session, we share our limited experience using Turbohawk in treatment of severely calcified TASC CD

fempop lesiom.


洪士杰醫師 Shih-Chieh Hung, M.D., Ph.D.

Professional Position:

2015~present (借調): Professor, Institute of Clinical Medicine, China

Medical University; Director, Integrative Stem Cell Center, China

Medical University Hospital, Taichung, Taiwan

2007-present: Professor, Institute of Clinical Medicine, School of

Medicine, National Yang-Ming University, Taipei, Taiwan

2009-2015: Director, Management Center for Medical Science-Technical

Building; 2001~present, Investigator, Stem Cell Laboratory, Dept.

of Medical Research; Attending Physician, Orthopaedics, Taipei

Veterans General Hospital, Taipei, Taiwan

2013~presnt: Joint Appointment Research Fellow, Institute of Biomedical Sciences, Academia Sinica

2004~2005: Senior Research Scientist, Center for Gene Therapy, Tulane University Health Science

Center: Prof. Prockop-DJ

1996~1997: Postdoctoral Fellowship: Department of Biochemistry, The University of Tokyo

1993~1997: Research Fellowship: Department of Orthopaedics, Faculty of Medicine, The University of

Tokyo

1992~2000: Residency, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital

1990~1992: Residency, Surgical Department, Fan-Lin Veterans Hospital, Hwa-Ling, Taiwan

Education:

1990: M.D. National Yang-Ming University

1997: Ph.D. The University of Tokyo

Committee Appointments:

醫工學門副召集人，Ministry of Science and Technology(科技部), 2014.

Peer Review Committee, National Science Council, Division of Life Science 2000~present

Advisory Committee for the Orthopaedic Program in the Division of Life Science, National Science Council

2004~present

Advisory Committee for the Stem Cells/Regenerative Medicine Program in the Division of Life Science,

National Science Council 2007~present

Advisory Committee, Institute of Cell Biology and Anatomy, National Ynag-Ming University, 2006, 2007.


Application of hypoxic mesenchymal stem cells for critical limb ischemia treatment: from bench to bedside 中國醫大洪士杰

The effects of hypoxia have been investigated on mesenchymal stem cells (MSCs). For long term

culture, hypoxia can inhibit senescence, increase the proliferation rate and enhance differentiation

potential along the different mesenchymal lineages. More importantly, hypoxic culture increases the

expression of pluripotency transcription factors in MSCs, which in turn upregulate Dnmt1, thereby

inhibiting the expression of p16 and p21, and the developmental markers or lineage genes. Hypoxia

also modulates the paracrine effects of MSCs, causing upregulation of various secretable factors,

including the vascular endothelial growth factor and IL-6, and thereby enhances wound healing and

fracture repair. Hypoxia also plays an important role in mobilization and homing of MSCs, primarily

by its ability to induce SDF-1-CXCR4.

Recently, we demonstrated that hypoxic MSCs from B6 mice ameliorate limb ischemia of Balb/c mice

compared with normoxic MSCs. We also demonstrated that hypoxic MSCs have an increased ability to

engraft in allogeneic recipients by reducing natural killer (NK) cytotoxicity when transplanted in vivo.

These allogeneic hypoxic MSCs gave rise to CD31+ endothelial cells and α-smooth muscle actin

(SMA)+ and desmin+ muscle cells, thereby enhancing angiogenesis and restoring muscle structure.

Moreover, application of anti-NK antibodies together with normoxic MSCs enhanced angiogenesis and

prevented limb amputation in allogeneic recipients with limb ischemia. These results strongly suggest

that hypoxic MSCs are intrinsically immunoprivileged and can serve as a 'universal donor cell' for

treating cardiovascular diseases. The therapeutic effects of hypoxic MSCs manufactured from normal

volunteer donors are currently tested in a Phase I/II clinical trial in patients with critical limb

ischemia. Even this is a double blind trial, we are glad to know that some out of the 10 patients that

have received the treatment reported improvement of ischemic pain, skin color, regrowth of hair and

nail and improved PcTO2 after receiving the treatment.


羅健洺醫師

Education and training course: 1. Bachelor Degree: Medicine department of China Medical University

(2001/07 -2007/06) 2. Resident course: Department of Surgery in National Taiwan

University Hospital (2007/07 – 2012/06) 3. Fellow course: Department of Surgery in National Taiwan University

Hospital (2012/07-) 4. Visiting staff course: Shin-Chu branch, National Taiwan University

Hospital Skills, and Study: 1. Cardiovascular surgery 2. Heart Transplantation in Patients with Amyloidosis; TRANSPLANTATION PROCEEDINGS v.42 n.3

pp.927-929 3. Pediatric Heart Transplantation Bridged with Ventricular Assist Devices; Transplantation

Proceedings v.42 n.3 pp.913-915 4. Heart Retransplantation for Pediatric Primary Allograft Failure; Transplantation Proceedings

Volume 44, Issue 4, May 2012, Pages 913–914 5. Extracorporeal Membrane Oxygenation and Thoratec Pneumatic Ventricular Assist Devices as

Double Bridge to Heart Transplantation; Transplantation Proceedings, Volume 44, Issue 4, May 2012, Pages 878-880

6. The Effect of Statins on Cardiac Allograft Survival; Transplantation Proceedings, Volume 46, Issue 3, April 2014, Pages 920-924

7. Transapical Endovascular Repair with a Table-Tailored Endograft to Treat Ascending Aortic Dissection, Journal of Cardiac Surgery Volume 29, Issue 6, pages 824–826,November 2014

8. Dimerized plasmin fragment D as a potential biomarker to predict successful catheter-directed thrombolysis therapy in acute deep vein thrombosis, Phlebology 2014 Oct 7. Epub 2014 Oct 7.


Experience with EKOS in Treatment of Pulmonary Embolism 新竹臺大羅健洺

Pulmonary embolism (PE) is a potentially life-threatening condition. A majority of pulmonary

embolism patients have a benign clinical course once therapeutic levels of anticoagulation are

established. However, high-risk PE involving circulatory collapse or systemic arterial hypotension is

associated with an early mortality rate of approximately 50%, in part from right ventricular failure.

Surgical pulmonary artery thrombectomy is one treatment for high risk PE patients, but carries a

substantial risk of morbidity. Thus, there is a need for effective treatment alternatives for acute PE

that facilitates the reversal of right ventricular dysfunction without causing excess in systemic

bleeding complications. Systemic thrombolysis is another treatment that improves right ventricular

dilatation, is associated with major bleeding, and is withheld in many patients at risk. Therefore,

catheter directed thrombolysis was generated to treat acute pulmonary embolism, and decrease the

risk of systemic hemorrhage.

Randomized Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute

Intermediate-Risk Pulmonary Embolism (ULTIMA) is a randomized trial to test a standardized

catheter intervention procedure in patients with acute PE and confirmed that ultrasound- assisted

catheter-directed thrombolysis (USAT) regimen was superior to anticoagulation with heparin alone in

improving right ventricular dysfunction at 24 hours, without an increase in bleeding complications.

In recent one year, we performed ultrasound- assisted catheter-directed thrombolysis for five

patients with high risk of acute pulmonary embolism in National Taiwan University Hospital. All

patients were survived without systemic hemorrhage.

Reference:

1. Wood K. Major pulmonary embolism: review of pathophysiology approach to the golden hour of

hemodynamically significant pulmonary embolism. Chest 2002;121:877–905.

2. Clinical recognition of pulmonary embolism: problem of unrecognized and asymptomatic cases.

Mayo Clin Proc 1998; 73:873–9.

3. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute

intermediate-risk pulmonary embolism. Circulation. 2014 Jan 28;129(4):479-86.

4. Catheter-Based Reperfusion Treatment of Pulmonary Embolism. Circulation 2011, 124:2139-2144

5. Catheter-directed ultrasound-accelerated thrombolysis for the treatment of acute pulmonary

embolism. Thrombosis Research. Volume 128, Issue 2, August 2011, Pages 149–154

http://www.ncbi.nlm.nih.gov/pubmed/24226805

http://www.sciencedirect.com/science/journal/00493848

http://www.sciencedirect.com/science/journal/00493848/128/2


李明禮醫師

Current Position: Attending Surgeon, Cardiovascular surgery, China Medical University Hospital

Tutorship: Clinical instructor of Surgery, China Medical University

Education: 1987-1994: MD, China Medial University

Comparison between EVRF and EVLT Treatment for Lower Extremities Varicose Vein 中國醫大李明禮

Endovenous thermal ablation of the saphenous veins using radiofrequency(EVRF) or laser(EVLT) as

energy sauce is a well-established, strongly-recommended, low-invasive and safe technique with

several advantages over standard open surgery for treatment of the trunk varicose veins of lower

extremities. EVRF and EVLT are similar technique in many ways with the same promising result

according to many RCTs and studies but there are some differences in post-operative pain and

bruising.

The choice of these two thermal ablation methods can be individualized by surgeons’ preference,

technical or anatomical considerations. Increasing use of 1470nm laser fiber is observed due to

amazing and satisfactory results compared to the previous experience of shorter wavelength laser

fibers. But prolonged pull-back time is also noted.

The main drawback of choosing EVRF is the extremely large, superficialized, tortuous and lower leg

saphenous vein trunk varices. ( >15mm in diameter and <0.5cm below the skin ) for the concerns of

skin or nerve injury. Actually, the thinner and suppler character of laser fiber makes it possible to pass

the tortuous main saphenous vein, branch varices and perforating veins. The wire-supported and

introducing sheath-guided technique makes it easier to pass tortuous superficialized saphenous veins.

We will demonstrate some techniques to treat branch varices and pass the tortuous vein trunk with

laser fiber.


崔源生醫師

現職:台中榮民總醫院神經外科血管科主任/助理教授

學歷:國防醫學院醫學士

經歷:

民國 85.08-89.09 台北榮民總醫院神經外科住院醫師

民國 89.10-90.09 台北榮民總醫院神經外科總醫師

民國 90.10-92.10 竹東榮民醫院神經外科主治醫師

民國 92.11-103.04 台中榮民總醫院神經外科主治醫師

民國 95.12-96.12 日本國立東北大學腦血管內治療學科臨床研究員

民國 98.12—迄今台中榮民總醫院影像導引混成手術室負責人

民國 103.04-迄今台中榮民總醫院神經外科介入性腦血管科主任

專業証照:

台灣外科專科醫師

台灣神經外科專科醫師

台灣血管外科專科醫師

台灣重症醫學專科醫師

專長:

腦血管內介入性導管手術治療

Management of acute ischemic stroke: Update for vascular surgeons 急性缺血性腦中風治療近況介紹: 血管外科醫師版

ABSTRACT Background: To summarize the current literatures, published in New England Journal of Medicine (NEJM), regarding management of patients with acute ischemic stroke and to offer update knowledge for neurosurgeons of Taiwan Society of Neurosurgery. Methods: To Review 5 randomized clinical trials, including as, MR CLEAN, Extend-IA, ESCAPE, SWIFT PRIME, REVASCAT, published in 2015 NEJM regarding best initial medical management of patients with acute ischemic stroke secondary to large vessel occlusion. Results: The increased rates of functional independence (90-day modified Rankin score of 0 to 2) with the intra-arterial thrombectomy intervention were reported as followings: 32.6% vs. 19.1% (odds ratio,1.67; 95% confidence interval [CI], 1.21 to 2.30) in MR CLEAN; 71% vs. 40% (P=0.01) in Extend-IA; 53.0%, vs. 29.3% (odds ratio, 2.6; 95% CI, 1.7 to 3.8; P<0.001) in ESCAPE; 60% vs. 35% (P<0.001) in SWIFT PRIME; 43.7% vs. 28.2% (odds ratio, 2.1; 95% CI, 1.1 to 4.0) in REVASCAT. Conclusion: In patients with acute ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Penumbra aspiration catheter or stent retriever, as compared with alteplase alone, improved early neurologic recovery and

90-day functional outcome.


陳偉華醫師





Multi-discipline Approach to Build-up an Optimal Hemodialysis Access Management Team 安南醫院陳偉華

Quality of hemodialysis access is one of the major issue to improved survivial for ESRD patient

population. Communications between dialysis unit and AV access Managemenr team is crucial to

achieve good quality of hemodialysis. In the past 8 yrs, We have set up an AV access management Team

which had performed 11000 AV accesss related procedure with more than 10000 echography exam

before each procedure. Our Multi-discipline team includes team coordinator, radiology technician,

dialysis headnurses, Plastic Surgeon, Cardiovascular surgeron and also nephrologist. We would like to

share our experience of setting up standards for management of failing AV access and also

maintenance of AV access for better dialysis quality.


鄭佳欣醫師

學經歷:

中山醫學大學

台北馬偕外科住院醫師

台中榮總外科住院醫師

台中榮總心臟血管外科總醫師

現職:

台中榮總嘉義分院心臟血管外科主治醫師

嘉義陽明醫院心臟血管外科主治醫師

How to Deal with Thrombosed AV Access 嘉義榮總鄭佳欣

回復阻塞血液透析通路有時是相當花費時間跟令人感到困擾的，我們將從廔管的歷史，種類及外

觀，選擇適當的方式處理，在最短的時間恢復其功能，減少 catheter based hemodialysis.比較

trans radial artery跟 trans fistula 各有何優缺點，以及人工血管跟自體廔管在治療選擇上有

何不同。何時需要 hybrid approach才能得到好的結果。


蔡財福醫師

經歷：

新光醫院心臟外科主治醫師(2011.07~迄今)

新光醫院外傷科兼任主治醫師(2011.09~迄今)

新光醫院心臟外科臨床研究員(2009.07~2011.06)

新光醫院心臟外科第三、四年住院醫師及總醫師(2005.08~2009.06)

新光醫院外科第一、二年住院醫師(2003.08~2005.07)

學歷：

國防大學醫學院醫學士

專科證書：

台灣外科醫學會外科專科醫師

台灣胸腔及心臟血管外科學會心臟血管外科專科醫師

台灣血管外科學會專科醫師

台灣血管外科學會主動脈支架操作醫師

Flair Covered Stent for Recurrent VGJ Stenosis in AV Access Management 新光醫院蔡財福

The leading cause of failure of a prosthetic arteriovenous hemodialysis graft is venous graft junction

recurrent stenosis. Comparing to balloon angioplasty, stent graft has showed its higher primary

patency rate in this situation. Among those available stent grafts, the flair covered stent is the first

endovascular system approved to treat VGJ stenosis. It is effective to restore blood flow at the venous

anastomosis and keep the area open longer compared to treatment with balloon angioplasty alone.


楊智鈞醫師

現職

台中榮民總醫院嘉義分院心臟血管外科主治醫師

學經歷

台北市立建國高級中學畢業

國立陽明大學醫學系畢業

台北榮民總醫院外科部住院醫師

台中榮民總醫院心臟血管外科住院醫師/總醫師

台中榮民總醫院心臟血管外科主治醫師

台中榮民總醫院嘉義分院心臟血管外科主治醫師 (2014迄今)

專業證照

中華民國外科專科醫師

中華民國心臟胸腔外科專科醫師

中華民國血管外科專科醫師

中華民國心臟學會專科醫師

中華民國重症加護醫學會會員

中華民國主動脈支架操作專科授証醫師

醫學專長

I. 成人心臟手術

冠狀動脈疾病：冠狀動脈繞道手術、不停跳冠狀動脈繞道手術。

心臟瓣膜：二尖瓣逆流修補手術、人工瓣膜置換手術。

II. 血管手術

主動脈剝離手術、主動脈瘤支架手術、周邊血管繞道手術、下肢動脈球囊擴張 / 支架手術、洗腎瘻

管手術、洗腎透悉管路球囊擴張 / 支架手術

III. 葉克膜

體外循環、心臟機械輔助。

特殊成就:

第十屆台灣血管外科學會理事長獎青年醫學演講比賽 - 總冠軍

2015 中國血管外科論壇病例演講全國大賽上海總決賽入選

2015 急救加護醫學會會員大會受邀講師

第二屆全國超級簡報力簡報大賽 - 亞軍

第一屆台北醫學大學簡報大賽 - 受邀示範講者

台北市立萬芳高級中學【生死智慧】受邀講師

台中榮民總醫院【臨床實戰醫病溝通講座】全院演說受邀講師

衛生福利部台中醫院【臨床實戰醫病溝通講座】全院演說受邀講師

台北市華陽扶輪社醫學專題受邀講師

中國醫藥大學『醫療崩壞論壇』受邀講者

手術演示醫師 - 台灣血管外科學會

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