Browsing by Author "Lee, Chih-Hsien"

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Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital
(2016-07)
Lee, Chih-Hsien
;
Chang, Chien-Jung
;
Huang, Jau-Kang
;
Yang, Ten-Fang
;
生物科技學系
Background: The purpose of this study was to compare the outcomes of elective endovascular abdominal aortic aneurysm repair (EVAR) and ruptured abdominal aortic aneurysm (rAAA) in patients at a district general hospital. Methods: A retrospective clinical study was conducted using data on 16 patients with elective abdominal aortic aneurysm (AAA) and nine patients with consecutive rAAA treated with EVAR from January 2010 to December 2014 in a district general hospital in Taiwan. Results: The preoperative characteristics of the two groups are listed. Thirty-six percent (9/25) of the patients were referred from other hospitals that did not offer surgical services. The percentage of patients with rAAA that were transferred from other hospitals was 55.5% (5/9). The stay durations in the intensive care unit for elective EVAR cases were shorter than those for emergent EVAR (1.75 +/- 1 d elective vs. 10 +/- 13.37 d emergent; P<0.019). The hospitalization days (11.06 +/- 4.07 d elective vs. 21.89 +/- 18.36 d emergent; P<0.031), operative time (183.63 +/- 57.24 min elective vs. 227.11 +/- 59.92 min emergent; P<0.009), and blood loss volumes (115.63 +/- 80.41 mL elective vs. 422.22 +/- 276.26 mL emergent; P<0.005) are shown; statistics for use of Perclose ProGlide (R) (7 cases elective vs. 0 case emergent; P<0.024) are compared. The overall 30-d mortality rate was 11.11% (1/9). Conclusions: The results confirm that EVAR surgery can be safely performed in a district general hospital with an integrated health care system. Using Perclose ProGlide (R) for selected cases may reduce blood loss and operative time.
Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital
(2016-06)
Lee, Chih-Hsien
;
Huang, Jau-Kang
;
Yang, Ten-Fang
;
生物科技學系
;
Department of Biological Science and Technology
Background: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. Methods: In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan. Results: The median age of the patients was 49 +/- 22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights. The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively. Conclusions: Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.
Localised bullous eruptions after extravasation of normal saline in the forearm during left ventricular device-assisted surgery
(2013-03-01)
Lee, Chih-Hsien
;
Chang, Cheng-Hsi
;
Wu, Ching-Wen
;
Wei, Jeng
;
Tsai, Yi-Ting
Peripheral infusion of intravenous agents is a daily routine in hospitals. Extravasation is an unintended complication associated with intravenous infusion where accidental injection or leakage of fluid occurs into the perivascular or subcutaneous space. Extravasation is fairly common but is usually without serious consequences. This has led clinicians to underestimate the potentially serious consequences of extravasation. Extravasation injury results from a combination of factors, including cytotoxicity of the solution, osmolality, vasoconstrictor effects, infusion pressure and other factors. We describe a case of upper extremity localised bullous eruptions resulting from the pressurised infusion of crystalloid solutions through an intravenous catheter, placed in the operating room during left ventricular device-assisted surgery. Peri-operative management of acute localised bullous eruptions requires surveillance for unforeseen consequences. Early recognition, diagnosis and intervention averted potential complications and morbidity.
New vascular ring connectors in surgery for intramural haematoma of the abdominal aorta progressing to rupture
(2013-07-01)
Lee, Chih-Hsien
;
Ko, Li-Wei
;
Lin, Yi-Chang
;
Yen, Chih-Chien
;
Yang, Hsiang-Yu
Aortic intramural haematoma is similar to classic aortic dissection, which causes a life-threatening medical condition, and immediate diagnosis and treatment are crucial. The optimal therapy for intramural haematoma of the abdominal aorta remains controversial. Conservative medical management is usually the first choice of treatment for uncomplicated cases. Surgical intervention is usually required for complicated intramural haematomas of the abdominal aorta, including conventional open repair and endovascular treatment with stent-grafts. A new vascular ring connector that achieves a quick, blood-sealed and sutureless anastomosis has been designed for aortic dissection. We herein report a case of intramural haematoma of the abdominal aorta, progressing to rupture on day 14 after onset, which had successful aortic repair with the new vascular ring connector. The new vascular ring connector could be an alternative method for the treatment of complicated intramural haematomas of the abdominal aorta.
Posture and Gender Differentially Affect Heart Rate Variability of Symptomatic Mitral Valve Prolapse and Normal Adults
(2016-07)
Chang, Chien-Jung
;
Chen, Ya-Chu
;
Lee, Chih-Hsien
;
Yang, Ing-Fang
;
Yang, Ten-Fang
Background: Heart rate variability (HRV) has been shown to be a useful measure of autonomic activity in healthy and mitral valve prolapsed (MVP) subjects. However, the effects of posture and gender on HRV in symptomatic MVP and normal adults had not been elucidated in Taiwan. Methods: A total of 118 MVP patients (7 males, 39 +/- 7 years old; and 111 females, 42 +/- 13 years old) and 148 healthy control (54 males, 28 +/- 4 years old; and 94 females, 26 +/- 6 years old) were investigated. The diagnosis of MVP was confirmed by cross-sectional echocardiography. A locally developed Taiwanese machine was used to record the HRV parameters for MVP and control groups in three stationary positions. Thereafter, the HRV time-domain parameters, and the frequency-domain parameters derived from fast Fourier transform or autoregressive methods were analyzed. Results: The MVP group showed a decrease in time domain parameters and obtunded postural effects on frequency domain parameters moreso than the control group. Though the parasympathetic tone was dominant in female (higher RMSSD, nHF and lower nLF vs. male), the sympathetic outflow was higher in MVP female (lower SDNN, NN50 and higher nLF vs. normal female). While the parasympathetic activity was lower in male, sympathetic outflow was dominant in MVP male (lower nHF and higher nLF vs. normal male). Conclusions: Both MVP female and male subjects had elevated levels of sympathetic outflow. The obtunded postural effects on frequency domain measures testified to the autonomic dysregulation of MVP subjects.
Stent graft repair of iatrogenic femoral arteriovenous fistula with acute bleeding after hemodialysis catheter insertion
(2016-10)
Lee, Chih-Hsien
;
生物科技學系
;
Department of Biological Science and Technology
An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. Double-lumen catheters are widely used for gaining temporary access in patients requiring acute hemodialysis (HD). Several complications are associated with the insertion of these catheters, including bleeding, infection, arterial injuries, and deep venous thrombosis. An iatrogenic AVF is a rare and severe complication following catheterization for temporary HD. Here, we report the case of a patient who developed an iatrogenic AVF following catheterization for acute HD resulting in acute bleeding. A 61-year-old male experienced acute renal failure with pulmonary edema. A 12 French (Fr) dialysis catheter was inserted into the right femoral vein for emergent HD. Active pulsation bleeding was observed around the catheter at the right inguinal area after first HD. A thrill was felt at the superficial femoral artery after the repair of its anterior side. Angiography revealed iatrogenic AVF, which was successfully treated with stent graft repair.
Successful continuous-flow left ventricular assist device implantation with adjuvant tricuspid valve repair for advanced heart failure
(2016-07-08)
Lee, Chih-Hsien
;
Wei, Jeng
;
生物科技學系
;
Department of Biological Science and Technology
The prevalence of end-stage heart failure (HF) is on the increase, however, the availability of donor hearts remains limited. Left ventricular assist devices (LVADs) are increasingly being used for treating patients with end-stage HF. LVADs are not only used as a bridge to transplantation but also as a destination therapy. HeartMate II, a new-generation, continuous-flow LVAD (cf-LVAD), is currently an established treatment option for patients with HF. Technological progress and increasing implantation of cf-LVADs have significantly improved survival in patients with end-stage HF. Here we report a case of a patient with end-stage HF who was successfully supported using cf-LVAD implantation with adjuvant tricuspid valve repair in a general district hospital.
Use of a Perclose ProGlide Device for Percutaneous Endovascular Aortic Aneurysm Repair in a General Hospital Experience
(2016-10-01)
Lee, Chih-Hsien
;
Huang, Jau-Kang
;
Yang, Ten-Fang
;
生物科技學系
;
Department of Biological Science and Technology
Background: This study evaluated the safety and efficacy of percutaneous endovascular aortic aneurysm repair (EVAR) with a Perclose ProGlide device compared with endovascular aortic repair with surgical cutdown of common femoral artery in patients at a general hospital. Methods: A retrospective clinical study was conducted using data on 10 patients with elective EVAR, 7 patients with percutaneous EVAR, and 9 patients with consecutive rupture abdominal aortic aneurysm treated with emergency EVAR from January 2010 to December 2014. Results: The median length of intensive care unit stay for elective EVAR, percutaneous EVAR, and emergency EVAR cases: 1.80 +/- 0.92 days, 1.67 +/- 1.21 days, and 10.00 +/- 13.27 days, respectively; hospital days: 11.10 +/- 4.28 days, 11.00 +/- 4.10 days, and 21.89 +/- 18.35 days, respectively. Seven patients have no calcification in common femoral artery, and the use of a Perclose ProGlide device was under the guidance of sonography for percutaneous EVAR. The operative times of elective EVAR, percutaneous EVAR, and emergency EVAR were 192.3 +/- 52.0 minutes, 169.2 +/- 67.5 minutes, and 227.1 +/- 59.9 minutes, and blood loss volumes were 150.0 +/- 77.5 ml, 95.0 +/- 78.6 ml, and 422.2 +/- 276.3 ml, respectively. Technical success rate of Perclose ProGlide was 100%. Conclusions: Selective percuta-neous access of the femoral arteries for EVAR is safe and effective in the studied cases. The complications can be avoided with careful selection of patients based on preoperative imaging. Using Perclose ProGlide for select cases may reduce blood loss and operative time.