Vascular surgeon Po-Jen Ko MD 血管外科 柯博仁醫師
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5 tips to be a competent endovascular surgeon?

5/18/2014

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(eBeing a vascular surgeon nowadays, it is imperative to learn to be an endovascualr surgeon. after all, minimal invasiveness is a must for modern doctors performing any kind of treatment.
How to become a competent endovascular surgeon/ interventinist?

1. Believe in endovascular therapy
Passion is the fundamental element of being a competent Endovascular surgeon. Passion is everything. You have to from the start believe that endovascular therapy is the right way to do. Most of us have been trained well in open/traditional techniques to solve the clinical problems. However, when you are facing vascular problems nowadays, please do not stick only to the traditional way of treatment. Think over and over again the advantages of endovascular treatment in contrast to traditional cut and shooters, you would then be confident in what you're doing.
2. Be open minded
Always be humble. Interventionists are not almighty. We cannot really cure diseases, we help. We are merely doing what we can to improve our patients' quality of life and make them happier. So, stay hungry and foolish. Be ready to listen to the ones who need our help.
Endovascular therapy is an art of interaction. Be sure to know the culprit lesion then decide the best/suitable intervention policy. It's not only about giving treatment, it's about communication with the heart of caring.
3. Update! update! update!
in this ever hanging world, the rationale, technique and devices evolve so fast that you may miss the catching-up-with easily. With the passion for Endovascular surgery, an Endovasculat surgeon should keep on updating his knowledge on the treatment not only because of his own curiosity but also for the calling deep in his mind. Make sure to read the latest informations, attend up-to-date symposiums and take part in every events (ex. vascular attachment program in CGMH) which may refresh and energize surgeons' concept and technique of patient care.
4. Find your mentor
Surgeons learn a lot from clinical practice. And during the practice, we want to minimize the complications as possible. Find a good clinical interventionist as your Endovascular mentor. Try to copy his procedures to treat your patients at your infant stage of clinical practice. Senior staffs' back up are always your patients' safety net. Learn the concept, attitude, technique, and knowledge from your role model in Endovasculat society. And thus the learning curve will be overcome within the shortest period of time.
5. Team work
Commending a modern endovascular therapy is like flying a jumbo jet. It takes a good teamwork two make sure that the procedure doesn't go wrong. Multidisciplinary professionals can guarantee to provide the best up-to-date technique in each steps during the whole procedure. Good preoperative study, and comprehensive preprocedure planning, Clea operation image acquisition, dedicate intervention technique, and available surgical bail-outs and back-ups are the keys to the success of modern endovascular procedures. The concept of team work can never be too important for anybody who wants to become a competent endovascular surgeon.
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Case study: Dialyaia graft outlet surgical revision

5/5/2014

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Dialysis graft outelt stricture is one of the most frequent complication/situation that a dialysis surgeon faces in his dailiy practice. To cope with the stenotic lesion, the oldest way, probably the most reliable, is to do surgical revision.

There are two ways of surgical revision of the graft outlet. Here shows the so called" patch angioplasty" method. If the stenotic lesion is a focal or short lesion, we can just longitudinally incise teh graft outlet, and apply a ePTFE patch (which is the same material of the graft) to augment the outelt space. after the operation, the graft outlet should be widely open.

The operation usually takes around 1 hour to perform. ofcourse, reoperation sometimes will be troublesome. However, most of the stenotic lesion can be fixed by patch angioplasty. Only if the lesion is too long, then we will try to fix the lesion using a jump graft.




Ofcourse nowadays most of the graft outelt stenotic lesion are first treated with angioplasty balloons/ stenting, which is less invasive. However, surgeon should always keep himself familiar with the open procedure. and once the PTA doesnt work, we still can provide a feasible choice of treatment instead of giving up the graft!

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什麼是完整的靜脈曲張微創治療計畫|博文血管聯盟

什麼是完整的靜脈曲張微創治療計畫

三大系統整合:主幹 × 穿透支 × 分枝|博文血管聯盟專業團隊

靜脈曲張不只是腿上血管凸起的外觀問題,而是靜脈回流壓力異常的警訊。若只處理表層血管,而忽略深層逆流源頭,復發率極高。
因此,完整的微創治療計畫包含三個關鍵步驟:

找出病因 → 精準治療 → 穩定修復

□ 一、完整評估:以超音波描繪「逆流地圖」

治療的第一步,是進行立姿高解析血管超音波檢查。醫師會針對三大系統進行評估與標記:

  • 主幹系統(Main trunk):大隱靜脈與小隱靜脈的逆流,是主要病灶源頭。
  • 穿透支系統(Perforator veins):連接深層與淺層靜脈,容易成為壓力外溢的通道。
  • 分枝系統(Tributary branches):表層曲張與蜘蛛網狀靜脈的來源。

□這份「逆流地圖」能精確規劃出每位病患的專屬治療藍圖。

□ 二、完整病灶處理:三大系統逐層整合

1️⃣ 主幹系統:治本的關鍵

主幹逆流是靜脈曲張的根本。治療目標是封閉逆流主幹靜脈,讓血流回到健康通道。

  • 靜脈膠水封閉術(VenaSeal):無需麻醉,幾乎無疼痛感,當天可走路返家。
  • 雷射封閉術(EVLA)或射頻治療(RFA):以精準熱能封閉病變血管。

□ 修正主幹後,腿部壓力顯著下降,症狀明顯改善。

2️⃣ 穿透支系統:消除「壓力回流點」

穿透支若逆流,會讓深層高壓血液倒灌至表層,導致皮下曲張與色素沉著。

  • 超音波導引下高張溶液局部治療
  • 微創導管式封閉(如膠水或射頻導管)

⚙️ 處理穿透支可「關閉閘門」,降低皮膚變色與復發機率。

3️⃣ 分枝系統:外觀與壓力的最後平衡

主幹與穿透支穩定後,表層分枝曲張可透過:

  • 高張溶液局部治療(局部注射方式)
  • 極細針孔微切除術:改善外觀與壓力分布。

□ 這是「修飾與精緻化」階段,讓腿部更輕盈、美觀自然。

□ 三、術後修復與追蹤:穩定循環、防止復發

  • 進行壓力治療(如彈性壓力套或專用繃帶),促進靜脈回流。
  • 避免長時間久站或久坐。
  • 定期超音波追蹤,偵測新生分支或殘餘逆流。
  • 維持健康體重與均衡飲食,減少靜脈壓力負擔。

□️ 這一步是防止復發與維持治療成果的關鍵。

□ 博文血管聯盟的三層治療理念

主幹穩 → 穿透支通 → 分枝美

博文血管聯盟以超音波影像導引為核心,整合靜脈膠水、雷射、射頻與高張溶液局部治療,形成完整、精準又安全的靜脈曲張微創治療體系。

□ 通路維護與靜脈治療專線:02-7709-9197

立即預約諮詢

□ www.pwclinic.tw

#靜脈曲張 #微創治療 #靜脈膠水 #血管健康 #雷射治療 #高張溶液 #分層整合 #博文血管聯盟 #PWClinic #腿部修復 #血流重建 #醫療衛教 #健康新循環


微創膠水治療經驗

累積豐富的靜脈曲張微創膠水治療經驗

除了大量微創雷射經驗以外,我們的專業團隊也已累積近1000 例的靜脈微創膠水治療經驗,透過先進技術與個人化診療方式,致力於為患者提供最優質的醫療服務。

若有任何疑問或需要進一步資訊,歡迎聯繫我們的診所!

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