Clinical data
Symptomatic Type B Dissection with acute thoracic pain
with malperfusion left kidney 12/2012
Arterial hypertension, obesity (BMI 35 kg/m2)
Procedural steps
1. Cut down right common femoral artery
2. Right brachial access
- 6F, 25 cm Radiofocus Introducer (TERUMO)
3. Zenith TX2 TAA Endovascular Graft (COOK)
4. Stenting of the SMA on indication
- Herculink 6,5/18 mm (ABBOTT)
5. Implantation of a Zenith Dissection Endovascular Stent 46-164 mm (COOK)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 03 – Renal denervation in drug resistant hypertension
Center:
Leipzig
Case 03 – LEI 02: female, 60 years (I-H)
Operators:
Martin Werner,
Klaus Hertting
Clinical data
Office blood pressure: 180/95 mmHg
Ambulatory BP
Cerebrovascular disease: 70% stenosis ICA right
LV Hypertrophy
Renal function: GFR 93 ml/min
Medikation: Ca++ Blocker, ACE Inhibitor, betablocker, diuretic
Procedural steps
1. Femoral access right groin
2. Placement of a 8F 70 cm sheath (COOK)
3. Wiring the renal arteries (0.014")
4. Renal Denervation
- Vessix V2 System (BOSTON SCIENTIFIC)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 04 – Occlusion of the left SFA
Center:
Leipzig
Case 04 – LEI 03: male, 67 years (H-K)
Operators:
Andrej Schmidt,
Sven Bräunlich
Clinical data
PAOD Rutherford 3, claudication at 150 meters left calf
CAD, PTCA 12/2012
Hypertension, hyperlipidaemia, former smoker
ABI left 0.71
Procedural steps
1. Cross-over-access from right to left
- 7F 40 cm Flexor Check-Flo Introducer (COOK)
2. Attempt to pass the lesion intraluminally
- TruePath System (BOSTON SCIENTIFIC)
- Supported by a TrailBlazer 0.018" 135 cm Support-Catheter (COVIDIEN)
3. Introduction of a Spider-filter 6mm (COVIDIEN)
4. Atherectomy
- TurboHawk LX-C (COVIDIEN)
5. PTA
- Drug-eluting balloons: LEGFLOW® (CARDIONOVUM)
In case of flow limiting dissection:
- Tack-IT Endovascular Stapler SystemTM (INTACT VASCULAR)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 06 – Occlusion left anterior tibial artery
Center:
Leipzig
Case 06 – LEI 04: male, 73 years (V-W)
Operators:
Sven Bräunlich,
Michael Piorkowski
Clinical data
PAOD Rutherford 5, ulceration toe I left foot
ABI left 0,4
Stenting left proximal ATA with DES 4/2012
Stenting right SFA 9/2012
Coronary artery disease, stenting RCX, RCA, LAD 9/2012
Atrial fibrillation with phenprocoumon-therapy
Hypertension, hyperlipidemia, DM, former smoker (~60 py)
Procedural steps
1. Antegrade access left groin
- 5F 55 cm Check Flo Introducer sheath, Ansel Modification (COOK)
2. Guide wire Passage of the lesion with
- Hi-Torque Command 300 cm (ABBOTT)
3. Dilatation of the lesion
- 2,5/200 mm Armada 14 PTA Catheter (ABBOTT)
4. Stenting on indication
- Xience Prime BTK Everolimus eluting stent (ABBOTT)
5. Optionally PTA of the posterior tibial artery
Wednesday, January 23rd:
-
,
Main Arena 2
Case 13 – Renal denervation in resistant hypertension
Center:
Leipzig
Case 13 – LEI 09: female, 75 years (M-O)
Operators:
Martin Andrassy,
Klaus Hertting
Clinical data
Office BP: 170/ 80 mmHg
Ambulatory BP: 147/ 78 mmHg
non dipping profile
Renal function: GFR 78 ml/min
BMI 31 kg/m2, diabetes mellitus 2, Hyperlipidemia
Secondary causes of HTN excluded
Medication: AT1- Blocker, betablocker, diuretic, centrally acting agent (clonidine)
Drug intolerance: ACE Inhibitor (allergic), Ca++ -blocker (peripheral edema)
Procedural steps
1. Femoral access right groin (7F)
2. Placement of a 7F 70 cm guiding catheter
- HS / IMA (Mach-1, BOSTON SCIENTIFIC)
Clinical data
PAOD Rutherford 3, claudication at 50 meters both legs
Art. hypertension, former smoker, diabetes mellitus
ABI bilateral 0.65
Procedural steps
1. Left brachial approach
- 5F Pigtail-catheter (CORDIS)
- 0.035" angled soft Terumo 180 cm (TERUMO)
- 0.035" 300 cm Supra Core (ABBOTT)
- 6F – 90 cm Flexor Check-Flo Sheath (COOK)
2. Passage of the occlusion from brachial
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" angled stiff Terumo 260 cm (TERUMO)
3. Snaring of the Terumo via 7F groin sheath bilateral
- 7F and 11F 25 cm Introducer Sheath (TERUMO)
4. Exchange
- to 0.035" SupraCore 300 cm guidewires via groin-access (ABBOTT)
5. PTA of the occlusion
- Armada 35 6/120 mm (ABBOTT)
6. Stenting
- Aorta: Sinus Aortic Stent 22/80 mm (OPTIMED)
- Iliac arteries: Omnilink Elite Peripheral Stent System 8/59 mm (ABBOTT)
Optional: Advanta 12 Covered Stent (ATRIUM/Maquet Getinge Group)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 07 – Occlusion of the left popliteal artery, failed antegrade recanalization-attempt
Center:
Leipzig
Case 07 – LEI 05: male, 68 years (D-K)
Operators:
Andrej Schmidt,
Michael Piorkowski
Clinical data
PAOD Rutherford 4, claudication at 50 meters left calf
ABI 0.4 left
Antegrade recanalization attempt with failed distal re-entry 12/2012
Hypertension, hyperlipidaemia, adipositas, diabetes mellitus, former smoker (25 py)
Cerebrovascular disease: stroke 2006
Chronic renal impairment (GFR 35 ml/min)
Infrarenal AAA (max. diameter 39 mm)
Procedural steps
1. Antegrade access left groin
- 6F 55 cm Flexor Check-Flo Introducer, Ansel Modification (COOK)
2. Left peroneal artery retrograde sheathless approach
- 21 Gauge 4 cm puncture needle (COOK)
- Quick-Access Needle Holder (SPECTRANETICS)
- 0.018" V-18 Control 300 cm guidewire (Boston Scientific) supported by
- 0.018" Quick Cross support catheter, 90 cm (SPECTRANETICS)
3. Snaring of the wire from antegrade access
- Quick Cross Capture-Wire Connector (SPECTRANETICS)
4. Predilation
- Exchange to a 0.014" guidewire (PT2, Boston Scientific)
- 2.5/80 mm Chocolate PTA Balloon Catheter (TriReme MEDICAL)
5. PTA
- 3.0/80 and 4.0/120 mm In.Pact Amphirion Drug Eluting Balloon (MEDTRONIC)
6. Stenting on indication
- Complete-SE for ATK, Maris Deep for BTK (MEDTRONIC)
Wednesday, January 23rd:
-
,
Technical Forum
Case 19 – Complex stenosis and occlusion of the left EIA, CFA and SFA
Center:
Leipzig
Case 19 – LEI 12: female, 69 years (E-F)
Operators:
Matthias Ulrich,
Daniela Branzan,
Bernd-Michael Harnoss
Clinical data
PAOD Rutherford 4, restpain and severe claudication left thigh and calf
Aortic valve replacement 02/2011
Interventional thrombectomy right groin 02/2011
Arterial hypertension, former smoker (30py)
Procedural steps
1. TEA left common femoral artery
2. Cross-over PTA/Stent of the external iliac artery
- Armada 35 LL PTA Catheter 6/80 mm (ABBOTT)
- Complete selfexpanding stent 7/100 mm (MEDTRONIC)
3. Recanalization of the SFA and PTA with DEBs
- InPact Pacific (MEDTRONIC)
Case 09 – Occlusion of the right tibio-peroneal trunk, CLI
Center:
Leipzig
Case 09 – LEI 06: male, 65 years (V-S)
Operators:
Andrej Schmidt,
Matthias Ulrich
Clinical data
PAOD Rutherford 5, ulceration right heel
Stenting right SFA 2009, left SFA 2010
History of myocardial infarction, CAD, CABG 2002
Arterial hypertension, obesity, former Smoker (30py)
Procedural steps
1. Right antegrade access
- 6F 55 cm Flexor Check-Flo Performer (COOK)
2. Antegrade passage of the popliteal lesion
3. PTA and implantation of a Supera-Stent into the popliteal artery (IDEV)
4. Antegrade attempt to pass the TPT occlusion
- 0.018" CXI Support-Catheter 90 cm (COOK)
- 0.014" Approach Hydro ST Guide wire, 300 cm (COOK)
5. In case of failure retrograde approach via posterior tibial artery
- Micropuncture® Transpedal Access Set (COOK) with
- 21 Gauge 4 cm needle and 3F Sheath (COOK)
- 0.018" CXI Support-Catheter 90 cm (COOK)
- 0.014" Approach CTO Guidewire 18 g, 300 cm (COOK)
6. PTA of TPT and PA from retrograde with
- Advance Micro 14 Balloon (COOK)
7. Optional drug-eluting balloon PTA
- In.Pact Deep (MEDTRONIC)
Wednesday, January 23rd:
-
,
Main Arena 2
Case 16 – Highgrade stenosis left popliteal artery
Center:
Leipzig
Case 16 – LEI 10: male, 56 years (M-G)
Operators:
Matthias Ulrich,
Klaus Hertting
Clinical data
PAOD Rutherford 5, ulceration left D1
Claudication at 150 meters left calf
Stenting left SFA 09/2011
PTA right SFA and popliteal artery 12/2012
Art. hypertension,
ABI left 0.41
Procedural steps
1. Left antegrade access
- 8F 10 cm Sheath (TERUMO)
2. PTA of the In-Stent Restenosis
- DEB, Lutonix Drug-Coated-Balloon 5/80 (BARD)
3. Guide wire Passage of the Popliteal artery
- V18 Control wire (BOSTON SCIENTIFIC)
4. Atherectomy
- Jetstream Navitus Atherectomy Catheter (BAYER HEALTH CARE)
5. PTA
- Drug-eluting balloons: In.Pact Deep 4.0/120 mm (MEDTRONIC)
6. Stenting on indication
- LifeStent (BARD)
Wednesday, January 23rd:
-
,
Technical Forum
Case 20 – Occlusion of all BTK arteries right leg
Center:
Leipzig
Case 20 – LEI 13: male, 67 years (WR-B)
Operators:
Andrej Schmidt,
Sven Bräunlich
Clinical data
PAOD Rutherford 5, CLI, forefoot-gangrene
Diabetes mellitus
Hypertension, former smoker
ABI right not measurable
CAD with urgent CABG 1/2013
Procedural steps
1. Right antegrade approach
- 5F 55 cm Flexor Check-Flo Performer Introducer Sheath (COOK)
2. Intraluminal passage of the occlusion of the peroneal artery
- Command 0.014" GW 300 cm (ABBOTT)
- Armada 14 2.5/120 mm 120 cm (ABBOTT)
3. In case of failure exchange to
- Winn 80 or 200 T 0.014" guidewire 300 cm (ABBOTT)
4. PTA and potentially implantation of a DES (P3-stenosis)
- Xience Prime BTK 3.5/38 mm (ABBOTT)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 11 – Occlusion of the left distal SFA
Center:
Leipzig
Case 11 – LEI 07: male, 62 years (G-P)
Operators:
Sven Bräunlich,
Matthias Ulrich,
Martin Werner
Clinical data
PAOD Rutherford 3, claudication left calf at 150 meters, ABI 0.67
Stenting left common iliac artery 10/2012 for restpain
PTA right SFA for claudication 11/2012
Bilateral groin hematoma and dissection 11/2012
Diabetes mellitus type 2, art. hypertension, current smoker
Procedural steps
1. Right brachial access
- 5F Flexor 110 cm Check-Flo Performer Tibial sheath (COOK)
2. Passage of the occlusion
- 0,035" stiff angeled Terumo Glidewire 300 cm (TERUMO)
- Supported by a Trailblazer 0,035", 150 cm (COVIDIEN)
3. Exchange
- for a V18 control guide wire (BOSTON SCIENTIFIC)
4. PTA
- Powercross PTA Balloon catheter 5/150 mm, 150 cm (COVIDIEN)
5. Implantation
- of a 6/120 mm Everflex Self-expanding Peripheral Stent with 5 French Entrust Delivery System (COVIDIEN)
Wednesday, January 23rd:
-
,
Main Arena 1
Case 12 – Occlusion of the right medial SFA
Center:
Leipzig
Case 12 – LEI 08: male, 54 years (A-R)
Operators:
Andrej Schmidt,
Michael Piorkowski
Clinical data
PAOD Rutherford 3, claudication right calf at 100 m, ABI 0.69 right
Failure to recanalize the occlusion 12/2012
Arterial hypertension, current smoker (40py)
Procedural steps
1. Left femoral cross-over approach
- 5F, 55 cm, Flexor Check-Flo Introducer (COOK)
2. Second attempt to pass the occlusion from antegrade:
Subintimal passage of the occlusion
- 0.035" Terumo Guidewire 260 cm (TERUMO)
- and 0.035" Trailblazer Support Catheter, 135 cm (COVIDIEN)
- Reenter the true lumen with the Enteer Re-Entry System (COVIDIEN)
4. Implantation
- of a 5F compatible Stent (7/120 cm) Everflex Self-expanding Peripheral Stent with Entrust Delivery System (COVIDIEN)
Thursday, January 24th:
-
,
Main Arena 2
Case 36 – Occlusion of the Posterior Tibial Artery, CLI
Center:
Leipzig
Case 36 – LEI 22: male, 57 years (V-S)
Operators:
Roberto Ferraresi,
Andrej Schmidt
Clinical data
PAOD Rutherford 6, heel-ulceration right
PAOD Rutherford 5 left, PTA 1/2013
Stenting right SFA 2008
Occlusion of the posterior tibial artery
Diabetes mellitus type 2, art. Hypertension
Procedural steps
1. Right antegrade access
- 5F 55 cm Flexor Check-Flo Performer (COOK)
2. PTA and stenting of the anterior tibial artery
- Xience Prime BTK drug-eluting stent (ABBOTT)
3. Passage of the occlusion of the posterior tibial artery
- 0.018" Glidewire Advantage 300 cm (TERUMO)
- 0.035" NaviCross angeled support-catheter 135 cm (TERUMO)
Case 45 – Endovenous Laser Therapy incompetent small saphenous vein
Center:
Leipzig
Case 45 – LEI 27: female, 47 years (I-W)
Operators:
Thomas Schwarz,
Eva von Hodenberg
Clinical data
CVI I (Widmer)
Recurrent oedema and pain right lower leg
Varicose tributaries
Procedural steps
1. Duplex ultrasound of the varicose veins
2. Retrograde access SSV mid lower leg with permanent venous catheter
3. Placement of the ELVeS Radial SLIM fiber (BIOLITEC) into the SSV until 1 cm up to the sapheno-popliteal junction
4. Anesthesia with anesthesia with 200 ml ultracaine, 5 ml sodium carbonate, 5 ml epinephrine diluted in 500 ml cooled saline around the fibre
5. Connecting the fiber to the 1470 nm diode laser (BIOLITEC)
6. Laser treatment from proximal to distal (application of 60 J/cm vein laser energy)
7. Application of 1% polidocanol foam sclerotherapy (KREUSSLER) in tributaries distally with use of ultrasound guidance
Thursday, January 24th:
-
,
Technical Forum
Case 46 – Endovenous laser therapie incompetent great saphenous vein
Center:
Leipzig
Case 46 – LEI 28: female, 70 years (R-K)
Operators:
Matthias Ulrich,
Christina Julia Harzendorf
Clinical data
CVI II (Widmer)
Dysaesthesia and chronic oedema both lower leg
History of erysipelas right lower leg
Night Cramps in the calf
Procedural steps
1. Duplex ultrasound of the varicose veins
2. Retrograde access GSV upper right lower leg calf with a 6F sheath
3. Placement of the ELVeS Radial fiber (BIOLITEC) into the GSV until 1 cm up to the sapheno-femoral junction
4. Anesthesia with 25 ml ultracaine diluted in 500 ml cooled saline around the fiber
5. Connecting the fiber to the 1470 nm diode laser (BIOLITEC)
6. Laser treatment from proximal to distal (application of 60 J/cm vein laser energy)
7. Application of 1% polidocanol foam sclerotherapy (KREUSSLER) in tributaries distally with use of ultrasound guidance
Thursday, January 24th:
-
,
Main Arena 1
Case 25 – Complex SFA-occlusion left
Center:
Leipzig
Case 25 – LEI 14: male, 55 years (G-R)
Operators:
Andrej Schmidt,
Sven Bräunlich
Clinical data
PAOD Rutherford 3, painfree walking-capacity 100 meters
ABI left 0.67
Asymptomatic Internal carotid artery stenosis
Small abdominal aneurysm (35 mm)
Diabetes mellitus type 2, art. hypertension, hyperlipidemia
Procedural steps
1. Right femoral access and cross-over approach
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)
2. Attempt to pass intraluminally
- TruePath-system (BOSTON SCIENTIFIC)
- Rubicon 18 Support-Catheter, 135 mm (BOSTON SCIENTIFIC)
3. In case of subintimal passage and inability to reenter distal
- V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
- OffRoad Reentry System (BOSTON SCIENTIFIC)
Clinical data
PAOD Rutherford 5, heel-ulceration right
SFA-Angioplasty bilateral 2011 and 2012
Arterial hypertension
Procedural steps
1. Antegrade Access right groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)
2. Antegrade passage of the occlusion
- Connect 250 T Guidewire (ABBOTT)
- QuickCross Support-Catheter 0.018” 90 cm (SPECTRANETICS)
3. In case of antegrade failure retrograde puncture of the proximal ATA
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018” 90 cm (SPECTRANETICS)
4. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)
4. Post Dilatation
- 5.0/30 mm Sterling (BOSTON SCIENTIFIC)
5. Closure of the access site
- Perclose Proglide (ABBOTT)
Thursday, January 24th:
-
,
Main Arena 2
Case 39 – Calcified SFA-Occlusion Left
Center:
Leipzig
Case 39 – LEI 23: male, 74 years (G-U)
Operators:
Andrej Schmidt,
Sven Bräunlich,
Martin Werner
Clinical data
PAOD Rutherford 3, painfree walking-capacity 20 meters
ABI left 0.57
CAD, NSTEMI 12/2012, COPD
Atrial fibrillation with oral anticoagulation
Chronic renal failure (GFR 65 ml/min)
Diabetes mellitus type 2, art. hypertension, hyperlipidemia
Procedural steps
1. Right femoral access and cross-over approach
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)
2. Passage of the lesion
- Passeo 18 Balloon 5.0/170 mm (BIOTRONIK)
- Cruiser S 0.018" Guidewire 300 cm (BIOTRONIK)
- Exchange for XT-14 Guidewire (BIOTRONIK)
3. Lesion preparation
- AngioSculpt XL Scoring-Balloon 5/80 mm (BIOTRONIK)
4. Exchange to 0.035" guidewire
- SupraCore (ABBOTT)
4. PTA
- Three Lutonix Drug-Coated-Balloons 5/100 (C. R. BARD)
5. Stent implantation (spot stenting)
- 6/170 mm LifeStent (C. R. BARD)
Thursday, January 24th:
-
,
Main Arena 1
Case 29 – Total occlusion of the abdominal artery and both common iliac arteries
Center:
Leipzig
Case 29 – LEI 17: male, 56 years (J-M)
Operators:
Peter Goverde,
Andrej Schmidt
Clinical data
PAOD Rutherford 3-4
Severe claudication both sides (hip, buttock, thigh)
Restpain / paraesthesia during night both feet
Risk factors: Diabetes mellitus type 2, former smoker, hyperlipidaemia
Left ventricular cardiomyopathy, EF 45%
Procedural steps
1. Left brachial approach
- 7F-90 cm Destination guiding sheath (TERUMO)
2. Passage of the occlusion from brachial
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" angled stiff Terumo 260 cm (TERUMO)
3. Snaring of the Terumo via 7F groin sheath bilateral
- 7F and 11F 25 cm Introducer Sheath (TERUMO)
4. Exchange to
- 0.035" SupraCore 300cm guidewires via groin-access (ABBOTT)
5. Implantation of
- Advanta 12 7/38 mm-Covered Stents (ATRIUM/Maquet Getinge Group) in both renal arteries
6. PTA of the occlusion
- Admiral 5/80 mm (MEDTRONIC)
8. Postdilation of the abdominal stent
- Maxi LD 15/40 mm (CORDIS)
Thursday, January 24th:
-
,
Main Arena 1
Case 30 – In-stent occlusion left SFA
Center:
Leipzig
Case 30 – LEI 18: female, 70 years (R-P)
Operators:
Matthias Ulrich,
Johannes Schuster
Clinical data
PAOD Rutherford 3, claudication left calf at 100 meters
PTA left SFA and stenting for claudication 11/2011
Elsewhere failed recanalization-attempt 12/2012 left SFA
Inability to direct the guidewire into the stent
Diabetes mellitus type 2, art. hypertension, hyperlipidaemia
Procedural steps
1. Right femoral access and cross-over approach
- 2.6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)
2. Retrograde puncture of the SFA-stent
- 18 Gauge 7cm needle (COOK)
- Quick-Access Needle Holder (SPECTRANETICS)
- 0.035" stiff, angled Terumo, 300 cm (BOSTON SCIENTIFIC)
3. Retrograde passage of the stent and snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)
Clinical data
Arterial Hypertension, insufficiently controlled by 5 antihypertensive drugs, hyperlipidemia, former smoker
PAOD, thrombectomy and PTA Stent left SFA 01/2012
Procedural steps
1. Retrograde access right groin and guiding catheter
- 6F Radiofocus Introducer II Sheath, 25 cm (TERUMO)
- 6F MACH 1 Guiding Catheter (BOSTON SCIENTIFIC)
2. Passing of the lesion, Pre-dilation and Stenting
- 0.014" Galeo ES guide-wire, 175 cm (BIOTRONIK)
- 3.0/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
- 6.0/18 mm ArchStent Ostial System (Ostial Inc.)
Thursday, January 24th:
-
,
Main Arena 1
Case 31 – CLI, long occlusion of ATA, failed antegrade recanalization
Center:
Leipzig
Case 31 – LEI 19: male, 82 years, E-S
Operators:
Andrej Schmidt,
Michael Piorkowski
Clinical data
PAOD Rutherford 5, ulceration D2 left
ABI left 0.4
Failed antegrade recanalization of the ATA 01/2013
Diabetes mellitus type 2, art. Hypertension
Renal failure, on dialysis for 3 years
Amputation right lower limb after car accident
CAD, PTCA/Stent LAD/D1, RIM 02/2012
Procedural steps
1. Antegrade Access left groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde puncture of the anterior tibial artery
- Quick-Access Needle Holder (SPECTRANETICS)
- Micropuncture Pedal Access Set (COOK)
- 21 Gauge / 4 cm needle (COOK)
- 3 French pedal sheath (COOK)
- 0.014" Hydro ST 300 cm guidewire (COOK)
- 0.018" CXI Supportcatheter 90 cm (COOK)
PTA via the 3F sheath:
- Advance Micro 14 Ultra Low-Profile PTA Balloon-Catheter (COOK)
3. After retrograde angioplasty guidewire-passage from antegrade
- 0.014" Hydro ST 300 cm guidewire (COOK)
4. Antegrade angioplasty with DEBs
- In.Pact Deep 2.5/120 mm and 3.0/120 mm (MEDTRONIC)
Thursday, January 24th:
-
,
Main Arena 2
Case 42 – EVAR of an abdominal aortic aneurysm
Center:
Leipzig
Case 42 – LEI 25: male, 53 years (J-R)
Operators:
Andrej Schmidt,
Daniela Branzan,
Bernd-Michael Harnoss
Clinical data
Screening for an abdominal aortic aneurysm
Diameter 5.4 mm
Arterial hypertension, current smoker
Renal insufficiency, GFR 55
Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)
3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)
4. Ovation Main Body (TRIVASCULAR) via right groin
5. Bilateral implantation of limb-extensions
6. Post-dilatation with Reliant-Balloon (MEDTRONIC)
Thursday, January 24th:
-
,
Main Arena 2
Case 42 – EVAR of an abdominal aortic aneurysm
Center:
Leipzig
Case 42 – LEI 25: male, 53 years (J-R)
Operators:
Andrej Schmidt,
Daniela Branzan,
Bernd-Michael Harnoss
Clinical data
Screening for an abdominal aortic aneurysm
Diameter 5.4 mm
Arterial hypertension, current smoker
Renal insufficiency, GFR 55
Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)
3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)
4. Ovation Main Body (TRIVASCULAR) via right groin
5. Bilateral implantation of limb-extensions
6. Post-dilatation with Reliant-Balloon (MEDTRONIC)
Thursday, January 24th:
-
,
Main Arena 1
Case 34 – Chronic total occlusion left SFA
Center:
Leipzig
Case 34 – LEI 20: male, 52 years (W-K)
Operators:
Matthias Ulrich,
Michael Piorkowski
Clinical data
PAOD Rutherford 3, severe claudication left calf
ABI left 0.68
Arterial hypertension, nicotine abuse
Procedural steps
1. Right groin cross-over access
- 6F 40 cm Balkin Up & Over Contralateral Check-Flo Introducer (COOK)
2. Guidewire-passage
- 0.035" stiff angled Terumo 260cm (TERUMO)
- Supported by a Judkins Right 5F-diagnostic catheter (CORDIS)
- Exchange to 0.018" Steel Core Guidewire 300 cm (ABBOTT)
3. Predilatation
- 4.0/100 mm Mustang Balloon (BOSTON SCIENTIFIC)
4. DEB-angioplasty
- 3 x 6/100 mm Lutonix drug-coated-balloon (C.R. BARD)
5. Stenting on indication
- Spot-stenting with the Tack-IT Endovascular Stapler SystemTM (INTACT VASCULAR)
Thursday, January 24th:
-
,
Main Arena 1
Case 35 – Chronic occlusion of the left superficial femoral artery
Center:
Leipzig
Case 35 – LEI 21: male, 68 years (W-L)
Operators:
Sven Bräunlich,
Martin Werner
Thursday, January 24th:
-
,
Main Arena 2
Case 44 – Aneurysm of infrarenal aorta and common iliac artery
Center:
Leipzig
Case 44 – LEI 26: male, 69 years (D-V)
Operators:
Andrej Schmidt,
Daniela Branzan,
Bernd-Michael Harnoss
Friday, January 25th:
-
,
Global Expert Exchange
Case 86 – Renal denervation in drug resistant hypertension
Center:
Leipzig
Case 86 – LEI 48: male, 63 years (H-R)
Operators:
Matthias Ulrich,
Klaus Hertting
Clinical data
Office BP: 184/ 100 mmHg
Ambulatory BP: 154/89 mmHg, non dipping profile
Supraaortic disease: stenting left ICA 201
Atrial fibrillation (oral anticoagulation)
Renal function: GFR 56 ml/min
LV Hypetrophy
Medication: ACE-Inhibitor, AT1-Blocker, betablocker, diuretic Vasodilator, central acting angent (Moxonodine)
Procedural steps
1. Femoral access right groin 8F
2. Placement of a 8F 55 cm EnligHTN Guide Catheter (RCD-1)
Clinical data
Type -B- Dissection (max diameter descending aorta 40 mm) with dissection into the left subclavian artery
Acute "Stabbing" back-pain with intermittent paraplegia (10 min) in 12/12, currently intermittent back pain
Arterial hypertension (6 antihypertensive drugs)
Procedural steps
1. Surgical cut down right common femoral artery
7. Closure device of the access sites
- Perclose Proglide (ABBOTT)
Friday, January 25th:
-
,
Main Arena 1
Case 60 – Re-occlusion of the left SFA
Center:
Leipzig
Case 60 – LEI 34: male, 38 years (S-S)
Operators:
Matthias Ulrich,
Klaus Hertting
Clinical data
PAOD Rutherford 3 (walking capacity 100 m) left
ABI left 0.6
PTA left SFA 12/2010, PTA right SFA 6/2011
Coronary artery disease: stenting RCA, PLA 2010 and 2011
Hypertension, hyperlipidemia (hereditary), former smoker (20 py)
Procedural steps
1. Right crossover femoral access
- 8F Flexor Check-Flo Introducer Sheath, 45 cm (COOK)
2. Wiring the occlusion
- 0.018" V-18 Control guide wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
4. Renal artery denervation with the Simplicity® RF Catheter (MEDTRONIC)
Friday, January 25th:
-
,
Main Arena 2
Case 72 – Debranching and Stenting thoracic aortic aneurysm
Center:
Leipzig
Case 72 – LEI 41: m
Operators:
Marc van Sambeek,
Michael Piorkowski
Clinical data
Progressive aneurysm of the decending thoracic aorta
CAD (CABG 2005)
TEA left CFA 2008
Arterial hypertension, hyperlipidemia
Procedural steps
1. Debranching of all supraaortal vessels
2. Implantation of a stentgraft (C-TAG, GORE)
Friday, January 25th:
-
,
Main Arena 1
Case 62 – Occlusion left EIA and left SFA
Center:
Leipzig
Case 62 – LEI 35: female, 55 years (D-W)
Operators:
Johannes Schuster,
Matthias Ulrich
Clinical data
PAOD Rutherford 3 (walking capacity 50 m) both thighs and left calf
ABI left 0.43, right 0.72
Hypertension, hyperlipidemia, current smoker (50 py)
Procedural steps
1. Left brachial approach for diagnostic angiograms
- 5F Pigtail-catheter (CORDIS)
- 0.035" angled soft Terumo 180 cm (TERUMO)
- 0.035" 300 cm Supra Core (ABBOTT)
- 5F MP catheter (CORDIS)
2. Left femoral retrograde access
- 6F Radiofocus introducer, 10 cm (TERUMO)
3. Passage of the occlusion from retrograde
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" Aquatrack Hydrophilic Guidewire (CORDIS)
4. Redirection with a re-entry device
- 0.014" Stabilizer Plus 300 cm Straight (CORDIS)
- Outback Re-entry Catheter (CORDIS)
5. PTA
- Powerflex Pro PTA Dilatation Catheter, 5/40 mm (CORDIS)
6. Stent implantation
- Smart Control Iliac Stent system, 7/60 mm (CORDIS)
7. Closure access site left groin
- Exoseal Vascular Closure Device
Friday, January 25th:
-
,
Main Arena 2
Case 73 – Infrarenal abdominal aortic aneurysm
Center:
Leipzig
Case 73 – LEI 42: male, 66 years (T-W)
Operators:
Jean-Paul de Vries,
Daniela Branzan,
Bernd-Michael Harnoss
Clinical data
AAA, diameter 54mm,
Long CTO left SFA
CAD, impaired left ventricula function (EF 38%), CABG 2011
Arterial hypertension, former smoker (30py), hyperlipidemia
Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
- 2.9F 10 cm Radiofocus Introducer II both groins (TERUMO)
- 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)
4. Implantation of an AFX Endovascular AAA System (Endologix)
Friday, January 25th:
-
,
Technical Forum
Case 81 – Occlusion of the left SFA, failed antegrade recanalization-attempt
Center:
Leipzig
Case 81 – LEI 44: female, 68 years (I-T)
Operators:
Andrej Schmidt,
Michael Piorkowski
Clinical data
PAOD Rutherford 3, claudication at 100 meters left calf
Antegrade PTA-attempt 10/2012 with perforation
Retrograde recanalization of the right SFA 12/2012 after perforation from during recanalization-attempt from antegrade
Hypertension, hyperlipidaemia, adipositas
Procedural steps
1. Cross-over-access from right to left
- 6F 40 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde puncture of the distal SFA
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 15 cm needle (COOK) in coaxial technique through a 18 Gauge 7 cm needle
- V-18 Control 300 cm guidewire (Boston Scientific)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)
3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)
Clinical data
PAOD Rutherford 4, restpain right
Recurrent occlusions right SFA
Failure to pass the BTK-occlusions right from antegrade 12/2012
ABI right 0.46
SFA-Angioplasty right 2011 and 2012
Bypass left with recurrent reocclusion
Art. hypertension,
Chronic renal insufficiency (GFR 55ml / min)
Procedural steps
1. Antegrade Access right groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde puncture of the peroneal artery
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)
3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)
Case 83 – Occlusion of the left SFA, failed antegrade recanalization-attempt
Center:
Leipzig
Case 83 – LEI 46: male, 45 years (E-L)
Operators:
Kazushi Urasawa,
Michael Piorkowski
Clinical data
PAOD Rutherford 3, claudication at 100 meters left calf
Elsewhere failed antegrade PTA attempt left SFA 12/2012
PTA/stenting left EIA 12/2012
Hyperlipidaemia, current smoker
Procedural steps
1. Cross-over-access from right to left
- 6F 40 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde passage of the lesion via Profunda-branch
- 0.014" Regalia XS 1.0 Guidewire (ASAHI INTECC) or Fielder FC 300 cm (ASAHI INTECC)
- Asahi Corsair Support Catheter (ASAHI INTECC)
4. After retrograde passage of the guidewire snaring from antegrade
6. Implantation of selfexpanding nitinol-stents
- Zilver PTX-Stent (COOK)
Friday, January 25th:
-
,
Main Arena 1
Case 65 – Renal Denervation in resistant hypertension
Center:
Leipzig
Case 65 – LEI 36: male, 53 years (A-S)
Operators:
Klaus Hertting
Friday, January 25th:
-
,
Technical Forum
Case 84 – 3-Vessel occlusion left BTK
Center:
Leipzig
Case 84 – LEI 47: female, 78 years (W-B)
Operators:
Andrej Schmidt,
Matthias Ulrich
Clinical data
PAOD Rutherford 4, restpain right
Failure to pass the BTK-occlusions left from antegrade 12/2012
ABI right 0.3
Pulmonary embolism 10/2011
Recurrent swelling the lower leg both sides
Art. Hypertension
Procedural steps
1. Antegrade access left groin
- 5F 55 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde puncture of the posterior and anterior tibial artery
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)
3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS) or
- Judkins Right 5F catheter (CORDIS)
5. Guidewire exchange
- 0.014" guidewire Floppy ES (ABBOTT)
6. Drug-eluting balloon angioplasty of the posterior tibial artery
- Freeway (EUROCOR)
Friday, January 25th:
-
,
Main Arena 1
Case 67 – Asymptomatic high grade stenosis right internal carotid artery
Center:
Leipzig
Case 67 – LEI 37: male, 76 years, (W-W)
Operators:
Dierk Scheinert,
Matthias Ulrich
Clinical data
PTA/Stent high grade ICA-stenosis left 11/2012
Intracerebral cross-flow von right to left
CAD, PTCA/Stent of LAD/D1, RCX/PLA2 and RCA
Arterial hypertension, diabetes mellitus, hyperlipidaemia
Renal insufficiency
Procedural steps
1. Right femoral access
- 9F sheath, Radiofocus introducer, 25 cm (TERUMO)
3. Passing of the lesion
- Galeo ES 0.014" ES Guidewire, 185 cm (BIOTRONIK)
4. 3.5/20 mm MiniTrek RX PTA Balloon Catheter (ABBOTT)
5. 7-10/40 mm Xact Carotid Self-Expanding Stent-System, 135 mm(ABBOTT)
6. 5/20 mm Viatrac RX PTA Balloon Catheter (ABBOTT)
Friday, January 25th:
-
,
Main Arena 1
Case 68
Center:
Leipzig
Case 68 – LEI 38: female, 86 years
Operators:
Axel Linke,
Gerhard Schuler
Saturday, January 26th:
-
,
Main Arena 1
Case 90 – EVAR of an Abdominal Aortic Aneurysm
Center:
Leipzig
Case 90 – LEI 50: male, 76 years (R-F)
Operators:
Andrej Schmidt,
Daniela Branzan,
Bernd-Michael Harnoss
Clinical data
Progression of an abdominal aneurysm,
56mm diameter.
Arterial hypertension, CAD, PTCA 2002
COPD
Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)
3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)
4. Ovation Main Body (TRIVASCULAR) via right groin
5. Bilateral implantation of limb-extensions
6. Post-dilatation with Reliant-Balloon (MEDTRONIC)
Saturday, January 26th:
-
,
Main Arena 1
Case 91 – Suprarenal abdominal aortic aneurysm
Center:
Leipzig
Case 91 – LEI 51: male, 65 years (G-G)
Operators:
Andrej Schmidt,
Daniela Branzan,
Michael Piorkowski,
Bernd-Michael Harnoss
Clinical data
Progressive suprarenal aneurysm (max diameter 65 mm)
Aortic valve replacement with aortic arch replacement (Hemashield-prosthesis, Elephant trunk) due to Type-A-Dissection and implantation of 2 Gore-TAG-Endoprostheses in to the descending aorta (2007)
Arterial hypertension, hyperlipidemia, nicotine abuse
Procedural steps
1. Surgical cut down left subclavian artery and implantation of a 12F sheath
2. Preloading of the left common femoral artery with the Proglide system (ABBOTT)
3. Pullthrough of a Lunderquist Extra-Stiff 0.038" guide wire (COOK)
4. Implantation of a 4-Vessel T-branched Tube-graft (ATRIUM/Maquet Getinge Group, COOK)
5. Implantation of covered stents ( Advanta V12, ATRIUM) into the visceral and renal arteries via the subclavian approach
6. Reinforcemant of the Advanta-Stents by Self-expanding Nitinol Stents (Zilver-Stents, COOK)
Saturday, January 26th:
-
,
Main Arena 1
Case 93 – Symptomatic occlusion of the left subclavian artery
Center:
Leipzig
Case 93 – LEI 53: male, 67 years (R-P)
Operators:
Andrej Schmidt,
Dierk Scheinert
Clinical data
Subclavian steal syndrom
Vertigo and claudication left arm
Stenocardia (CABG with LIMA – bypass 2006)
RR brachial right: 160 mmHg systolic
RR brachial left: 100 mmHg systolic
Hypertension, hyperlipidemia, diabetes mellitus 2
Procedural steps
1. Right femoral access and placement of a 6F sheath
- 5F JR Catheter (CORDIS)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 190 cm (ABBOTT)
- 7F Flexor Check-Flo Performer Introducer Sheath, 90 cm (COOK)
2. Left brachial access an d placement of a 6F sheath
- 6F Flexor Check-Flo Performer Introducer Sheath, 55 cm (COOK)
3. Wiring the occlusion
- 0.018" V-18 Control guide wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
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