LINC 2013 live case guide

Find all Live Cases and operators listed below.

Conference day 1

  • - , Main Arena 1

    Case 01 – Subacute type B – dissection

    Center:
    Leipzig
    Case 01 – LEI 01: female, 55 years (L-W)
    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)
  • - , Main Arena 1

    Case 02 – Asymptomatic high grade stenosis right internal carotid artery

    Center:
    Mercogliano
    Case 02 – MER 01: male, 69 years (Z-G)
    Operators:
    • Paolo Rubino,
    • Giovanni Sorropago,
    • Eugenio Stabile
    Clinical data
    Hypertension, COPD, hyperlipidaemia, former smoker

    Duplex
    Fibrotic plaque determining severe stenosis of the right ICA (3.4 m/sec.)

    Procedural steps
    1. Navigation of a diagnostic catheter into the Right ECA
    - 5F JR diagnostic catheter, 100 cm (CORDIS)
    - 0.035" Radifocus Terumo angled soft guide-wire, 180 cm (TERUMO)

    2. Introduction of the cerebral protection device and endovascular clamping
    - 9F–25 cm Radifocus Introducer II (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - Endovascular Clamping Device – MoMa Ultra (MEDTRONIC)

    3. Passing of the lesion and stenting
    - 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
    - 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
    - 8.0/40 mm Precise PRO Rx Carotid Stent (CORDIS)

    4. Postdilatation
    - 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)#



    Clinical data
    Duplex
    Procedural steps
  • - , 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)
  • - , 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)
  • - , Main Arena 1

    Case 05 – Chronic Critical Limb Ischemia

    Center:
    Berne
    Case 05 – BER 01
    Operators:
    • Dai-Do Do
    Clinical data
    PAOD Rutherford 4, pretibial skin ulcers
    CAD, MI 2008; TIA, DVT right calf 2011
    10/2012: elsewhere successful PTA of the left SFA,
    however failure to recanalize the left popliteal artery
    Arterial hypertension, hyperlipidemia, GFR 50 ml/min

    Procedural steps
    1. Antegrade left femoral access and sheath insertion
    - 6F 10 cm Radiofocus Introducer (TERUMO)

    2. Passage of the lesion
    - 4 F Berenstein (MERIT MEDICAL)
    - 0.018" Connect Flex (ABBOTT)
    - Re-entry device OUTBACK (CORDIS) on indication
    - 0.014" HT Command (ABBOTT)

    3. Predilatation and Dilatation
    - Armada 14, Fox SV (ABBOTT)

    4. Stenting on indication
    - Absolute (above knee), Xpert (below knee) selfexpanding nitinol stents (ABBOTT)

    5. Retrograde access via ATA, if antegrade access fails
  • - , 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
  • - , 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)

    3. Buddy wire renal artery
    - 0.014" Hi-torque Spartacore 14 (ABBOTT)

    4. Renal artery denervation
    - Simplicity® RF Catheter (MEDTRONIC)
  • - , Technical Forum

    Case 18 – Occlusion of the aortic bifurcation

    Center:
    Leipzig
    Case 18 – LEI 11: male, 54 years (H-U)
    Operators:
    • Dierk Scheinert,
    • Sven Bräunlich,
    • Johannes Schuster
    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)
  • - , Main Arena 2

    Case 14 – Iliofemoral venous intervention

    Center:
    Berne
    Case 14 – BER 02: male, 60 years (Z-H)
    Operators:
    • Nils Kucher,
    • Gerard O'Sullivan
    Clinical data
    Severe post-thrombotic syndrome of the right leg with
    Venous claudication, varicose veins, leg swelling
    History of acute iliofemoral DVT right leg & massive
    PE 6 months ago
    DVT treated with anticoagulation & compression
    PE treated with catheter assisted thrombolysis

    Procedural steps
    1. Popliteal venous access with ultrasound guidance (7F-sheath)

    2. Phlebography

    3. Wire crossage
    - Astato 20 0.014"; Astato 30 0.018"; Conquest 0.014" (ASAHI)

    4. Predilation of lesion
    - Amphirion 0.014" 1.5-2.0 mm (MEDTRONIC)
    - Fox SV 0.018" 3.0-6.0 mm (ABBOTT)

    5. Implantation of dedicated venous stents over Terumo angled wire 0.035
    - Iliac veins: Sinus-Venous 14-18 mm (OPTIMED), Zilver Vena 14-16 mm (COOK)
    - Common femoral vein: Sinus-Super-Flex 12 mm (OPTIMED), Wallstent 12 mm (BOSTON SCIENTIFIC)

    6. High-pressure post-dilation of stents
    - Fox Cross 0.035" 8.0-12.0 (ABBOTT)
  • - , 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)
  • - , 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)

    4. Stenting on indication
    - Innova selfexpanding nitinol stent (BOSTON SCIENTIFIC)
  • - , Main Arena 1

    Case 08 – Diffuse In stent restenosis of the right SFA

    Center:
    Mercogliano
    Case 08 – MER 02: male, 62 years (D-A)
    Operators:
    • Eugenio Stabile,
    • Vittoro Ambrosini,
    • Grigor Popusoi
    Clinical data
    PAOD, Rutherford 3, PTA/Stent right and left SFA 2010
    Claudication right limb
    Arterial hypertension, COPD, former smoker, hyperlipidaemia
    Diabetes mellitus
    CAD (Previous Anterior AMI and PCI LAD)

    Duplex
    Severe in stent stenosis right SFA (3.4 m/sec; PSVR: 4.67)

    Procedural steps
    1. Contralateral access and placement of a cross-over sheath
    - 5F JR4 Radifocus Angiographic Catheter (TERUMO)
    - 0.035" Radifocus Terumo angled soft guide-wire, 180 cm (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - 8F – 45 cm Destination Guiding Sheath (TERUMO)

    2. Passage of the lesions
    - 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)

    3. Lesion debulking
    - Turbo Booster ELCA Laser Ablation Catheter (SPECTRANETICS)

    4. Drug Eluting Balloon Dilation
    - 5/120 mm Admiral IN.PACT Balloon Catheter (MEDTRONIC)
  • - , Global Expert Exchange

    Case 23 – Left critical limb ischemia due to anterior tibial artery occlusion and tibioperoneal trunk stenosis

    Center:
    Mercogliano
    Case 23 – MER 05: male, 47 years (C-C)
    Operators:
    • Angelo Cioppa,
    • Luigi Salemme,
    • Linda Cota
    Clinical data
    PAOD, Rutherford 4
    Arterial hypertension, former smoker, hyperlipidaemia, diabetes mellitus
    CAD (CABG 2009 and PCI 2011)

    Duplex
    Fibrotic Plaque determining severe stenosis of the tibioperoneal trunk and occlusion of the anterior tibial artery

    Procedural steps
    1. Contralateral access and placement of a cross-over sheath
    - 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
    - 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - 6F-90 cm Destination Guiding Sheath (TERUMO)

    2. Passage of the lesions and predilation
    - 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)
    - 3/80 mm Amphirion DEEP Balloon Catheter (MEDTRONIC)

    3. Drug Eluting Balloon Dilation, Intravascular Ultrasound Assessment and Bail-Out Stenting
    - 3/80 mm Amphirion IN.PACT Balloon Catheter (MEDTRONIC)
    - Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
    - Stenting on indication Inperia Advance (CID)
  • - , Main Arena 2

    Case 15-1 – Iliofemoral venous intervention

    Center:
    Berne
    Case 15 – BER 03: male, 50 years (B-F)
    Operators:
    • Nils Kucher,
    • Gerard O'Sullivan
    Clinical data
    Chronic venous insufficiency (C5-6EsAd9Po) right leg with
    – Recurrent venous ulcers
    – Leg swelling despite compression
    Pelvic Vein Thrombosis 01/1995
    Right Renal Vein Thrombosis 1962
    – Nephrectomy right kidney 1963
    Suspected coagulation disorder treated with
    Permanent oral anticoagulation
    PTS treated with compression hosiery

    Procedural steps
    1. Bilateral popliteal venous access with ultrasound guidance
    (10F-sheath), may use additional jugular vein access (6F-sheath), general anaesthesia

    2. Phlebography

    3. Wire crossage
    - Astato 20 0.014"; Astato 30 0.018"; Conquest 0.014" (ASAHI)

    4. Predilation of lesion
    - Amphirion 0.014" 1.5-2.0 mm (MEDTRONIC)
    - Fox SV 0.018" 3.0-6.0 mm (ABBOTT)

    5. Implantation of dedicated venous stents over Terumo angled wire 0.035
    - Iliac veins: Sinus-Venous 14-18 mm (OPTIMED), Zilver Vena 14-16 mm (COOK),
    - Common femoral vein: Sinus-Super-Flex 12 mm (OPTIMED), Wallstent 12 mm (BOSTON SCIENTIFIC),
    - IVC: Optimed XL 18-22 mm (OPTIMED)

    6. High-pressure post-dilation of stents
    - Fox Cross 0.035" 8.0-12.0 (ABBOTT)
  • - , Main Arena 1

    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)
  • - , Main Arena 1

    Case 10 – Popliteal aneurysm right leg

    Center:
    Miami
    Case 10 – MIA 01: female patient
    Operators:
    • Barry Katzen,
    • Alex Powell
    Clinical data
    St.p. AAA (Gore Excluder Endograft 2006)
    Contralateral PAA treated 2012
    Art. hypertension, hyperlipidemia, smoking (quit 6 years ago)
    St.p. colon cancer (42 years ago)
    St.p. breast cancer (2009), TURP (1997)
    St.p. pacemaker due to arrhythmia
    Hiatal hernia, gastritis / GERD, mild COPD

    Procedural steps
    1. Right antegrade access
    - 6F vascular sheath
    - straight marking catheter
    - torque wire

    2. Exchange to 7F/8F sheath and 0.018 BMW wire (ABBOTT)

    3. 7 x 15 Viabahn stent (GORE)

    4. 8 x 15 Viabahn stent (GORE)

    5. Balloon dilatation with 8 x 4 Cook balloon (COOK)

    6. AngioSeal (St. Jude Medical)
  • - , 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)
  • - , 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)
  • - , Technical Forum

    Case 21 – Asymptomatic high grade in stent restenosis right internal carotid artery

    Center:
    Mercogliano
    Case 21 – MER 03: male, 57 years (G-G)
    Operators:
    • Stephen Ramee,
    • Eugenio Stabile,
    • Tullio Tesorio
    Clinical data
    Hypertension, hyperlipidaemia, NIDDM
    03/99 AMI and CABG; 10/12 PCI RCA
    10/01 Right CEA; 02/02 Right CAS
    08/09 PAD (Aorto – Right CFA Graft)

    Duplex
    Fibrotic hyperplasia determining severe stenosis of the left ICA (3.2 m/sec.)

    Procedural steps
    1. Introduction of the carotid guiding sheath and cerebral protection device
    - 6F-90 cm Destination Carotid Guiding Sheath (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
    - 5.0 Spider Fx Embolic Protection System (ev3)

    2. Passing of the lesion, intravascular ultrasound evaluation and stenting
    - 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
    - Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
    - 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
    - 8.0 – 10.0 / 40 mm XACT Carotid Stent System (ABBOTT)

    3. Postdilatation
    - 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
  • - , 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)
  • - , Main Arena 2

    Case 17 – Iliofemoral venous intervention

    Center:
    Berne
    Case 17 – BER 04: female, 73 years (A-P)
    Operators:
    • Nils Kucher,
    • Gerard O'Sullivan
    Clinical data
    Recurrent left sided varicosis with
    – Leg & groin discomfort
    – Swelling of the leg
    Recurrent PE’s & femoro-popliteal DVT’s treated with anticoagulation & compression
    Symptomatic varicose veins
    Stripping of left GSV

    Procedural steps
    1. Popliteal venous access with ultrasound guidance (7Fr-sheath)

    2. Phlebography

    3. Wire crossage
    - Terumo angled wire 0.035", may use Astato 0.018" 30 (ASAHI)

    4. IVUS only if angiographic significance of lesion is doubtful

    5. Implantation of dedicated venous stent over Terumo angled wire 0.035
    - Iliac vein: Sinus-Venous 14-18 mm (OPTIMED), or Zilver Vena 14-16 mm (COOK)

    6. High-pressure post-dilation of stent
    - Fox Cross 0.035" 10.0-12.0 (ABBOTT)
  • - , Technical Forum

    Case 22 – Symptomatic high grade stenosis of ostial left CCA and proximal left ICA

    Center:
    Mercogliano
    Case 22 – MER 04: female, 75 years (E-A)
    Operators:
    • Giovanni Sorropago,
    • Paolo Rubino,
    • Eugenio Stabile
    Clinical data
    12/12 TIA (Dysarthria and right hand paresis)
    Hypertension, hyperlipidaemia, NIDDM
    06/12 ACS – PCI LM (DES)

    Duplex
    Fibrolipidic Plaque determining severe stenosis of the Left ICA (1.8 m/sec)
    Calcific plaque determining severe stenosis of the ostial left CCA

    Procedural steps
    1. Introduction of the Carotid Guiding Catheter and cerebral protection device
    - 8F JR4 4.0 Launcher Guiding Catheter (TERUMO)
    - 4.0 – 7.0 Emboshield NAV Embolic Protection System (ABBOTT)

    2. Stenting the lesions
    - 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
    - 8.0/19 mm PALMAZ GENESIS Peripheral Stent (CORDIS) for CCA
    - 8.0/40 mm Precise PRO Rx Carotid Stent (CORDIS) for ICA

    3. Postdilatation
    - 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
  • - , 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)

    3. PTA
    - Powercross PTA Balloon Catheter 5/100 mm Balloon (COVIDIEN)

    4. Implantation
    - of a 5F compatible Stent (7/120 cm) Everflex Self-expanding Peripheral Stent with Entrust Delivery System (COVIDIEN)

Conference day 2

  • - , 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)

    4. PTA
    - Senri RX PTA Balloon dilatation catheter (2.0/150m, TERUMO)
  • - , Global Expert Exchange

    Case 53

    Center:
    Mercogliano
    Case 53 – MER 09: female, 83 years (C-M)
    Operators:
    • Eugenio Stabile,
    • Giovanni Sorropago,
    • Paolo Rubino
  • - , Technical Forum

    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
  • - , Main Arena 1

    Case 24 – Occlusion of the popliteal artery and all proximal BTK arteries

    Center:
    Berlin
    Case 24 – BLN 01: female, 77 years (D-R)
    Operators:
    • Ralf Langhoff,
    • Jens Stegemann
    Clinical data
    PAOD Rutherford 5, minor tissue loss on the right foot,
    walking capacity 20m and rest pain at night
    Bilateral diabetic foot syndrome
    Recanalization of the left popliteal artery 12/2012,
    Diabetes mellitus (IDDM, HbA1c >8,5), art. hypertension
    Renal insufficiency (CKD III), CAD, atrial fibrillation with oral anticoagulation

    Procedural steps
    1. Antegrade access
    - 45 cm 6 F braided sheath (TERUMO)

    2. Lesion passage into the posterior tibial artery
    - Truepath CTO Device (BOSTON SCIENTIFIC)
    - Add on wires: Victory 0,014/0,018 and V18 control (BOSTON SCIENTIFIC)
    - Add on Support: Rubicon Catheter (BOSTON SCIENTIFIC) and angled CXI support catheter (COOK)

    3. PTA
    - 3 mm resp. 4 mm Coyote balloon (BOSTON SCIENTIFIC)

    4. Stenting on indication
    - Promus Element Plus BTK (BOSTON SCIENTIFIC)
  • - , Main Arena 2

    Case 37

    Center:
    Mercogliano
    Case 37 – MER 07: female, 70 years (DP-A)
    Operators:
    • Marco Manzi,
    • Luigi Salemme,
    • Armando Pucciarelli
  • - , 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
  • - , 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)

    4. PTA
    - Mustang 5/120 mm Balloon (BOSTON SCIENTIFIC)
    - LegFlow Drug-eluting-balloon proximal (CARDIONOVUM)

    5. Stenting
    - Innova Selfexpanding Nitinol-Stents (BOSTON SCIENTIFIC)
  • - , Technical Forum

    Case 47 – Persistent Type II endoleak with aneurysm growth

    Center:
    Münster
    Case 47 – MÜN 01: male, 82 years (B-S)
    Operators:
    • Arne Schwindt,
    • Konstantinos Donas
    Clinical data
    3/2013 EVAR (main body Zenith Flex, iliac extensions Zenith spiral COOK)
    CT-control 11/12: axial diameter increase from initially 53 mm to 58 mm

    Procedural steps
    1. Right femoral approach
    - 5F 10 cm sheath (TERUMO)

    2. Cannulation right ileolumbar artery
    - 0.035" Glidewire, 5F Glidecath MP (TERUMO)

    3. Cannulation Endoleak
    - 0.014" Choice PT II (BOSTON SCIENTIFIC) and
    - 0.014" Echelon™ Microcatheter (COVIDIEN)

    4. Embolisation inflow and outflow vessel with Ethylene-Vinyl-Alcohol

    5. Copolymer Onyx® 34 (COVIDIEN)
  • - , Main Arena 1

    Case 26 – Calcified Apop-Occlusion right, CLI

    Center:
    Leipzig
    Case 26 – LEI 15: 66 years (G-R)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski
    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)

    5. Antegrade angioplasty
    - 5/40 Savvy-Balloon (CORDIS)

    6. Stent-implantation
    - Supera Veritas Interwoven Selfexpanding Nitinol-Stent (IDEV)
  • - , Main Arena 2

    Case 38 – Long occlusion of the right ATA

    Center:
    Berlin
    Case 38 – BLN 02: male, 56 years (L-M)
    Operators:
    • Ralf Langhoff,
    • Helgar Petrov
    Clinical data
    PAOD Rutherford 5 impaired wound healing and minor tissue loss right foot after amputation D1 11/2012
    Recanalisation of the right SFA and right TPT
    Diabetes mellitus with diabetic foot syndrome
    Renal insufficiency (CKD III)
    Left ventricular dysfunction, oral anticoagulation
    Current smoker, stroke in the past

    Procedural steps
    1. Right antegrade access
    - 4F Fortress 45 cm Sheath (BIOTRONIK)

    2. Passing the lesion
    - XT-14 or a Cruiser-18 guide wire (BIOTRONIK)

    3. Predilation
    - 2mm Passeo-14 or Passeo-18 (BIOTRONIK)

    4. PTA
    - Passeo-18 Lux drug coated balloon 2.5 mm (BIOTRONIK)

    5. Stenting on indication
    - Orsiro 3 x 40 mm coronary DES or Pulsar-18 self-epxanding stent system (BIOTRONIK)

    6. Prepare for a retrograde pedal access via ATA as a backup option
  • - , Global Expert Exchange

    Case 54 – Asymptomatic high grade stenosis of the left internal carotid artery

    Center:
    Leipzig
    Case 54 – LEI 31: male, 75 years (W-D)
    Operators:
    • Dierk Scheinert,
    • Sven Bräunlich
    Clinical data
    Bilateral stenosis of the internal carotid arteries
    Left ICA (80%): vmax = 3,5 m/s; ED vmax = 120 cm/s
    Right ICA (60%): vmax = 2,5 m/s; ED vmax = 60 cm/s
    Arterial hypertension, hyperlipidemia, adipositas (BMI 32 kg/m2)

    Procedural steps
    1. Femoral access right groin
    - 8F 10 cm sheath (TERUMO)
    - 8F Sidewinder II Guiding-Catheter (CORDIS)

    2. Distal protection
    - Filterwire EZ (BOSTON SCIENTIFIC)

    3. Primary stenting
    - 9/30 Carotid Wallstent (BOSTON SCIENTIFIC)

    4. Post Dilatation
    - 5.0/30 mm Sterling (BOSTON SCIENTIFIC)

    5. Closure of the access site
    - Perclose Proglide (ABBOTT)
  • - , 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)

    5. Stent-Implantation
    - Pulsar-35 Selfexpanding Nitinol-Stent (BIOTRONIK)

    6. Postdilation
    - Passeo-35 5/80 mm (BIOTRONIK)
  • - , Global Expert Exchange

    Case 55 – High grade symptomatic left ICA stenosis

    Center:
    Berlin
    Case 55 – BLN 03: male, 60 years (H-W)
    Operators:
    • Ralf Langhoff,
    • Brigitte Bäsell
    Clinical data
    2nd transient blindness in 2012 left eye
    Bilateral ICA Stenosis L>R, PSV ICA left >300cm/s, EDV 90 cm/sec
    CAD with stenting left main 12/2012
    PAOD with bilateral EIA stenosis
    Arterial hypertension, former smoker (till 12/2012), hyperlipidemia

    Premedication
    Aspirin 100 mg, Clopidogrel 75 mg since 12/2012, Simvastatin 40 mg
    Ramipril 5 mg and HCT 12,5 mg

    Procedural steps
    1. Femoral access right groin

    2. Stenting of the right EIA
    (Dynamic Balloon-Expandable Stent System 7 x 38 mm, BIOTRONIK)

    3. 260 cm stiff angeled Radiofocus guide wire (TERUMO)

    4. Weinberg Catheter for left CCA (COOK)

    5. Vista Brite Tip IG Guiding Catheter 8F MP Shape (CORDIS)

    6. Filterwire EZ Protection System (BOSTON SCIENTIFIC)

    7. 9/30 mm Wallstent (BOSTON SCIENTIFIC)

    8. PTA with 5 x 30 mm Sterling Balloon Dilatation Catheter (BOSTON SCIENTIFIC)
  • - , Main Arena 1

    Case 27 – Occlusion of the left SFA

    Center:
    Leipzig
    Case 27 – LEI 16: male, 62 years (R-S)
    Operators:
    • Michael Piorkowski,
    • Johannes Schuster
  • - , Technical Forum

    Case 48 – Radiofrequency ablation therapy GSV

    Center:
    Leipzig
    Case 48 – LEI 29: female, 49 years (L-A)
    Operators:
    • Karin Brachmann,
    • Daniela Branzan
  • - , Main Arena 2

    Case 40 – Occlusion of the left superficial femoral artery

    Center:
    Leipzig
    Case 40 – LEI 24: male, 53 years (P-K)
    Operators:
    • Matthias Ulrich,
    • Johannes Schuster
    Clinical data
    PAOD Rutherford 3, claudication left calf 50 m
    ABI left 0.7
    Arterial hypertension, current smoker (15 py)

    Procedural steps
    1. Right femoral access and cross-over approach
    - 6 Fr Balkin Up & Over Contralateral Flexor Check-Flo Performer 40cm (COOK)

    2. Intra-luminal passage of the lesion
    - 0.018" Connect guide wire, 300 cm (abbott)

    3. Predilatation
    - 4/120 Bantam OTW PTA catheter (C. R. BARD)

    4. PTA
    - Three Lutonix Drug-Coated-Balloons 5/100 (C. R. BARD)

    5. Stent implantation (spot stenting)
    - 6/170 mm LifeStent (C. R. BARD)
  • - , Main Arena 1

    Case 28 – Severe restenosis of calcific superficial femoral artery

    Center:
    Mercogliano
    Case 28 – MER 06: male, 70 years (M-A)
    Operators:
    • Angelo Cioppa,
    • Luigi Salemme,
    • Grigor Popusoi
    Clinical data
    PAOD Rutherford 3, claudication right leg
    PTA right SFA with DEB 2011
    PTA/Stent left ICA 10/12
    Hypertension, COPD, former smoker, hyperlipidaemia,
    Diabetes mellitus

    Duplex
    Fibroclacific plaque determining severe restenosis PSV: 4.9 m/sec

    Procedural steps
    1. Contralateral access and placement of a cross-over sheath
    - 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
    - 0.035" Radiofocus angled soft guide-wire M, 180 cm (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - 6F–45 cm Destination Guiding Sheath (TERUMO)

    2. Passage of the lesions and predilation
    - 0.018" V-18™ Control Wire® Guide Wire 300 cm (BOSTON)
    - 5/100 mm Pacific Balloon Catheter (Medtronic)

    3. Endovascular graft implantation
    - 6/150 mm 6 F VIABAHN® Endoprosthesis (GORE)
    - 6/120 mm Pacific Balloon Catheter (Medtronic)
  • - , 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)

    7. Stenting
    - Aorta: Advanta 12 Covered Stent 12/61 mm (ATRUIM/Maquet Getinge Group)
    - Iliac arteries: Advanta 12 Covered Stents 7/59 mm (ATRUIM/Maquet Getinge Group)
    - EIA: right: Complete 9/80 (MEDTRONIC), left: Absolute 9/100 (ABBOTT)

    8. Postdilation of the abdominal stent
    - Maxi LD 15/40 mm (CORDIS)
  • - , 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)

    4. PTA / stenting from antegrade
    - Advance 18 Balloon (COOK)
    - Zilver-PTX stents (COOK)
  • - , Technical Forum

    Case 49 – Stenosis of the right renal artery

    Center:
    Leipzig
    Case 49 – LEI 30: female, 61 years
    Operators:
    • Sven Bräunlich,
    • Martin Werner
    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.)
  • - , Main Arena 2

    Case 41 – Juxtarenal aortic aneurysm 55 mm

    Center:
    Ludwigsburg
    Case 41 – LUD 01: male, 77 years (L-W)
    Operators:
    • Johannes Gahlen,
    • Wilko Staiger,
    • Pirkko Hettrich
    Clinical data
    Progressive juxtarenal aortic aneurysm
    Arterial hypertension, hyperlipidemia, coronary heart disease
    Atrial fibrillation with oral anticoagulation

    Procedural steps
    1. Placement of a Zenith Endograft (2 fenestrations, 1 scallop, COOK)

    2. 3D Dyna CT run (Siemens Artis Zeego)

    3. Cannulation of the renal arteries with Virtual Guidance

    4. Implantation of the bridging stentgrafts
    (Advanta V12, ATRIUM/Maquet Getinge Group)

    5. Implantation of the distal bifurcated Endograft (COOK)
  • - , Global Expert Exchange

    Case 56 – Right critical limb ischemia due to anterior tibial artery occlusion and tibioperoneal trunk stenosis

    Center:
    Mercogliano
    Case 56 – MER 10: male, 75 years (DP-C)
    Operators:
    • Luigi Salemme,
    • Vittoro Ambrosini,
    • Linda Cota
    Clinical data
    PAOD Rutherford 4, rest pain right limb
    Hypertension, former smoker, hyperlipidaemia, diabetes mellitus

    Duplex
    Fibrotic plaque determining severe stenosis of the tibioperoneal trunk and occlusion of the posterior tibial artery

    Procedural steps
    1. Contralateral access and placement of a cross-over sheath
    - 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
    - 0.035" Radiofocus angled soft guide-wire M, 180 cm (TERUMO)
    - 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
    - 6F-90 cm Destination Guiding Sheath (TERUMO)

    2. Passage of the lesions and distal embolic protection positioning
    - 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)
    - 4.0 Spider Fx Embolic Protection Sysytem (COVIDIEN)

    3. Lesion debulking
    - Turbo-Hawk small vessel Peripheral Plaque Excision System Catheter (COVIDIEN)

    4. Drug Eluting Balloon Dilation, Intravascular Ultrasound Assessment and Bail-Out Stenting
    - 4/80 mm Amphirion IN.PACT Balloon Catheter (MEDTRONIC)
    - Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
    - Stenting on indication Inperia Advance (CID)
  • - , 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)
  • - , Main Arena 2

    Case 41 – Juxtarenal aortic aneurysm 55 mm

    Center:
    Ludwigsburg
    Case 41 – LUD 01: male, 77 years (L-W)
    Operators:
    • Johannes Gahlen,
    • Wilko Staiger,
    • Pirkko Hettrich
    Clinical data
    Progressive juxtarenal aortic aneurysm
    Arterial hypertension, hyperlipidemia, coronary heart disease
    Atrial fibrillation with oral anticoagulation

    Procedural steps
    1. Placement of a Zenith Endograft (2 fenestrations, 1 scallop, COOK)

    2. 3D Dyna CT run (Siemens Artis Zeego)

    3. Cannulation of the renal arteries with Virtual Guidance

    4. Implantation of the bridging stentgrafts
    (Advanta V12, ATRIUM/Maquet Getinge Group)

    5. Implantation of the distal bifurcated Endograft (COOK)
  • - , Global Expert Exchange

    Case 57 – In-Stent Occlusion of the right superficial femoral artery

    Center:
    São Paulo
    Case 57 – SAO 02: male, 64 years
    Operators:
    • Armando Lobato,
    • Dino Felli Colli
  • - , 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)
  • - , Main Arena 1

    Case 32 – Posterior tibial artery occlusion left

    Center:
    Dallas
    Case 32 – DAL 01: male, 84 years
    Operators:
    • Tony Das,
    • Huey McDaniel
    Clinical data
    PAOD Rutherford 5, non-healing ulcer left heel
    ABI left 0.4; right 0.7
    CAD, PVD
    Risk factors: Diabetes mellitus type 2, art. Hypertension

    Procedural steps
    1. Contralateral access

    2. Left pedal access by ultrasound

    3. Recanalization and CSI Stealth DB atherectomy (CSI Inc.)

    4. PTA with 3.0mm Chocolate balloon (TriReme)

    5. Provisional stenting
  • - , Global Expert Exchange

    Case 58 – Calcified stenosis right CFA, distal SFA stenosis

    Center:
    Münster
    Case 58 – MÜN 02: female, 75 years (W-M)
    Operators:
    • Arne Schwindt
  • - , 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)
  • - , Main Arena 1

    Case 33 – Aorto-Iliac Occlusion

    Center:
    Mountain View
    Case 33 – MOU 01: female, 73 years
    Operators:
    • James Joye,
    • Chad Rammohan
    Clinical data
    PAOD Rutherford 3,
    Debiliating hip, buttock and thigh-claudication
    Risk factors:
    Remote smoker, hyperlipidemia,
    Art. hypertension, familiy-history of CAD

    Procedural steps
    1. Ultrasound-guided bilateral femoral access

    2. Hydrophilic wire approach

    3. Low threshold for Pioneer-catheter (MEDTRONIC)

    4. Balloon-expandable stent graft delivered in kissing fashion

    5. Hemodynamic assessment of results
  • - , Main Arena 2

    Case 43 – Complex isolated iliac artery aneurysm

    Center:
    São Paulo
    Case 43 – SAO 01: male, 68 years
    Operators:
    • Armando Lobato,
    • Dino Felli Colli,
    • Robert Guimaraes
  • - , Technical Forum

    Case 50 – Non healing ulcer of R AKA stump

    Center:
    Dallas
    Case 50 – DAL 02: male, 85 years
    Operators:
    • Tony Das,
    • Huey McDaniel
  • - , 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)
  • - , 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
  • - , 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
  • - , Technical Forum

    Case 51 – Critical limb ischemia

    Center:
    Mountain View
    Case 51 – MOU 02: female, 93 years
    Operators:
    • James Joye,
    • Chad Rammohan

Conference day 3

  • - , Technical Forum

    Case 77 – Complex AAA Aorto-Iliac Obstruction

    Center:
    Hamburg
    Case 77 – HAM 06: female 73 years
    Operators:
    • Hans Krankenberg,
    • P. Burchardt
    Clinical data
    POD Rutherford 4 left side / right side 5, little lesion dig. 1 right
    RF: current smoker, arterial hypertension, Apoplex,
    DVT left side 10/2012

    Angio
    Occlusion of infrarenal aorta, bilateral common/external iliac arteries

    Duplex
    Bilateral monophasic flow CFA
    ABI: left 0.5 / right not detectable

    Procedural steps
    1. Transbrachial approach left side
    - 6F Flexor Check Flo Performer Introducer
    Sheath, 90 cm (COOK)
    - 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
    - 0.035" Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)

    2. Transbrachial recanalization bilateral with femoral wire extraction and exchange for a stiff wire
    - 0.018" V-18 control wire 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Radiofocus angled + straight stiff guide wire, 260 cm (TERUMO)
    - 4 + 5F multipurpose guiding (custom made) Catheter, 125 cm (CORDIS)
    - 0.035" Supra core guide wire, 300 cm (ABBOTT)
    - Quick Cross Catheter 0.035", 135 cm (SPECTRANETICS)

    3. Transfemoral approach bilateral
    - Left: 7F Introducer Sheath, 23 cm (ST JUDE)
    - Right: 12F Introducer Sheath, 45 cm (COOK)

    4. Predilatation in kissing balloon technique
    - 4.0/120 mm Admiral Xtreme OTW Dilatation Catheter, 130 cm (MEDTRONIC)

    5. Stenting of the infrarenal aorta
    - CP STENT 2.8 cm (NUMED)
    - BIB Stent Placement Catheter 20mm/40mm (NUMED)

    6. Stenting and postdilatation in kissing-stent technique of aortic bifurcation/iliac arteries
    - 8.0/120 mm Complete SE Iliac 130 cm (Medtronic Invatec) or
    - 8.0/78 mm Scuba Peripheral CO-CR Stent 80 cmm (Medtronic Invatec)
    - Optional: ADVANTA V12 (Atrium) covered stents
  • - , 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)

    3. Multielectrode Renal Denervation
    - EnligHTN Renal Denervation System (St. Jude Medical)
  • - , Main Arena 2

    Case 69 – Type-B-Dissection

    Center:
    Leipzig
    Case 69 – LEI 39: female, 65 years (R-W)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Michael Borger
    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

    2. Left transbrachial approach
    - 7F 55cm Flexor Check-Flo Introducer (COOK)

    3. Implantation of a covered stent into the the left subclavian artery in "Chimney-technique"
    - 10/38mm, Advanta V12 (ATRIUM/Maquet Getinge Group)

    4. Implantation of a Thoracic Stentgraft System
    - Captiva (MEDTRONIC)
  • - , Main Arena 1

    Case 59 – Occlusion right common iliac artery

    Center:
    Leipzig
    Case 59 – LEI 33: male, 68 years (K-R)
    Operators:
    • Matthias Ulrich,
    • Johannes Schuster
    Clinical data
    PAOD Rutherford 3, walking capacity 100 m
    Claudication right thigh, ABI right 0.85
    Hypertension, current smoker (60 py)

    Procedural steps
    1. Left brachial access
    - 6F 90 cm Flexor Check-Flo Introducer (COOK)

    2. Antegrade Passage of the lesion
    - 0.035" Stiff Angled Terumo guide wire, 260 cm (TERUMO)
    - 5F Multipurpose, 125 cm (CORDIS)

    3. Right femoral access
    - 6F 25 cm destination introducer sheath (TERUMO)

    4. Snaring of the antegrade wire and exchanging for a
    - 0.035" SupraCore, 300 cm (ABBOTT)

    5. Predilation of the lesion
    - 0.035" Armada-Balloon 5/80 (ABBOTT)

    6. Kissing stent implantation
    - 9.0/59 mm Omnilink Elite Cobalt Chromium Stent (ABBOTT)

    7. Closure device of the access sites
    - Perclose Proglide (ABBOTT)
  • - , Main Arena 2

    Case 70 – Rapid progressive infrarenal aortic aneurysm 47mm

    Center:
    Ludwigsburg
    Case 70 – LUD 02: male, 82 years, (S-E)
    Operators:
    • Johannes Gahlen,
    • Wilko Staiger,
    • Pirkko Hettrich
    Clinical data
    Rapid progressive infrarenal aortic aneurysm
    Arterial hypertension, hyperlipidemia, obesity

    Procedural steps
    1. Placement of the distal part of the Endurant II Tube Endograft (Medtronic)

    2. Placement of the proximal part of the Endurant II Tube Endograft (Medtronic)

    3. Fixation of the proximal Endograft to the proximal aneurysm neck with HeliFX Endoscrews (Aptus Endosystems)

    4. Fixation of the distal Endograft to the distal aneurysm neck with HeliFX Endoscrews (Aptus Endosystems)
  • - , Global Expert Exchange

    Case 87 – Renal denervation using the ReCor© ultrasound balloon

    Center:
    Hamburg
    Case 87 – HAM 08: female, 75 years
    Operators:
    • Karl-Heinz Kuck,
    • Jaspers von Wedel,
    • Martin Bergmann
    Clinical data
    Dyspnea on exertion
    24h RR: mean systolic values: 182mmHg w/ peak of ~240mmHg
    Medication: Bisoprolol 1x 5mg, Torasemid 1x 10mg
    Candesartan 1x 32mg, Doxazosin 1x 2mg
    Risk factors: Hypercholesterinemia, s/p tobacco use
    Resistant hypertension for >10y

    Procedural steps
    1. 8F guiding catheter

    2. Wire distal A. renalis

    3. 3 ablation points with balloon 6mm, 2ATM

    4. 30 sec/ablation
  • - , 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)

    3. Thrombectomy/ Atherectomy
    - SpiderFX Embolic Protection Device (COVIDIEN)
    - 6F Rotarex S Thrombectomy Catheter (STRAUB MEDICAL)

    4. PTA with DEB
    - In.Pact Pacific 6/120 DEB (MEDTRONIC)

    5. Stenting on indication
    - Life Stent (BARD)
  • - , Main Arena 2

    Case 71 – Abdominal aortic aneurysm

    Center:
    Leipzig
    Case 71 – LEI 40: male, 81 years (K-G)
    Operators:
    • Jost Philipp Schäfer,
    • Daniela Branzan,
    • Bernd-Michael Harnoss
  • - , Technical Forum

    Case 78 – Occlusion right superficial femoral artery

    Center:
    Münster
    Case 78 – MUE 05: female 89 years (S-E)
    Operators:
    • Arne Schwindt,
    • Konstantinos Donas
    Clinical data
    Recurrent PAOD, Rutherford 4, right leg

    Procedural steps
    1. Left femoral approach 5F 10 cm sheath (TERUMO)

    2. 7F 45 cm Destination x-over sheath via Advantage 0,035 wire (TERUMO)

    3. Cannulation Stenosis 0.014 Choice PT2 (BOSTON SCIENTIFIC)

    4. Placement 5mm Spiderfilter FX via 0,035 Trailblazer support catheter (COVIDIEN)

    5. Atherectomy with large tip Turbohawk smoothcutter (COVIDIEN)

    6. Post PTA with 4-5 x 120 IN.PACT Admiral balloon (MEDTRONIC)
  • - , Global Expert Exchange

    Case 88 – Renal denervation in resistant hypertension

    Center:
    Leipzig
    Case 88 – LEI 49: female, 69 years (B-K)
    Operators:
    • Martin Werner,
    • Klaus Hertting
    Clinical data
    Office BP: 160/ 95 mmHg
    Ambulatory BP: 143/ 91 mmHg, non dipping profile
    Stenting renal artery right 2000
    RI left:0.72, RI right:0.74
    Coronary artery disease; PAOD (Stenting SFA right)
    Renal function: GFR 45 ml/min
    Supraaortic disease: asymptomatic moderate ICA stenosis (60%) right

    Procedural steps
    1. Femoral access right groin (7F)

    2. Placement of a 7F 70 cm guiding catheter HS / IMA (Mach-1, BOSTON SCIENTIFIC)

    3. Buddy wire renal artery:
    0.014" Hi-torque Spartacore 14 (ABBOTT)

    4. Renal artery denervation with the Simplicity® RF Catheter (MEDTRONIC)
  • - , 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)
  • - , Main Arena 1

    Case 61

    Center:
    Hamburg
    Case 61 – HAM 01: male, 74 years
    Operators:
    • Sigrid Nikol,
    • Sven Bräunlich
  • - , Technical Forum

    Case 80 – Occlusion left common iliac artery, stenosis common femoral artery

    Center:
    Münster
    Case 80 – MUE 07: male, 64 years, (H-P)
    Operators:
    • Arne Schwindt,
    • Konstantinos Donas
    Clinical data
    PAOD Rutherford III left leg, ABI 0,5
    PTA/ BES right CIA 11/2012, frustrane retrograde recanalisation attempt left CIA
    Arterial hypertension, CAD; COPD

    Procedural steps
    1. Surgical TEA left CFA

    2. Transbrachial Recanalisation left CIA
    - 6F 90 cm Shuttle sheath (COOK)

    3. Recanalisation
    - 0.035" Quickcross (SPECTRANETICS) and
    - 0.035" Glidewire stiff (TERUMO)

    4. Primary stenting
    - 8 mm Dynamic Balloon expandable stent (BIOTRONIK)
  • - , 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
  • - , 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)
  • - , 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)

    4. Antegrade angioplasty
    - 5/120 Mustang Balloon (Boston Scientific)

    5. Implantation of selfexpanding nitinol-stents
    - Supera Interwoven Nitinol Stent (IDEV)
  • - , Main Arena 1

    Case 63 – Long occlusion right superficial femoral artery

    Center:
    Hamburg
    Case 63 – HAM 02: female, 60 years
    Operators:
    • Hans Krankenberg,
    • P. Burchardt
    Clinical data
    POD Rutherford 3, walking distance 50 m right calf,
    Long bilateral SFA occlusion with recanalisation/2 nitinol stents left SFA 11.12
    Failed recanalisation right SFA 12.12
    Arterial hypertension, diabetes mellitus, former smoker (40 py)
    Stroke 05/2012

    Procedural steps
    1. Contralateral access and placement of a cross-over sheath left groin, 5F (COOK)
    - 5F Hook Catheter (COOK)

    2. Bringing the patient in a prone position

    3. Puncture right AP under road map control
    - 6F sheath, 10 cm (St Jude Medical)

    4. Passage of the lesion
    - 0.035" Aquatrack angled stiff guide-wire, 180 cm (Cordis)
    - 0.035" Glidecath Catheter, straight, 65 cm (TERUMO)

    5. After passage of the lesion change to
    - 0.018" Steel Core, 300 cm (Abbott)
    - Optional: Outback Catheter - 0.014 Ironman, 300 cm (Cordis)

    6. Predilation
    - 0.035" Powerflex Pro 4 mm (Cordis)

    7. Stentimplantation
    - SMART (Cordis)
  • - , Technical Forum

    Case 82 – 3-Vessel occlusion right BTK, CLI

    Center:
    Leipzig
    Case 82 – LEI 45: male, 76 years (A-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    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)

    4. Antegrade angioplasty (Predilatation)
    - 3.0/80 mm Chocolate PTA Balloon (TriReme MEDICAL)

    5. In.Pact Pacific 4.0/120 mm (MEDTRONIC)
  • - , Main Arena 1

    Case 64 – Renal denervation with OneShot balloon (Re – Do)

    Center:
    Hamburg
    Case 64 – HAM 03: male, 55 years
    Operators:
    • Karl-Heinz Kuck,
    • Jaspers von Wedel,
    • Martin Bergmann
    Clinical data
    55 y male w/ resistant hypertension for >10y
    s/p renal denervation w/ Simplicity© cath. 02/2012
    Systolic mean 24h RR-values remain ~148 mmHg resulting in headaches and dyspnea on exertion.
    Invasive r/o of CHD 02/2012
    Medikation: Metoprolol 2 x 100mg, Felodipin 2 x 5mg,
    Candesartan 1 x 32 mg, Urapidil 90 mg 1 x 1, Dihydralazin 2 x 12.5mg

    Procedural steps
    1. Analgosedation w/ Midazolam, Fentanyl, Propofol

    2. Right femoral access (8F, 7.500 IE Heparin)

    3. 8F RDC Guiding catheter (CORDIS)

    4. 0.014" Sion blue guidewire (ASAHI)

    5. OneShot™ Ballon (COVIDIEN): left 7 mm (or 2 x 6 mm?) / right 6 mm
  • - , Main Arena 2

    Case 74 – Infrarenal abdominal aortic aneurysm

    Center:
    Münster
    Case 74 – MUE 03: male, 78 years (W-E)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
    Clinical data
    CAD, CABG 2001
    Art. hypertension
    Hostile abdomen after colon resection
    Aneurysm diameter 55 cm
    Very short neck

    Procedural steps
    1. Percutanous approach both groins Prostar XL (Abbott) and 14 F sheath (COOK)

    2. Placement of the Endurant bifurcated endograft (Medtronic) just below the renal arteries.

    3. Additional fixation of the Endograft with HeliFXTM
    Aortic Securement System (Aptus)
  • - , Technical Forum

    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

    5. Antegrade angioplasty
    - 5/120 Pacific Extreme PTA Balloon Catheter (MEDTRONIC)

    6. Implantation of selfexpanding nitinol-stents
    - Zilver PTX-Stent (COOK)
  • - , Main Arena 1

    Case 65 – Renal Denervation in resistant hypertension

    Center:
    Leipzig
    Case 65 – LEI 36: male, 53 years (A-S)
    Operators:
    • Klaus Hertting
  • - , Main Arena 1

    Case 66 – Carotid artery stenting with cerebral embolic protection

    Center:
    Hamburg
    Case 66 – HAM 04: female, 73 years
    Operators:
    • Joachim Schofer,
    • Klaudija Bijuklic
    Clinical data
    Symptomatic 70% stenosis right ICA
    Amaurosis fugax and dyphasia
    Risk factors: hypercholesterinemia
    Medication: Clopidogrel 75 mg /die (starting 5 days prior to procedure)
    Simvastation 20mg /die

    Procedural steps
    1. Long sheath

    2. Filter protection (because of incomplete circle of Willis)

    3. Stenting

    4. Postdilatation
  • - , 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)

    4. Antegrade angioplasty
    - 3.0/80 Pacific (MEDTRONIC)

    5. Guidewire exchange
    - 0.014" guidewire Floppy ES (ABBOTT)

    6. Drug-eluting balloon angioplasty of the posterior tibial artery
    - Freeway (EUROCOR)
  • - , Technical Forum

    Case 85 – Chronic total occlusion of right popliteal artery and trifurcation

    Center:
    Hamburg
    Case 85 – HAM 07: female
    Operators:
    • Sigrid Nikol,
    • Sven Bräunlich
  • - , 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)

    2. Introduction of protection device
    - 9F Endovascular Clamping Device – MoMa Ultra (Medtronic)

    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)
  • - , Main Arena 2

    Case 75 – Pararenal abdominal aortic aneurysm

    Center:
    Münster
    Case 75 – MUE 04: male, 78 years (W-HH)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
    Clinical data
    Arterial hypertension, atrial fibrillation with oral anticoagulation
    Diabetes mellitus, impaired renal function, shrinkage of right kidney
    Aneurysm diameter 64 cm
    Narrow and calcified iliac arteries

    Procedural steps
    1. Percutanous approach left groin Prostar XL (Abbott), 14 F sheath (COOK)

    2. Percutanous approach right groin 8 F sheath (COOK)

    3. Cannulation of the SMA and the left renal artery (8F shuttle sheath, COOK) via left axillary a (cut down)

    4. Deployment of three Endurant tube endografts (Medtronic) just below the celiac trunk

    5. Placement of chimney stent-grafts (Advanta V12, Atrium) in the SMA and left renal artery
  • - , Main Arena 2

    Case 76 – Juxtarenal Aortic Aneurysm

    Center:
    Hamburg
    Case 76 – HAM 05: male, 76 years
    Operators:
    • Hans Krankenberg,
    • P. Burchardt
    Clinical data
    Asymptomatic juxtrarenal aortic aneurysm / 5.6 cm
    Y-prosthesis infrarenal aorta 1/2001
    Coronary artery disease: D1 90%
    Atrial fibrilation
    RF: Hypertension

    Procedural steps
    1. Transbrachial approach left side
    - 7F Flexor Check Flo Performer Introducer Sheath, 90 cm (COOK)
    - 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
    - 0.035`` Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)

    2. Bilateral femoral surgical cut-down

    3. Stentgraft implantation
    - Implantation of the JOTEC E-extra fenestrated graft (JOTEC)
    - Implantation of 4 covered V12 Advanta Stents (ATRIUM) in Coeliac trunk, AMS and both renal arteries
  • - , Main Arena 1

    Case 68

    Center:
    Leipzig
    Case 68 – LEI 38: female, 86 years
    Operators:
    • Axel Linke,
    • Gerhard Schuler

Conference day 4

  • - , Main Arena 1

    Case 89 – Type A dissection with growing thoraco-abdominal false lumen aneurysm

    Center:
    Münster
    Case 89 – MUE 08: male, 57 years (M-G)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
    Clinical data
    Dilatative cardiomyopathy with impaired left ventricular function, CAD
    Chronic obstructive pulmonary disease (GOLD 4)
    Replacement aortic valve and ascending aorta 2003
    Aortic arch replacement with elefant trunk 2008
    TEVAR 2009
    TIA 2004
    Diabetes mellitus, arterial hypertension, obesity
    Hostile abdomen

    Procedural steps
    1. 14 F sheath (COOK) both groins and cannulation of the true lumen

    2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA

    3. Implantation of a tapered thoracic endograft

    4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side

    5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing

    6. Implantation of the iliac branched device (ZBIS – COOK) on the right side

    7. Placement of the aortic bifurcated device through the left side

    8. Placement of the bridging limb through the right side
  • - , 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)
  • - , 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)
  • - , Main Arena 1

    Case 89 – Type A dissection with growing thoraco-abdominal false lumen aneurysm

    Center:
    Münster
    Case 89 – MUE 08: male, 57 years (M-G)
    Operators:
    • Martin Austermann
    Clinical data
    Dilatative cardiomyopathy with impaired left ventricular function, CAD
    Chronic obstructive pulmonary disease (GOLD 4)
    Replacement aortic valve and ascending aorta 2003
    Aortic arch replacement with elefant trunk 2008
    TEVAR 2009
    TIA 2004
    Diabetes mellitus, arterial hypertension, obesity
    Hostile abdomen

    Procedural steps
    1. 14 F sheath (COOK) both groins and cannulation of the true lumen

    2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA

    3. Implantation of a tapered thoracic endograft

    4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side

    5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing

    6. Implantation of the iliac branched device (ZBIS – COOK) on the right side

    7. Placement of the aortic bifurcated device through the left side

    8. Placement of the bridging limb through the right side
  • - , 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)

    4. PTA and stent implantation
    - 5.0/20 Admiral OTW PTA balloon Catheter (MEDTRONIC)
    - 8.0/18 mm Assurant Cobalt Iliac Ballon-Expandable Stent (MEDTRONIC)