LINC 2014 live case guide

Find all Live Cases and operators listed below.

Conference day 1

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    Case 12 – Iliofemoral venous intervention

    Case 12 – BER 01: female, 23 years (F-L)
    Operators:
    • Nils Kucher,
    • Rolf Engelberger
    Clinical data
    Ilio-femoro-popliteal vein thrombosis left side 03/2009
    PTS treated with compression stockings
    and extended-duration anticoagulation therapy (VKA)
    Chronic venous insufficiency left leg (CEAP C3) with:
    - Leg swelling despite compression
    - Mild venous claudication
    - Varicous veins without skin changes

    Procedural steps
    1. General anaesthesia

    2. Venous access with ultrasound guidance in left popliteal
    - 10F sheath

    3. Phlebography

    4. Wire crossage
    - Terumo 0.035" stiff angled, Astato 20 0.014" (Asahi), Astato 30 0.018 (Asahi)

    5. Predilation: up to 12 mm

    6. Implantation of dedicated venous stents over Terumo stiff angled wire 0.035"
    - Iliac vein stents: Sinus-Venous 14-18 mm (OptiMed), Sinus-XL Flex 14-18 mm (OptiMed) or Zilver Vena 14-16 mm (Cook),
    - Common femoral vein: Sinus-Super-Flex 12 mm

    7. High-pressure post-dilation of stents
    - Fox Cross 0.035" 12-14 mm (Abbott)
  • - , Main Arena 1

    Case 01 – Chronic occlusion right SFA

    Center:
    Leipzig
    Case 01 – LEI 01: female, 55 years (P-B)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    Clinical data
    PAD Rutherford Class 3, severe claudication right calf
    ABI right 0.64
    PTA of the left popliteal artery / stenting right CIA 12/2013

    Risk factors
    Current smoker, art. hypertension

    Angio
    SFA-occlusion right

    Procedural steps
    1. Left groin retrograde cross-over approach
    - 6F Balkin Up&Over 40 cm sheath (COOK)

    2. Passage of the SFA-occlusion right
    - 0.035" stiff angled Terumo guidewire, 300 cm (TERUMO)
    - Armada 35 5/120 mm Balloon (ABBOTT)
    - Exchange to a 0.018" SteelCore guidewire (ABBOTT)

    3. Stenting on indication
    - Distal: SUPERA Interwoven Nitinol-Stent (ABBOTT)
    - Proximal: Absolute Selfexpanding Nitinol-Stent (ABBOTT)
    View image
  • - , Main Arena 2

    Case 02 – BTK occlusion right leg in a CLI patient

    Center:
    Berlin
    Case 02 – AAL 01: male, 75 years
    Operators:
    • Koen Deloose,
    • Lieven Maene
    Clinical data
    Cardiovascular history: TIA, diabetic ulcer right foot

    Risk factors
    Arterial hypertension, IDDM type 2 (with retinopathy/nephropathy)

    Present state
    non healing trophic ulcer D2 right.
    Bilateral femoral pulses, no distal pulses and ABI bilateral 0.54

    Procedural steps
    1. Anterograde right common femoral access
    - 18G needle (CORDIS)
    - 6F brite tip sheath 12 cm (CORDIS)
    - Angled-stiff Terumo glide wire 0.035" (TERUMO)
    - 4F RIM (COOK)
    - Destination-sheath 6F – 45 cm (TERUMO)

    2. Right anterior tibial passage
    - 0.014" Command ES wire (ABBOTT)
    - CXI 0.014" 90 cm (COOK)

    3. Dilatation anterior tibial
    - Armada 0.014/XT (ABBOTT)

    4. Spot-stenting anterior tibial if necessary
    - Multilink Vision/Xpert Pro 0.014" (ABBOTT)

    5. In case of passage failure, sheathless retrograde anterior tibial access
    - 0.014" Command ES Abbott, Armada XT 0.014" (ABBOTT)

    6. Passage right peroneal artery
    - Command ES 0.014" Abbott, CXI 0.014" 90 cm (Cook)

    7. Stenting right peroneal artery
    - Xience prime 0.014" (Abbott)
    View image
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    Case 13 – Iliofemoral venous intervention

    Case 13 – GAL 01: female, 34 years
    Operators:
    • Anthony Ryan,
    • Gerard O'Sullivan
    Clinical data
    Pelvic vein thrombosis x 2; (2000 and 2003),
    Minimal risk factors (oral contraceptive pill)
    Leg swelling and tightness when exercises
    Has changed her exercise pattern to avoid running by taking up yoga.
    Thickened skin overlying your shins
    Varicose veins over your calves and now across the top of your groin
    in the front close to the pudendal region.
    No weight gain

    Procedural steps
    1. Prone left popliteal venous access 10F sheath; urethral catheter, general anaesthesia

    2. Back-up plan: internal jugular vein or contralateral common femoral vein

    3. Venography

    4. IVUS (Volcano system)

    5. Wire crossing
    - 0.035 Angled and stiff glide wire (Merit Medical/Terumo)
    - 0.035 Roadrunner (Cook)
    - Astato 20/30 0.014 (Asahi)

    6. Predilatation of lesion
    - Bard Atlas 6/10/14/16 mm high pressure

    7. Implantation of dedicated venous stent
    - Veniti 16/120 x 2 over Amplatz 260 cm 0.035 wire

    8. Post dilatation to 16 mm
    - Atlas high pressure balloons (BARD)
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    Case 14 – Iliofemoral venous intervention

    Case 14 – BER 02: female, 40 years (G-K)
    Operators:
    • Nils Kucher,
    • Rolf Engelberger
    Clinical data
    Ilio-femoro-popliteal vein thrombosis left side 10/2012
    VTE Risk factors: FVL, oral contraception and smoking
    PTS treated with compression stockings, extended-duration anticoagulation therapy (VKA)
    Superficial thrombophlebitis right leg 07/2012

    Procedural steps
    1. Anaesthesia standby

    2. Venous access with ultrasound guidance in left popliteal vein
    - 10F sheath

    3. Phlebography

    4. Wire crossage
    - Terumo 0.035 stiff angled, Astato 20 0.014 (Asahi), Astato 30 0.018 (Asahi)

    5. Predilation up to 12 mm

    6. Implantation of dedicated venous stents over Terumo stiff angled wire 0.035"
    - Iliac vein stents: Sinus-Venous 14-18 mm (OptiMed), Sinus-XL Flex 14-18 mm (OptiMed) or Zilver Vena 14-16 mm (Cook),
    - Common femoral vein: Sinus-Super-Flex 12 mm

    7. High-pressure post-dilation of stents
    - Fox Cross 0.035" 12-14 mm (Abbott)
  • - , Technical Forum

    Case 03 – Subacute type B - Dissection

    Center:
    Münster
    Case 03 – LEI 02: male, 44 years (S-S)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Bernd-Michael Harnoss
    Clinical data
    Type B dissection with onset 1 month ago
    Poorly controlled art. hypertension with intermittend recurrence of pain

    Risk factors
    Arterial hypertension, current smoker

    Procedural steps
    1. Percutaneous approach right groin with preloading of two Proglide-closure-devices (ABBOTT)

    2. Left groin access with 5F for angiography during implantation

    3. IVUS -examination to verify guidewire-position in the true lumen Visions PV 0.035" Digital IVUS Catheter (VOLCANO)

    4. Right ventricular overdrive pacing during implantation of the stentgraft

    5. Valiant® Thoracic stentgraft with Captiva Delivery System (MEDTRONIC)
    View image
  • - , Discussion Forum

    Case 04 – Renal denervation in uncontrolled arterial hypertension

    Center:
    Bad Krozingen
    Case 04 – BLN 01: female, 73 years (A-H)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    Clinical data
    Chronic heart failure NYHA II-III
    Atrial fibrillation
    Uncontrolled arterial hypertension
    Office blood pressure: 176/95 mmHg
    Medication: 6 antihypertensive drugs

    Duplex
    RI: 0.75 bilateral
    Absence of renal artery stenosis

    CTA
    Singular bilateral renal arteries with slightly steep offspring of the right renal artery

    Procedural steps
    1. Right femoral access with 8F Cook Ansel sheath

    2. Navigation of 0.014" guide wire (Terumo Advantage angled 180 cm) into the right RA

    3. If direct probing fails support with a Cobra Catheter (CB1 Cordis 4F)

    4. Removing the diagnostic catheter

    5. Advancing a Vessix 6 mm renal denervation balloon into the right RA (Boston Scientific)

    6. Calibrating the Vessix Denervation console

    7. Activating and inflating the balloon for at least 30 seconds

    8. Remove the balloon

    9. Probing the sheath into the left RA

    10. Following once again steps 4-8.

    11. Device retrieval

    12. Access closure with Angioseal 8F (St. Jude) or Proglide 6F (Abbott)
    View image
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    Case 15 – Iliofemoral venous intervention

    Case 15 – BER 03: male, 57 years (U-W)
    Operators:
    • Nils Kucher,
    • Rolf Engelberger
    Clinical data
    Ilio-femoro-popliteal vein thrombosis left side 04/2013
    Heterozygote FV-Leiden mutation
    PTS treated with compression stockings, extended-duration anticoagulation therapy (VKA)
    Infrarental aortic aneurysm (MD 3.3 cm)
    Diabetis mellitus

    Procedural steps
    1. Local anaesthesia

    2. Venous access in left popliteal vein
    - 10F sheath

    3. Phlebography

    4. Wire crossage
    - Terumo 0.035 stiff angled

    5. IVUS

    6. Implantation of dedicated venous stents over Terumo stiff angled wire 0.035"
    - Iliac vein stents with high radial force: Sinus XL 16-22 mm (OptiMed)
    - Sinus XL Flex 14-18 mm (OptiMed)

    7. High-pressure post-dilation of stents
    - Fox Cross 0.035" 12-14 mm (Abbott)
  • - , Scientific Posters

    Case 05 – In-Stent Occlusion right SFA

    Center:
    Berne
    Case 05 – LEI 03: male, 61 years (T-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Sabine Steiner
    Clinical data
    PAOD Rutherford 3, claudication right calf at 100 meters
    PTA right SFA and stenting for claudication 11/2012
    Failed recanalization-attempt 01/2014 right SFA
    Inability to direct the guidewire into the stent
    Diabetes mellitus type 2, art. hypertension, hyperlipidaemia

    Procedural steps
    1. Left femoral access and cross-over approach

    2. 6Fr Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    3. Retrograde puncture of the SFA-stent
    - 18 Gauge 7 cm needle (COOK)
    - Quick-Access Needle Holder (SPECTRANETICS)
    - 0.035" stiff, angled Terumo, 300 cm

    4. Retrograde passage of the stent and snaring from antegrade
    - CXC-support-catheter, 90 cm 0.035" (COOK)

    5. PTA / stenting from antegrade
    - Advance PTX 18 Balloon (COOK)
    - Zilver-PTX stents (COOK)
    View image
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    Case 16 – Renal denervation in treatment resistant hypertension

    Case 16 – HEI 01: male, 69 years (H-B)
    Operators:
    • Erwin Blessing,
    • Britta Vogel
    Clinical data
    Office blood pressure: 170/85 mm Hg
    Ambulatory blood pressure:
    24 h Average: 160/80 mm Hg
    Daytime average: 167/84 mm Hg

    Procedural steps
    1. Femoral access right groin

    2. Placement of 6F short sheath (Cordis)

    3. Placement of 6F short (55 cm) LIMA guide catheter (Medtronic)

    4. Renal denervations with Symplicity Flex (Medtronic)
  • - , Global Expert Exchange

    Case 06 – Chronic SFA-Occlusion right leg

    Center:
    Heidelberg
    Case 06 – AAL 02: female patient, 69 years
    Operators:
    • Koen Deloose,
    • Lieven Maene
    Clinical data
    Cardiovascular history: PTA - Stenting left common iliac artery

    Risk factors
    Arterial hypertension

    Present state
    Bilateral claudication RB 3
    Bilateral femoral pulses
    No popliteal/distal pulses and ABI bilateral 0.8

    Procedural steps
    1. Left common femoral access
    - 18G needle (CORDIS),
    - 6F brite tip sheath 12 cm (CORDIS)

    2. Cross over procedure
    - Angled-stiff Terumo glide wire 0.035" (TERUMO)
    - 5F RIM (COOK)
    - Destination-steath 6F – 45 cm (TERUMO)

    3. Right SFA passage
    - Terumo glide wire 0.035" angled-stiff (TERUMO)
    - CXI 0.035" 90 cm (COOK)

    4. Predilatation right SFA
    - 0.018" Advantage wire (TERUMO)
    - Advance 18LP PTA (COOK)

    5. Stenting right SFA
    - Zilver PTX SE stent (COOK)

    6. Dilatation right popliteal artery
    - Advance 18LP PTX PTA (COOK)

    7. In case of anterograde passage failure, right retrograde distal posterior access
    - pedal micropuncture access kit (COOK)
    View image
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    Case 17 – Renal denervation in treatment resistant hypertension

    Case 17 – HEI 02: male, XX years (X-X)
    Operators:
    • Erwin Blessing,
    • Britta Vogel
    Clinical data
    Office blood pressure: mm Hg
    Ambulatory blood pressure:
    24 h Average: mm Hg
    Daytime average: mm Hg
    Medication:

    Procedural steps
    1. Femoral access right groin

    2. Renal denervations with Symplicity Flex (Medtronic)
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    Case 18 – Iliofemoral venous intervention

    Case 18 – BER 04: female, 21 years (L-B)
    Operators:
    • Nils Kucher,
    • Rolf Engelberger
    Clinical data
    Ilio-femoro-popliteal vein thrombosis left side 02/2011
    - Heterozygote Factor V Leiden Mutation
    - Anticoagulation with VKA until 10/2012
    PTS treated with compression stockings
    No extended-duration anticoagulation therapy
    Chronic venous insufficiency left leg with:
    Leg swelling despite compression (4 cm plus)
    Mild venous claudication
    Large pudendal varicosis

    Procedural steps
    1. Anaesthesia standby

    2. Venous access with ultrasound guidance in left popliteal vein
    - 10F sheath

    3. Phlebography

    4. Wire crossage
    - Terumo 0.035 stiff angled, Astato 20 0.014 (Asahi), Astato 30 0.018 (Asahi)

    5. Predilation up to 12 mm

    6. Implantation of dedicated venous stents over Terumo stiff angled wire 0.035"
    - Iliac vein stents: Sinus-Venous 14-18 mm (OptiMed), Sinus-XL Flex 14-18 mm (OptiMed) or Zilver Vena 14-16 mm (Cook),
    - Common femoral vein: Sinus-Super-Flex 12 mm

    7. High-pressure post-dilation of stents
    - Fox Cross 0.035" 12-14 mm (Abbott)
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    Case 19 – Iliofemoral venous intervention

    Case 19 – GAL 02: female, 23 years (JC)
    Operators:
    • Gerard O'Sullivan,
    • Anthony Ryan
    Clinical data
    Acute left IF DVT March 2013
    37 weeks pregnant
    Attempted thrombolysis at 4 weeks from thrombus diagnosis – unsuccessful –
    heavy collaterals – poor inflow – procedure abandoned
    CTV Nov 2013 showed clearer inflow
    Wears Class 2 thigh high compression stockings
    Left leg swells and gets tight at 200 m on the flat
    Weight gain 6 kg
    Leg slightly swollen at rest
    No ulceration

    Procedural steps
    1. Prone left popliteal venous access 10F sheath; urethral catheter, general anaesthesia.
    Ideally access groin region through profunda

    2. Back-up plan: internal jugular vein or contralateral common femoral vein

    3. Venography

    4. Wire crossing
    - 0.035" Angled and stiff glide wire (Merit Medical/Terumo)
    - 0.035" Roadrunner (Cook)
    - Miracle Bros 12 0.014" (Medtronic)

    5. Predilatation of lesion
    - Atlas 6/10/14/16 mm high pressure (Bard)

    6. Implantation of dedicated venous stent
    - Optimed 16/150; 140/100 over Amplatz 260cm 0.035 wire

    7. Post dilatation to 16 mm
    - Atlas high pressure balloon (Bard)
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    Case 22 – PAOD Rutherford III, CTO of the right SFA, lesion length >15 cm + 3 vessel run off

    Case 22 – BLN 02: female, 67 years (M-B)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    Clinical data
    Symptomatic PAOD right leg
    PTA of the left superficial artery in 12/2013
    Hyperlipidemia
    COPD
    Current smoker
    ABI 0.4 right, 0.9 left

    Angio
    Patent inflow via left iliac artery
    Ostial SFA stenosis right
    Occlusion of the right SFA

    Procedural steps
    1. Right femoral antegrade access
    - 6F sheath (Terumo)

    2. Passage of the lesion
    - 0,035" hydrophilic Terumo Glide wire (Terumo)

    3. Back-up
    - Glidecath 4F angled Terumo (65 cm)

    4. Back-up
    - JR4 5F Catheter 100 cm (Cordis)

    5. Reentry at reconstitution point proximal of the P1 segment

    6. PTA of the SFA
    - Reuma 4 x 100 mm monorail balloon (Terumo)

    7. PTA of the ostial SFA Lesion
    - 4 mm Angiosculpt balloon

    8. Stenting if needed
    - Misago Stent 6 mm (Terumo)

    9. Lesion post-dilatation
    - Renma PTA Balloon 5 mm
    - Back-up Material: Offroad Reentry Device (BSC) or additional transcrural retrograde access
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    Case 23 – Common iliac artery occlusion right leg

    Case 23 – AAL 03: male, 71 years
    Operators:
    • Koen Deloose,
    • Lieven Maene
    Clinical data
    Cardiovascular history: CABG – RIND

    Risk factors
    Arterial hypertension, hypercholesterolemia, smoking

    Present state
    Bilateral claudication RB 3
    No femoral/popliteal/distal pulses
    ABI bilateral 0.68

    Procedural steps
    1. Left common femoral access
    - 18G needle (CORDIS)
    - 6F brite tip sheath 23 cm (CORDIS)

    2. Retrograde left common iliac passage
    - Terumo glide wire 0.035" angled-stiff (TERUMO)
    - Berenstein 4F 0.035" 65 cm (CORIDS)

    3. Cross over procedure
    - angled-stiff/soft Terumo glide wire 0.035" (TERUMO)
    - 5F Universal Flush (CORDIS)

    4. Anterograde passage right common/external iliac artery
    - Terumo glide wire 0.035" angled-stiff (TERUMO)
    - Berenstein 4F 0.035" 65 cm (CORDIS)

    5. Right common femoral access
    - 18G needle (CORDIS)
    - 6F brite tip sheath 23 cm (CORIDS)

    6. Stenting Common iliac arteries
    - Multilink vision BE stents (ABBOTT)
    - if necessary prolonged by Absolute pro SE stent (ABBOTT)
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    Case 27 – Right sided chronic critical limb ischemia

    Case 27 – PA 03: male, 72 years (C.C.)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    Clinical data
    Severe renal failure (GFV 30ml/min)
    CAD
    Jan 2014 right chronic limb ischemia (I and II toe wound)
    ABI: 0.45

    Risk factors
    Hypertension, hyperlipemia, diabetes type II, nicotine abuse

    Duplex Scan
    anterior and posterior tibial arteries occlusion; pedal and distal tibial artery post-stenotic flow

    Procedural steps
    1. Right Femoral antegrade access with a 6F sheath placement

    2. Wiring the anterior tibial and peroneal arteries stenosis with a 0.014" wire (plantar loop technique) and supportive microcatheter (TotalAcross - Medtronic)

    3. Anterior tibial artery predilatation with 2.5/150 mm balloon and dilatation with 3,0/200 mm balloon

    4. Peroneal angioplasty with Deep 2.5/40 mm
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    Case 07 – Chronic occlusion left SFA

    Center:
    Palermo
    Case 07 – LEI 04: male, 69 years (HJ-A)
    Operators:
    • Matthias Ulrich,
    • Yvonne Bausback,
    • Saulius Korsakas
    Clinical data
    Rutherford 3, severe claudication left calf
    ABI right 0.56
    PTA of the right distal SFA with DEB 1/2014
    CAD, CABG 2008

    Risk factors
    Art. hypertension, former smoker, diabetes mellitus

    Angio
    Occlusion left SFA

    Procedural steps
    1. Right groin retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Second attempt to pass the occlusion
    - 0.035" stiff, angled Terumo guidewire, 260 cm (TERUMO)
    - 4/120mm Admiral-balloon (MEDTRONIC)
    - Exchange to a 0.018" guidewire (SteelCore (ABBOTT))

    3. PTA with drug-eluting balloons
    - In.Pact Pacific (MEDTRONIC)

    4. In case of dissections implantation of
    - Complete Selfexpanding Nitinol-Stent (MEDTRONIC)
    View image
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    Case 08 – Chronic occlusion right SFA

    Center:
    Galway
    Case 08 – LEI 05: female, 69 years (E-B)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster,
    • Sabine Steiner
    Clinical data
    Rutherford 3, claudication right calf, walking capacity < 100 m
    Stenting right iliac arteries 11/2013
    Frustaneous attempt to recanalize from antegrade 2013
    CAD with former stenting 06/2013
    Atrial fibrillation

    Risk factors
    art. hypertension, diabetis mellitus, hyperlipidemia

    Angio
    Occlusion right SFA

    Procedural steps
    1. Right groin retrograde cross-over approach (6F)

    2. Second attempt to pass the occlusion from antegrade

    3. PTA with drug-eluting balloons

    4. IStenting on indication (self expanding nitinol stents)
    View image
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    Case 28 – Left chronic critical limb ischemia

    Case 28 – PA 04: male, 68 years (C.F.)
    Operators:
    • Antonio Micari,
    • Giuseppe Roscitano,
    • Giuseppe Vadalà
    Clinical data
    2005 Unstable angina → LAD PCI
    2013 march: right CLI treated by right SFA and anterior tibial artery PTA
    2014 january: left chronic limb ischemia (calcaneal wound - Rutherford V)

    Duplex scan
    Anterior and posterior tibial arteries occlusion; pedal artery post-stenotic flow
    ABI: 0,41

    Risk factors
    Hypertension, hyperlipemia, diabetes type II, nicotine abuse

    Procedural steps
    1. Left Femoral antegrade access with a 6F sheath placement

    2. Wiring the anterior tibial and peroneal arteries stenosis with
    - 0.014" Pilot guidewire (ABBOTT) and supportive microcatheter (TotalAcross - Medtronic)

    3. Anterior tibial artery predilatation by Amphirion Deep 2.5/150 mm balloon and dilatation by 3.0/200 mm balloon.

    4. Peroneal angioplasty with a Maverick 2.5/30 mm (Boston Scientific).
  • - ,

    Case 24 – Abdominal aortic aneurysm 55 mm

    Case 24 – LEI 08: male, 77 years (E-H)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Saulius Korsakas
    Clinical data
    Progressive abdominal aortic aneurysm
    CAD, PTCA 2007, CABG 2005
    PAOD
    Arterial hypertension, hyperlipidemia, diabetes mellitus
    Renal insufficiency (GFR 48 ml/min)
    Atrial fibrillation with oral anticoagulation

    Procedural steps
    1. Bifemoral percutaneous approach in local anaesthesia
    - Preclosing with 2 Proglide-closure-devices each side (ABBOTT)
    - 5 F sheath (TERUMO)
    - 0.035" J-tip guidewire (CORDIS)
    - 9F 10 cm sheath (TERUMO)

    2. Guidewire-positioning
    - Lunderquist Extra Stiff Wire Guide 180 cm (COOK)

    3. Implantation of a bifurcational stentgraft
    - Ovation (TRIVASCULAR)

    4. PTA
    - Proximal seal: Reliant-balloon (MEDTRONIC)
    - Graft-bifurcation: 12/40 mm Armadal 35 balloon (ABBOTT)

    5. Closure of the groins with the preloaded Proglide-systems in place
  • - ,

    Case 09 – Chronic occlusion left distal SFA / P1-Segment

    Center:
    Columbus
    Case 09 – LEI 06: male, 50 years (A-S)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    Clinical data
    Rutherford 3, severe claudication left calf
    Painfree walking distance 50 meters
    ABI right 0.65

    Risk factors
    Art. hypertension, smoker

    Angio
    Occlusion left SFA

    Procedural steps
    1. Retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the occlusion and dilation
    - 0.035" stiff, angled Terumo guidewire, 260 cm (TERUMO)
    - 4/120 mm Mustang-balloon (BOSTON SCIENTIFIC)
    - Exchange to a 0.018" SteelCore guidewire, 300 cm (ABBOTT)

    3. PTA with drug-eluting balloons
    - Lutonix 5/100 mm DEB (BARD)

    4. In case of dissections implantation of
    - Intact Vascular Tack-IT Endovascular Stapler™ (INTACT VASCULAR)
    View image
  • - ,

    Case 29 – Chronic SFA-occlusion left leg

    Case 29 – AAL 04: male, 76 years
    Operators:
    • Koen Deloose,
    • Lieven Maene
    Present state
    Bilateral restpain, bilateral trophic ulcers of the toes
    Bilateral femoral pulses, no popliteal/distal pulses and ABI bilateral 0,53

    Cardiovascular history
    Fem-pop bypass right leg, TIA, atrial fibrillation

    Risk factors
    Arterial hypertension, hyperlipidemia

    Procedural steps
    1. Right common femoral access
    - 18G needle (CORDIS)
    - 6F brite tip sheath 12 cm (CORDIS)

    2. Cross over procedure
    - Angled-stiff Terumo glide wire 0.035" (TERUMO)
    - 5F RIM (COOK)
    - Destination-sheath 6F 45 cm (TERUMO)

    3. Left SFA passage
    - Terumo glide wire 0.035" angled-stiff (TERUMO)
    - CXI 0.035" 150 cm (COOK)

    4. Predilatation SFA
    - 0.014" Advantage wire (TERUMO)
    - Nanocross 0.014" (COVIDIEN)

    5. Stenting SFA
    - Everflex 6 mm SE stent (COVIDIEN)

    6. Left posterior tibial passage
    - 0.014" Advantage wire (TERUMO)
    - CXI 0.014" 150 cm (COOK)

    7. Predilatation posterior tibial
    - Nanocross 0.014" (COVIDIEN)

    8. Stenting posterior tibial artery
    - Stents PTX eluting SE stent

    9. In case of passage failure, retrograde posterior tibial access
    - Micropuncture pedal access kit (COOK)
  • - ,

    Case 20 – Iliofemoral venous intervention

    Case 20 – BER 05: female, 19 years (R-S)
    Operators:
    • Nils Kucher,
    • Rolf Engelberger
    Clinical data
    Ilio-femoro-popliteal vein thrombosis left side 09/2013

    Risk factors
    Heterozygote FV-Leiden mutation, 3 hour flight
    PTS treated with compression stockings, extended-duration anticoagulation therapy with rivaroxaban
  • - ,

    Case 21 – Iliofemoral venous intervention

    Case 21 – GAL 03: male, 44 years (PH)
    Operators:
    • Gerard O'Sullivan,
    • Anthony Ryan
    Clinical data
    Chronic venous insufficiency left leg (C4 Es Ad9P0) with
    - Swelling no ulcers
    - Skin discolouration
    - Venous claudication at 250 m, followed by severe discomfort and tightness
    Left Ilio-femoral Deep vein Thrombosis 1999
    On life long anticoagulation
    Compliant with thigh high Class 2 compression

    CT-scan
    Images showing left common and external iliac venous occlusion with heavy cross pelvic collaterals

    Procedural steps
    1. Prone left popliteal venous access 10F sheath; urethral catheter, general anaesthesia

    2. Back-up plan: internal jugular vein or contralateral common femoral vein

    3. Venography

    4. Wire crossing
    - 0.035 Angled and stiff glide wire (Merit Medical/Terumo)
    - 0.035 Roadrunner (Cook)
    - Astato 20/30 0.014 (Asahi)

    5. Predilatation of lesion
    - Atlas 6/10/14/16 mm high pressure (Bard)

    6. Implantation of dedicated venous stent
    - Cook Zilver Vena 16/140 x 2 over Amplatz 260 cm 0.035" wire

    7. Post dilatation to 16 mm
    - Atlas high pressure balloons (Bard)
  • - ,

    Case 25 – Right internal carotid artery critical stenosis

    Case 25 – PAL 02: male, 66 years (L. M. G.)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    Clinical data
    Atrial fibrillation
    1996 ictus cerebri with left side hypostenia
    2003 CABG
    Recent TIA (Hypostenia of the left arm)

    Risk factors
    Hypertension
    Hyperlipemia
    Previous nicotine abuse
    Diabetes Type II
    Chronic renal failure

    Duplex
    Right ICA sub-occlusion (PSV 6.0 m/sec)

    Cranial CT-scan
    Two right hypodense temporo-parietal areas
  • - ,

    Case 26 – Symptomatic very high grade left internal carotid artery stenosis

    Case 26 – BLN 03: female, 72 years (U-W)
    Operators:
    • Ralf Langhoff,
    • Frank Schönenberg
    Clinical data
    Symptomatic high grade stenosis of the left internal carotid artery (>80%)
    Short period of paralysis in the right arm late December 2013
    Because of time constraints (still actively working) she refused immediate treatment and refused surgical treatment option
    Current smoker >60 py
    Moderate arterial hypertension
    Lymphoma with chemotherapy and radiation of the chest in 2007

    Duplex
    Echogenic plaque left ICA, PSV 697 cm/s, EDV 377 cm/s

    Procedural steps
    1. Right femoral access with 8F Terumo-sheath

    2. Navigation of guide wire into the left ECA
    - 0,035" hydrophilic stiff guide wire (Terumo Stiff 260 cm)
    - Weinberg-Catheter (Cook)

    3. Removing the diagnostic catheter

    4. Advancing a 8F guiding sheath, MP shape
    - Vista Brite Tip IG (Cordis)

    5. Distal protection
    - Filter Wire EZ protection device (Boston Scientific)

    if not possible:
    6. Predilatation
    - 2.0 mm Maverick balloon (Boston Scientific)

    7. Stenting
    - Wallstent 7 x 30 mm (Boston Scientific)

    8. Lesion post-dilatation
    - 5.0/30 mm Sterling (Boston Scientific)

    9. Device retrieval
  • - ,

    Case 10 – Multilevel-disease left leg

    Center:
    São Paulo
    Case 10 – LEI 07: male, 63 years (H-T)
    Operators:
    • Arne Schwindt,
    • Michael Piorkowski,
    • Bruno Freitas
    Clinical data
    Rutherford 5, chronic, minor gangrene left dig 3/4
    Painfree walking distance 150 meters
    ABI left 0.44
    Chronic heartfailure, EF 35%,
    CAD, MI 11/2012, PTCA, repeat coronary angiography 1/2014
    Atrial fibrillation,
    Renal insufficiency (GFR 54 ml/min)

    Risk factors
    Art. hypertension, diabetes mellitus

    Angio
    Left: stenosis CFA, occlusion distal SFA, stenosis P2 and P3

    Procedural steps
    1. Right groin retrograde cross-over approach with 7F sheath
    - 7F Check-Flo Performer 55 cm (COOK)

    2. Passage of the SFA-occlusion and positioning of a protection-systeme
    - 0.018" 18g Victory guidewire, 300 cm (BOSTON SCIENTIFIC)
    - TrailBlazer Support-Catheter, 135 cm (COVIDIEN)
    - Spider-Filter 6 mm (COVIDIEN)

    3. Atherectromy
    - CFA and SFA: L-SC, large-vessel TurboHawk 6 cm-tip (COVIDIEN)
    - Popliteal artery: S-SM, Small-vessel TurboHawk (COVIDIEN)

    4. Drug-eluting balloon treatment
    - Lutonix DEB (BARD)
    View image
  • - ,

    Case 11 – Right superficial femoral artery chronic total occlusion

    Case 11 – PAL 01: male, 65 years (D.M.V.)
    Operators:
    • Antonio Micari,
    • Giuseppe Vadalà,
    • Gentian Germeni
    Clinical data
    April 2013: severe bilateral claudicatio → bilateral SFA angioplasty
    December 2013: worsening of right claudicatio (FWI 90 mts)
    Right SFA occlusion and post-stenotic popliteal and tibial arteries flows.
    ABI: 0.71

    Risk factors
    Hypertension, hyperlipemia, diabetes type II, nicotine abuse

    Procedural steps
    1. Contralateral femoral access and placement of a cross-over sheath
    - JR 5F diagnostic catheter, hydrophilic 0.035 Terumo soft wire, 0.035" SupraCore wire (ABBOTT)
    - 6F 45 cm long Destination-sheath (TERUMO)

    2. Crossing the occlusion
    - 0.018" V 18 Controlwire (BOSTON SCIENTIFIC)

    3. Lesion pre-dilatation
    - 4.0/120 mm PowerCross (COVIDIEN)

    4. Primary stenting
    - 7/150 Everflex SES with Entrust delivery system (COVIDIEN)

    5. Post-Dilatation
    - 5.0/120 mm EverCross-Balloon (COVIDIEN)

Conference day 2

  • - ,

    Case 49 – Chronic occlusion right SFA

    Case 49 – LEI 18: male, 72 years (J-H)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Saulius Korsakas
    Clinical data
    Rutherford 3, severe claudication right calf,
    ABI right 0.58
    Unsuccessful recanalization-attempt right SFA 12/2013 elsewhere,
    inability to re-enter the GW distal to the CTO

    Risk factors
    Smoker, art. hypertension

    Procedural steps
    1. Retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the SFA-occlusion
    - 0.035" stiff, angled Terumo Glidewire, 260 cm (TERUMO)
    - 5F Judkins Right diagnostic catheter, 100 cm (CORDIS)
    - Exchange to a 0.014" Stabilzer guidewire, 300 cm (CORDIS)
    - Outback reentry-system (CORDIS)

    3. Predilatation and stenting
    - Powerflex 5/120 mm-Balloon (CORDIS)
    - SmartFlex selfexpanding stent (CORDIS)
  • - ,

    Case 50 – Chronic total occlusion of the left common iliac artery

    Case 50 – PA 06: male, 65 years (E.G.)
    Operators:
    • Antonio Micari,
    • Giuseppe Vadalà
    Clinical data
    December 2013: right coronary artery PCI
    PAOD: severe claudicatio Rutherford 3 (FWI 100 mts)

    Angio
    Distal right SFA occlusion. Left femoro-popliteal axis patent with post-stenotic flow at common femoral artery level
    ABI right: 0,71
    ABI left: 0,70

    Risk factors
    Hypertension, hyperlipemia, nicotine abuse

    Procedural steps
    1. Left femoral access and placement of a 6F 11 cm long sheath

    2. Left fomeral access and placement of a 6 F 90 cm long sheath (Destination)

    3. Crossing of the occlusion
    - 0.018" V18 Contolwire (Boston Scientific) or
    - 0,035" J-shaped stiff Glidewire (Terumo)

    4. Lesion pre-dilatation
    - 4.0/60 mm Evercross balloon (Covidien)

    5. Stenting
    - SMART iliac stent (Cordis)

    6. Post dilatation
    - 6/40 mm Evercross balloon (Covidien)
  • - ,

    Case 61 – Rutherford class 3 left leg: CTO SFA

    Case 61 – MUN 04: male, 69 years (R-W)
    Operators:
    • Bernd Gehringhoff,
    • Najib Jawadi
  • - ,

    Case 30 – Renal denervation in resistant hypertension

    Case 30 – LEI 09: female, 75 years (M-O)
    Operators:
    • Yvonne Bausback,
    • Matthias Ulrich
    Clinical dataOffice 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
    Medikation: 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 guiding catheter
    - 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
    - Vessix-catheter (BOSTON SCIENTIFIC)
  • - ,

    Case 40 – Calcified focal stenosis of the SFA right

    Case 40 – HEI 03: male, 81 years (S-P)
    Operators:
    • Erwin Blessing,
    • Britta Vogel
    Clinical data
    PAOD Rutherford 3, claudication at 150 m right calf
    Status post PTA with DCB left SFA 4 weeks ago
    CAD, multiple previous PCIs
    Hypertension, hyperlipidemia, former smoker

    Procedural steps
    1. Antegrad femoral access right groin
    - Placement of 6F short sheath (CORDIS)

    2. Attempt to pass the lesion within the lumen
    - Cruiser 0.018" wire (BIOTRONIK)

    3. Lesion preparation
    - Angiosculpt 6.0 x 40 mm (BIOTRONIK)

    4. Prevention of restenosis
    - Passeo 18 LUX Drug coated balloon 6.0 x 80 mm (BIOTRONIK)

    In case of flow limiting dissection:
    5. Placement of Pulsar 35 Stent (BIOTRONIK)
  • - ,

    Case 62 – Left superficial femoral artery in-stent chronic occlusion

    Case 62 – PAL 07: male, 69 years (A-G)
    Operators:
    • Antonio Micari,
    • Giuseppe Vadalà
    Clinical data
    PAOD: 2010 right SFA angioplasty and stenting
    2011 left SFA angioplasty
    January 2014 bilateral severe claudicatio (FWI <100 mts)
    Angiography: right SFA instent occlusion. Left SFA occlusion
    Left SFA recanalization planned
    ABI righ: 0,75 ABI left:0,69

    Risk factors
    Hypertension, hyperlipemia, diabetes type II, nicotine abuse

    Procedural steps
    1. Contralateral femoral access and placement of a cross-over sheath
    - JR 5 F diagnostic catheter
    - Idrofilic 0,035" soft wire (Terumo)
    - 0,035" SupraCore wire (Abbott)
    - 6F 45 cm long sheath Destination (Terumo)

    2. Crossing the occlusion
    - 0.035" stiff wire (Terumo)

    3. Lesion pre-dilatation

    4. Dilatation with Balloons

    5. Spot Stenting if needed
  • - ,

    Case 41 – Symptomatic PAOD left leg

    Case 41 – BLN 05: female, 45 years (S-V)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
  • - ,

    Case 42 – 7 cm aneurysm of the aortic arch in an "abnormal right arch with aberrant left subclavian artery"

    Case 42 – MUN 01: male 61, years (C-R)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
    Clinical data
    Jugular vein distension
    Arterial hypertension
    Renal impairment after nephrectomy right side

    Procedural steps
    1. Debranching of the aortic arch
    - with an octopus bypass from the ascending aorta to both carotid and subclavian arteries

    2. Access via both groins
    - Prostar XL right groin, 14 F sheath right groin and 5 F sheath left groin. Lunderquist wire through the right groin

    3. Implantation of a Zenith Alpha through the right groin just distal of the marked origin of the octopus-bypass to cover the aortic arch
  • - ,

    Case 63 – Left internal carotid artery critical in stent re-stenosis

    Case 63 – PAL 08: male, 63 years old (P-A)
    Operators:
    • Antonio Micari,
    • Giuseppe Vadalà,
    • Gentian Germeni
    Clinical data
    February 2011 left ICA stenting (Xact 8-10/40 mm)
    January 2014 dysarthria
    Left ICA in-stent re-stenosis (PSV 2,6 m/sec)
    Right ICA mild stenosis

    CT
    No hypodense cortical areas

    Risk factors
    Hypertension, hyperlipemia, previous nicotine abuse

    Procedural steps
    1. Femoral access with 8F sheath

    2. Left ICA cannulation
    - 8F (40 degree angle) guiding catheter (Boston Scientific)

    3. Distal protection with a distal filter
    - Filterwire EZ (Boston Scientific)

    4. Dilatation
    - 5.0/20 mm Maverick balloon (Boston Scientific)

    5. Cutting balloon? (Boston Scientific)

    6. In-stent stenting?
    - Carotid Wallstent (Boston Scientific)
  • - ,

    Case 31 – 3-Vessel occlusion right BTK, CLI

    Case 31 – LEI 10: female, 78 years (H-B)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Bruno Freitas
    Clinical data
    PAOD Rutherford 5, ulceration right forefoot
    PTA / stent of the SFA 1/2014
    Failure to pass the TPT-occlusions right from antegrade 01/2014
    ABI right 0.32
    CAD, MI 9/2013, PTCA 9/2013
    Art. hypertension, adipositas, former smoker
    Chronic renal insufficiency (GFR 79ml/min)

    Procedural steps
    1. Antegrade Access right groin
    - 5F 55 cm Flexor Check-Flo Introducer (COOK)

    2. Retrograde puncture of the peroneal artery
    - Transpedal puncture-set (COOK)
    - 21 Gauge / 4 cm needle (COOK)
    - 3F sheath (COOK)

    3. Retrograde passage of the TTF-occlusion
    - CXI Supportcatheter, 90 cm (COOK)
    - 0.014" Command ES guidewire, 300 cm (ABBOTT)
    - Predilation with Armada XT 3.0/20 mm OTW-balloon (ABBOTT)

    4. Antegrade Implantation of DES
    - Xience Prime 3.5/38 mm (ABBOTT)
  • - ,

    Case 51 – Varicocele Embolisation

    Case 51 – GAL 04: male, 29 years
    Operators:
    • Gerard O'Sullivan,
    • Anthony Ryan
  • - ,

    Case 64 – Asymptomatic high grade left internal carotid artery stenosis

    Case 64 – BLN 07: male, 63 years (S-H)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    Clinical data
    Asymptomatic high grade stenosis of the left internal carotid artery (>80%)
    Progression stenosis over 6 month
    Arterial hypertension
    Hyperlipidamia
    Current smoker

    Duplex
    Echogenic plaque left ICA,
    Echogenic plaque of the left ICA PSV >3 m/sec, EDV 100 cm/sec

    Procedural steps
    1. Right femoral access
    - 8F sheath (Terumo)

    2. Guide wire navigation
    - 0,035" hydrophilic stiff guide wire, 260 cm (Terumo) into the left ECA using a Weinberg-Catheter (Cook)

    3. Removing the diagnostic catheter

    4. Advancing a guiding sheath
    - 8F guiding sheath, MP shape, Vista Brite Tip IG (Cordis)

    5. Distal protection
    - Filter Wire EZ protection device (Boston Scientific)

    6. Predilation
    - Sterling 3 x 30 mm balloon

    7. Stenting
    - ADAPT 4-9 x 40 mm stent (Boston Scientific)

    8. Lesion post-dilatation
    - 5.0/30 mm Sterling (Boston Scientific)

    9. Device retrieval
  • - ,

    Case 52 – Colorectal liver metastases (CRM)

    Case 52 – HEI 05: male, 72 years
    Operators:
    • Boris Radeleff,
    • M. Klauss,
    • N. Kortes,
    • Natalie Tessendorf
    Clinical data
    Carcinoma of the colon descendens (resection 08/2012)
    Three liver metastases (bilateral; ED 2012)
    Several chemotherapies (SD) till november 2013 with 1x cycle Folfiri and 1x cycle Folfox
    11/2013 progressive disease (4 x liver mets)

    Procedural steps
    1. Transfemoral approach right groin

    2. Short 4F sheath Radifocus (Terumo)

    3. 0.035" 180 cm J-wire

    4. 4F 110 cm 4F Sidewinder Typ I (Cordis)

    5. 2.8F Microcatheter Progreat (Terumo)

    6. Embolisation
    - 40μm Tandem DEB-particles (CeloNova); loaded with 100 mg of Irinotecan
  • - ,

    Case 65 – Left sided chronic critical limb ischemia

    Case 65 – PAL 09: male, 72 years (N-C)
    Operators:
    • Marco Manzi,
    • Giuseppe Vadalà
  • - ,

    Case 32 – Chronic total occlusion left SFA

    Case 32 – LEI 11: male, 63 years (HJ-R)
    Operators:
    • Michael Piorkowski,
    • Matthias Ulrich,
    • Sabine Steiner
    Clinical data
    Rutherford 3, severe claudication left calf, 50 meters
    ABI right 0.6
    PTA / stent right SFA and EIA 2012

    Risk factors
    Former smoker, art. hypertension

    Angio
    Bilateral SFA-occlusion

    Procedural steps
    1. Retrograde cross-over approach with 7F sheath
    - 7F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the SFA-occlusion
    - 0.035" stiff, angled Terumo Glidewire, 260 cm (TERUMO)
    - Rubicon 0.035 Support-catheter, 135 cm (BOSTON SCIENTIFIC)
    - Exchange to a 0.018" SteelCore guidewire (ABBOTT)

    3. Predilatation
    - Sterling 5/120 mm balloon (BOSTON SCIENTIFIC)

    4. Implantation of a covered stent
    - Viabahn 6/250 mm (GORE)
  • - ,

    Case 44 – Abdominal aortic aneurysm 57 mm

    Case 44 – LEI 16: male, 75 years (W-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Bernd-Michael Harnoss
    Clinical data
    Progressive abdominal aortic aneurysm
    PAOD, Rutherford 5, minor gangrene dig 1 and 4 left
    Bypass-occlusion left (fem-pop)
    PTA of the SFA left 12/2013
    Arterial hypertension

    Procedural steps
    1. Bifemoral percutaneous approach in local anaesthesia
    - Preclosing with 2 Proglide-closure-devices both sides (ABBOTT)

    2. Guidewire-positioning
    - Lunderquist GW 180 cm (COOK)

    3. Implantation of a bifurcational stentgraft
    - Aorfix Endovascular Stentgraft (LOMBARD MEDICAL)

    4. PTA
    - proximal seal: Reliant-balloon (MEDTRONIC)
  • - ,

    Case 53 – Persistent Type II Endoleak after EVAR

    Case 53 – MUN 03: male, 79 years (B-S)
    Operators:
    • Arne Schwindt,
    • Najib Jawadi
    Clinical data
    2012 EVAR with Anaconda bifurcated Prothesis (Aorta-external iliac) with bilateral Amplatzer Plug embolisation of hypogastric artery
    12/2013 contained rupture of left hypogastric artery aneurysm due to persistent Type II Endoleak, treated by Onyx™ Embolisation
    Current status: persisting Type II Endoleak with aneurysm growth >8mm right hypogastric artery
    Comorbidities: CI, COPD, hypertension

    Procedural steps
    1. Right femoral approach
    - 5F 10 cm sheath with low puncture (Terumo)

    2. Cannulation circumflex femoral artery
    - 0.014" Choice PTII (Boston Scientific) and
    - 4F Glidecath (Terumo)

    3. Cannulation
    - 0.014" Echelon Microcatheter (Covidien)

    4. Embolisation
    - Ethylenvinyl Copolymer(Onyx™ 34) (Covidien)
  • - ,

    Case 33 – Occlusion left SFA

    Case 33 – LEI 12: 71 years (M-W)
    Operators:
    • Michael Piorkowski,
    • Sven Bräunlich
    Clinical data
    Rutherford 3, severe claudication left calf, ABI left 0.61
    PTA right EIA 12/2013
    CAD, PTCA 2010

    Risk factors
    Art. hypertension, smoker

    Angio
    Occlusion left SFA

    Procedural steps
    1. Right groin retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the SFA-occlusion and angioplasty
    - 0.035" stiff, angled Terumo Glidewire, 260 cm (TERUMO)
    - Powerflex balloon, 4/120mm (CORDIS)
    - Exchange to a 0.035” SupraCore guidewire, 300 cm (ABBOTT)

    3. Stent-Implantation
    - TIGRISR Vascular Stent (GORE)
  • - ,

    Case 53 – Persistent Type II Endoleak after EVAR

    Case 53 – MUN 03: male 79 years (B-S)
    Operators:
    • Arne Schwindt,
    • Najib Jawadi
    Clinical data
    2012 EVAR with Anaconda bifurcated Prothesis (Aorta-external iliac) with bilateral Amplatzer Plug embolisation of hypogastric artery
    12/2013 contained rupture of left hypogastric artery aneurysm due to persistent Type II Endoleak, treated by Onyx™ Embolisation
    Current status: persisting Type II Endoleak with aneurysm growth >8mm right hypogastric artery
    Comorbidities: CI, COPD, hypertension

    Procedural steps
    1. Right femoral approach
    - 5F 10 cm sheath with low puncture (Terumo)

    2. Cannulation circumflex femoral artery
    - 0.014" Choice PTII (Boston Scientific) and
    - 4F Glidecath (Terumo)

    3. Cannulation
    - 0.014" Echelon Microcatheter (Covidien)

    4. Embolisation
    - Ethylenvinyl Copolymer(Onyx™ 34) (Covidien)
  • - ,

    Case 66

    Case 66 – GAL 05: female, 43 years
    Operators:
    • Anthony Ryan,
    • Gerard O'Sullivan
  • - ,

    Case 44 – Abdominal aortic aneurysm 57 mm

    Case 44 – LEI 16: male, 75 years (W-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Bernd-Michael Harnoss
    Clinical data
    Progressive abdominal aortic aneurysm
    PAOD, Rutherford 5, minor gangrene dig 1 and 4 left
    Bypass-occlusion left (fem-pop)
    PTA of the SFA left 12/2013
    Arterial hypertension

    Procedural steps
    1. Bifemoral percutaneous approach in local anaesthesia
    - Preclosing with 2 Proglide-closure-devices both sides (ABBOTT)

    2. Guidewire-positioning
    - Lunderquist GW 180 cm (COOK)

    3. Implantation of a bifurcational stentgraft
    - Aorfix Endovascular Stentgraft (LOMBARD MEDICAL)

    4. PTA
    - proximal seal: Reliant-balloon (MEDTRONIC)
  • - ,

    Case 53b - Persisting type II endoleak after chimney EVAR with aneurysm growth > 10 mm

    Case 53b – MUN 03b: male, 90 years (S-M)
    Operators:
    • Arne Schwindt,
    • Najib Jawadi
  • - ,

    Case 34 – Total occlusion of right iliac arteries

    Case 34 – LEI 13: male, 62 years (I-R)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Saulius Korsakas
    Clinical data
    PAOD Rutherford 3-4,
    Severe claudication right thigh / calf
    Restpain / paraesthesia during night right foot
    PTA / stent of the left EIA
    CAD, MI 1986, EF 45%
    Minor stroke 2010
    Renal insufficiency (GFR 61ml /min)

    Risk factors
    Diabetes mellitus type 2, smoker, hyperlipidaemia

    Procedural steps
    1. Left brachial approach
    - 7F 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. In case of inability to pass the GW additional retrograde approach right groin
    - 7F and 11F 25 cm Introducer Sheath (TERUMO)

    4. Exchange
    - to 0.035" SupraCore 300 cm guide wires via groin-access (ABBOTT)

    5. Implantation
    - of Advanta V-12 Stentgrafts (MAQUET GETINGE GROUP)
    - Kissing-technique for the aortic bifurcation 9 mm diameter
  • - ,

    Case 54 – Pulmonary embolus

    Case 54 – COL 03: male, 53 years (D-M)
    Operators:
    • Gary Ansel,
    • Charles Botti,
    • Mitchell Silver,
    • John Phillips,
    • Michael Jolly,
    • Jefferson Lions
    Clinical data
    3 weeks post op right leg surgery, worsening dyspnea, former smoker, hypertension
    CT Pulmonary arteries – extensive bilateral pulmonary emboli in addition to a large saddle embolus

    Procedural steps
    1. Venous access
    - 7F Pinnacle sheath

    2. Lesion passage into the posterior tibial artery
    - Angiogram, Inferior vana cava

    3. IVC filter inserted
    - Celect femoral filter (COOK)

    4. Pulmonary artery angiogram

    5. Injection Tenecteplase 20 mg bilateral pulmonary arteries
  • - ,

    Case 55 – Upper extremity DVT

    Case 55 – COL 04: male, 44 years (S-A)
    Operators:
    • Gary Ansel,
    • Charles Botti,
    • Mitchell Silver,
    • John Phillips,
    • Michael Jolly
    Clinical data
    Facial infection treated with antibiotics & PICC line, arm swelling, on anticoagulants x 10 days, worse pain and swelling
    No previous history or family history of clotting disorder
    Venous ultrasound - brachial, axilla and subclavian vein clot

    Procedural steps
    1. Right femoral vein access
    - U/S guided access to brachial vein if needed (with snar to complete from groin)

    2. Angiojet thrombectomy with adjunctive pulse spray lysis

    3. Balloon angioplasty
    - 8-14 mm PTA balloon

    4. In lab lytic dwell, or continuous lytic infusion depending on outcome

    5. 3 months of anticoagulation post discharge
  • - ,

    Case 56 – Iliofemoral thrombus

    Case 56 – COL 05: female, 58 years (J-P)
    Operators:
    • Gary Ansel,
    • Charles Botti,
    • Mitchell Silver,
    • John Phillips,
    • Michael Jolly,
    • Jefferson Lions
    Clinical data
    Presents with 1 day left leg swelling
    PMH – Myasthenia gravis (remission),
    palindromic rheumatism, portal vein thrombosis,
    Former smoker
    Venous duplex – femoral vein and left iliac vein thrombus

    Procedural steps
    1. Venous access, right jugular vein 6F Pinnacle sheath
    - 45 cm 6F braided sheath (TERUMO)

    2. Angiogram inferior vena cava

    3. IVC filter placement
    - Celect Platinum jugular filter (COOK)

    4. Angiojet left femoral vein
    - Possis Solent Proxi thromb Set (MEDRAD)

    5. Angiojet left external iliac vein

    6. Angiojet left common iliac vein

    7. Peripheral angioplasty left common iliac vein
    - 8.0 x 40 FOX balloon (ABBOTT)

    8. Thrombolytic catheter left iliac vein
    - Angiodynamics INC Infusion catheter (ANGIODYNAMICS)
  • - ,

    Case 67 – Hypogastric Artery EndoRevascularization (Sandwich technique)

    Case 67 – SAO 02: male, 62 years
    Operators:
    • Armando Lobato,
    • Dino Colli,
    • Robert Guimaraes
    Clinical data
    Asymptomatic AAA associated with bilateral common iliac artery aneurysms and left hypogastric artery aneurysm (LHAA)
    AAA (40 mm), RCIAA (31 mm), LCIAA (29 mm) and LHAA (14 mm)

    Risk factors
    Arterial hypertension, former smoker, CAD, prostate cancer and lung cancer

    Procedural steps
    1. Deployment the main body of Endurant bifurcated stent-graft (Medtronic) through a femoral approach, leaving the distal end of the ipsilateral iliac limb 10 mm above the Hypogastric artery (HA) origin

    2. Cannulate the ipsilateral HA preferentially through a left brachial access using a long sheath (Destination 7F, 90 cm, TERUMO) and an extra-stiff guidewire (E-wire 260cm, JOTEC)

    3. Place the distal end of a Viabahn 8x100 (WL GORE) inside the HA

    4. Position an iliac limb extension (Endurant, MEDTRONIC) 10 mm below the proximal end of the Viabahn

    5. Deploy the iliac limb extension 16x13 (Endurant, MEDTRONIC) and model it using a latex balloon (Reliant, MEDTRONIC)

    6. Deploy the Viabahn 8x100 (WL GORE)

    7. Deploy the contralateral iliac limb 16x20 (Endurant, MEDTRONIC)
  • - ,

    Case 45

    Case 45 – HEI 04: male, 73 years (K-S)
    Operators:
    • Alexander Hyhlik-Dürr,
    • Dittmar Böckler,
    • Drosos Kotelis
  • - ,

    Case 35 – PAOD Rutherford III, CTO of the left superficial femoral artery, lesion length >25 cm

    Case 35 – BLN 04: male, 76 years (H-K )
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    Clinical data
    Symptomatic PAOD left calf
    Thrombolysis of the P1 bypass left 12/2012
    Stenting of the right external iliac artery in 12/2012
    Atrial fibrillation
    Hyperlipidemia, hypertension
    IDDM with nephropathy
    ABI right 0.90 left 0.48

    Angio
    Long stenotic lesion of the proximal left SFA and consecutive total occlusion of the medial SFA with reconstitution at the P1 Segment

    Procedural steps
    1. Right femoral crossover access
    - 6F sheath Destination (Terumo)

    2. Passing the left SFA
    - 0.035" hydrophilic guidewire and a Glidecatheter (Terumo)

    3. Exchange
    - to V18 control wire (Boston Scientific)

    4. PTA
    - 4 X 200 mm Vascutrak Scoring balloon for lesion preparation (Bard)

    5. PTA
    - Lutonix 5 mm ballons DEB (Bard)

    6. Stenting if needed
    - 6 mm LifeStent (Bard)

    7. Back-up Material
    - Outback-catheter for proper reentry (Cordis) or Offroad (Boston Scientific)
  • - ,

    Case 68 – Chronic total occlusion left SFA

    Case 68 – LEI 20: male, 66 years (R-B)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Michael Piorkowski,
    • Marcus Treitl
    Clinical data
    Rutherford 4, restpain and severe claudication left calf,
    ABI right 0.3
    Unsuccessful recanalization-attempt left SFA 1/2014 due to inability to enter the GW into the CTO from antegrade
    TEA left CFA and PTA/Stent EIA left 2009,
    CAD, EF 35%, ICD
    HLP with apheresis-therapy
    PTA of the apheresis-shunt left arm 1/2014

    Risk factors
    Former smoker, art. hypertension, HLP

    Procedural steps
    1. Right groin retrograde cross-over approach
    - 6F Balkin Up& Over Flexor Check-Flow Sheath, 40 cm (COOK)

    2. Retrograde puncture of the occluded SFA left
    - 18 Gauge 7 cm needle,
    - 0.035" stiff angled Terumo glidewire, 180 cm (TERUMO)
    - 6F 10 cm Terumo-steath

    3. Guidewire-passage
    - Reentry into the proximal stump of the occluded SFA
    - Pioneer reentry-catheter (VOLCANO)
    - Snaring of the guidewire from antegrade and
    - Antegrade GW-passage of the distal SFA

    4. Predilation and stenting
    - 6/120mm Pacific Extreme (MEDTRONIC)
    - Stenting from retrograde:
    - 6/150mm Supera Interwoven Nitinol-Stent (ABBOTT)
    - 10/40mm Smart Stent (CORDIS) proximal
    - Stenting of the distal SFA from antegrade:
    - 6/150mm Supera Interwoven Nitinol-Stent (ABBOTT)

    5. Closure of the groin access
    - Fish-closure device (MORRIS-INNOVATION)
  • - ,

    Case 58 – TIPS

    Case 58 – HEI 06: male, 56 years
    Operators:
    • Boris Radeleff,
    • Ulrike Stampfl,
    • K. H. Weiss,
    • N. Kortes,
    • Natalie Tessendorf
    Clinical data
    Therapy-refratory ascites (since 2005; last paracentesis 12/2013)
    due to a liver fibrosis with cirrhotic changes (histology 08/2013)
    and portal hypertension
    Recent CT scan without portal thrombosis
    Hepatic encephalopathy 0-I (08.2013)

    Procedural steps
    1. Transjugular venous access right side
    - 9F 20 cm sheath (Arrows)

    2. Puncture attempt
    - Right liver vein ➞ right PV TIPS-set (Optimed)
    - 0.035" superstiff wire (Boston Scientific)

    3. Predilatation
    - Mars balloon (Optimed)

    4. Stentgraft implantation
    - Viatorr-Stentgraft (Gore)
  • - ,

    Case 36 – Asymptomatic high grade stenosis left internal carotid artery, Asymptomatic stenosis left common carotid artery

    Case 36 – COL 01: male, 74 years (C-H)
    Operators:
    • Gary Ansel,
    • Charles Botti,
    • Mitchell Silver,
    • John Phillips,
    • Michael Jolly,
    • Jefferson Lions
    Clinical data
    S/P left CEA, HTN, EF 30%, CAD, IDDM, dyslipidemia, smoker

    Angio
    Common carotid artery left mid 70% stenosis, eccentric Internal carotid artery left mid 90% stenosis, eccentric

    Procedural steps
    1. 7Fr. Flexor sheath (COOK)

    2. Gore Embolic Filter (GORE)

    3. XACT stent (ABBOTT)
  • - ,

    Case 46 – Abdominal aortic aneurysm 55 mm

    Case 46 – LEI 17: male, 65 years (K-W)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Johannes Schuster
  • - ,

    Case 37 – Asymptomatic complex left internal carotid artery stenosis –SAPPHIRE WW study

    Case 37 – COL 02: female, 84 years (E-P)
    Operators:
    • Mitchell Silver,
    • Gary Ansel,
    • Charles Botti,
    • John Phillips,
    • Michael Jolly,
    • Jefferson Lions
    Clinical data
    Ischemic cardiomyopathy, HTN, hyperlipidemia, chronic lung disease,
    CAD s/p bypass, former smoker

    Angio
    internal carotid artery stenosis left 85%, complex

    Procedural steps
    1. Arterial access

    2. Angioguard EPD (Johnson & Johnson)

    3. Pre-dilation (possible)
    - Pre-dil balloon

    4. Stent deployment
    - Precise Pro RX (Johnson & Johnson)

    5. Post dilation
    - Post dil balloon (possible BSC Sterling)

    6. EPD retrieval

    7. Closure device
    - Perclose
  • - ,

    Case 69 – Right chronic critical limb ischemia

    Case 69 – PAL 10: female, 73 years (E-G)
    Operators:
    • Marco Manzi,
    • Fausto Castriota,
    • Giuseppe Vadalà
    Clinical data
    2009 CABG and PCI of LAD
    2013 PAOD treated by left SFA angioplasty
    2014 CLI: calcaneal wound
    Right SFA critical stenosis; anterior and posterior tibial arteries occlusion; popliteal and tibial arteries post-stenotic flow
    ABI: 0.48

    Risk factors
    Hypertension, hyperlipemia, diabetes type II

    Procedural steps
    1. Right Femoral antegrade access with a 6F sheath placement

    2. Retrograde Posterior Tibial access if needed

    3. Anterior and posterior tibial arteries recanalization with a
    - 0.014" wire Choice PT (BOSTON SCIENTIFIC)

    4. Predilatation with Amphirion Deep 2.5/150 mm balloon and dilatation
    - 3,0/200 mm balloon (MEDTRONIC)

    5. Drug eluting balloon
    - Lutonix (BARD)
  • - ,

    Case 47 – Juxtarenal AAA (Chimney technique)

    Case 47 – SAO 01: male, 79 years
    Operators:
    • Armando Lobato,
    • Dino Colli,
    • Marcello Cury
    Clinical data
    Asymptomatic juxtarenal AAA.
    CT-Angio: AAA (56 mm O), Proximal neck extension (lowest renal: 1 mm and highest renal: 5mm)

    Risk factors
    Arterial Hypertension, hyperlipidaemia, former smoker

    Procedural steps
    1. Cannulate both renal arteries preferentially through a left axillary artery open access using a Dryseal 18 F introducer (GORE), inside it 2 long sheaths (Destination 7F, 90 cm, TERUMO), and an extra-stiff guidewire (E-wire 260 cm, JOTEC)

    2. Place Viabahn 6x50 (GORE) inside both renal arteries

    3. Deployment the main body of Endurant bifurcated stent-graft (Medtronic) through a femoral approach, leaving the proximal cover stent juxta the SMA origin

    4. Model the Endurant using a latex balloon Reliant (MEDTRONIC)

    5. Deploy both Viabahns 6x50 (GORE)

    6. Deploy the Endurant contralateral iliac limb 16x13 (MEDTRONIC)
  • - ,

    Case 38 – Right renal artery critical stenosis

    Case 38 – PA 05: female 75 years (V.C.)
    Operators:
    • Giuseppe Vadalà,
    • Vincenco Pernice,
    • Sebastiano Lanteri
    Clinical data
    Moderate atherosclerosis of internal carotid arteries
    Uncontrolled hypertension (ACE inhibitors, Clonidine, furosemide, Ca-channel blockers and betablockers).
    Mild renal failure (GFV 52 ml/min). Worsening in the last month.
    Hypertensive Cardiomyopathy

    Duplex scan
    Right renal artery critical stenosis; PSV 3.5 m/sec; IR 0,80.

    Risk factors
    Hypertension, hyperlipemia, diabetes type II
  • - ,

    Case 59 – PAOD Rutherford III right leg, calcified high grade stenosis of the right SFA, lesion length 10 cm

    Case 59 – BLN 06: male, 71 years (H-G)
    Operators:
    • Ralf Langhoff,
    • Koen Deloose
    Clinical data
    Symptomatic PAOD right leg
    Stent-PTA of both SFA 2004/2006
    Re-PTA with POBA both SFA in 2010 and 2011
    CAD with CABG in 2006
    Hyperlipidemia, hypertension
    ABI 0.6 right, 0.9 left

    Angio
    Calcified lesion of the proximal right SFA with subtotal occlusion

    Procedural steps
    1. Left femoral crossover access
    - 7F sheath Destination (Terumo)

    2. Wire pasage of the lesion
    - 0,035" hydrophilic guide wire (Terumo)

    3. Lesion passage
    - 5F JR4 Diagnostic Catheter (Cordis)

    4. Wire exchange to
    - 6 mm Spider Protection device, 300cm (Covidien)

    5. Hawking the proximal lesion
    - Turbohawk C directional atherectomy device (Covidien)

    6. PTA
    - 5 x 100 mm Passeo 18 Lux DEB (Biotronik)

    7. Filter retrieval
    - JR4 Caheter

    8. Stenting if needed
    - 6 mm Smart Flex (Cordis)
  • - ,

    Case 39 – Aneurysm right renal artery

    Case 39 – LEI 14: male, 71 years (W-W)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Sabine Steiner
    Clinical data
    Incidental finding of an asymptomatic aneurysm of the right renal artery Surgery of rectal carcinoma 10/2012

    Risk factors
    Art. hypertension, HLP

    CTA-Angio
    30 mm diameter aneurysm of the right renal artery, 2 branches in the outflow

    Procedural steps
    1. Left groin retrograde access
    - 7F 55 cm Flexor Check-Flo Ansel-1-Mod. High-Flex Dilator (COOK)

    2. Guidewire-positioning
    - 0.018" SteelCore guidewire, 300 cm (ABBOTT)

    3. Implantation of a Multilayer-stent 8/60 (CARDIATIS)
  • - ,

    Case 48 – Juxtarenal aortic aneurysm 64 mm aneurysm

    Case 48 – MUN 02: male 65 years (H.H-J)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
  • - ,

    Case 60 – Chronic occlusion left SFA

    Case 60 – LEI 19: male, 57 years (J-M)
    Operators:
    • Jean-Paul de Vries,
    • Andrej Schmidt
    Clinical data
    Rutherford 3, claudication left leg
    ABI right 0.65
    Previous endovascular treatment of a Leriche-syndrome 12/2012 (CERAB-procedure)

    Angio
    Patent stentgrafts abdominal aorta and iliac arteries
    Chronic occlusion left SFA

    Procedural steps
    1. Antegrade approach left groin
    - 6F 10 cm Introducer sheath (TERUMO)

    2. Passage of the occlusion
    - 0.035" stiff, angled Terumo Glidewire, 260 cm (TERUMO)
    - Seeker 0.035" Support-catheter, 135 cm (C.R.BARD)
    - Exchange to a 0.018" V-18 Control guidewire (BOSTON SCIENTIFIC)

    3. Predilation of the lesion
    - Vascutrak 5.0/250 mm PTA Dilation Catheter (BARD)

    4. PTA with drug-eluting balloons
    - Legflow 6/150 mm Drug-Eluting Balloon (CARDIONOVUM)

    5. Stenting on indication
    - Supera Interwoven Nitinol-Stent (ABBOTT)

    6. Closure of the groin access
    - Fish-closure device (MORRIS-INNOVATION)

Conference day 3

  • - ,

    Case 88 – 3-Vessel Occlusion right BTK, CLI

    Case 88 – LEI 28: female, 77 years (T-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Bruno Freitas
    Clinical data
    PAOD Rutherford 5, ulceration forefoot right
    Stenting of a SFA-occlusion right 11/2013
    Failure to pass the TPT-occlusions right from antegrade 11/2013
    ABI right 0.32
    CAD, CABG 10/2013
    Art. Hypertension, diabetes mellitus type 2

    Procedural steps
    1. Antegrade access right groin
    - 5F 55 cm Flexor Check-Flo Introducer (COOK)

    2. Retrograde puncture of the peroneal artery and retrograde passage
    - 21 Gauge / 7 cm needle (COOK)
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Trail Blazer Supportcatheter, 90 cm (COVIDIEN)
    - Snaring of the retrograde GW to the antegrade sheath

    3. Antegrade implantation of DES
    - Xience Prime 3.5/38 mm (ABBOTT)
  • - ,

    Case 89 – Right sided chronic critical limb ischemia

    Case 89 – PAL 12: female, 71 years (C-M)
    Operators:
    • Marco Manzi,
    • Antonio Micari
  • - ,

    Case 70 – Calcified popliteal CTO

    Case 70 – BK 01: male, 73 years (X-X)
    Operators:
    • Thomas Zeller,
    • Aljoscha Rastan,
    • Elias Noory
    Clinical data
    Symptomatic claudication right calf, Fontaine IIb/ Rutherford 3
    Unsuccesful treatment attempt in referring hospital (unable to cross occlusion)

    Risk factors
    Hypertension, hypercholesteriemia, obesity

    Procedural steps
    1. Antegrade access right groin
    - 6F 11 cm sheath (Cordis)

    2. Crossing attempt of right APOP
    - 0.018" V18 wire (Boston Scientific)
    - Outback Reentry catheter (Cordis) on indication

    3. Predilatation and DEB treatment
    - Pacific and Pacific In.Pact balloon (Medtronic)

    4. Stent implantation
    - SUPERA-Stent (Abbott)

    5. Additional BTK treatment on indication
  • - ,

    Case 82 – Aortic dissection Stanford Type B

    Case 82 – HEI 06: male, 57 years (U-B)
    Operators:
    • Dittmar Böckler,
    • Alexander Hyhlik-Dürr,
    • Bischoff
    Clinical data
    Chronic expanding aortic dissection Stanford type B
    (max. diameter: 53 mm; progression: 3 mm/last 6 months; large entry tear: 28mm)
    COPD GOLD III
    History of smoking
    Arterial hypertension
    Hyperlipidemia

    Procedural steps
    1. Dyna-CT and fusion imaging
    - Artis Zeego/Leonardo (SIEMENS)

    2. Bifemoral cut-down

    3. Guidewire-positioning
    - Lunderquist GW 180 cm (COOK)

    4. Rapid pacing, TEE, spinal fluid drainage

    5. Implantation of a tapered stentgraft
    - Captiva (MEDTRONIC)
  • - ,

    Case 91 – Occlusion left tibio-peroneal-trunk and peroneal artery

    Case 91 – LEI 29: male, 70 years (A-B)
    Operators:
    • Kazushi Urasawa,
    • Johannes Schuster
  • - ,

    Case 71 – Short distal occlusion left SFA

    Case 71 – LEI 21: male, 78 years (H-M)
    Operators:
    • Sven Bräunlich,
    • Saulius Korsakas
  • - ,

    Case 98 – Resistent hypertension

    Case 98 – BK 08: male, 77 years
    Operators:
    • Elias Noory,
    • Thomas Zeller
  • - ,

    Case 90 – Recurrent ISR left SFS, popliteal artery and ATA origin, chronic occlusion of TPT

    Case 90 – BK 06: male, 69 years (X-X)
    Operators:
    • Thomas Zeller
    Clinical data
    PAOD Rutherford 5 left leg, non-healing ulcer big toe since 1/2013
    Angioplasties left femoro-popliteal axis &
    ATA 1/2008, 3/2008, 6/2008, 4/2009, 8/2009, 1/2011
    Failed bypass surgery 05/2013

    Risk factors
    Hypertension, hypercholesteremia, diabetes mellitus type II, tobacco abuse

    Procedural steps
    1. Retrograde cross-over access right groin
    - 8F 45cm Destination sheath (Cook)
    - 6F IMA diagnostic catheter (Cordis)
    - 0.035" Radiofocus stiff wire (Terumo)

    2. Crossing attempt of occlusion
    - 5F vertebral diagnostic catheter (Cordis)
    - 0.035" and 0.018" Radiofocus stiff wire (Terumo)

    3. Recanalisation procedure SFA & PA & ATA
    - Rotational thrombectomy (Straub Medical)
    - 5 mm drug eluting balloons (In.PACT Pacific, Medtronic)

    Recanalisation procedure TPT, PTA & PA
    - Retrograde access via distal PTA
    - 0.014 Pilot 150 wire (Abbott) / 0.018" V18 Control wire (Boston Scientific)
    - Pro 14 balloon catheter, 50cm shaft (Joline)
    - Lutonix 0.014 DEB (Bard) or Xience BTK DES (Abbott) on indication
    - Outbach Reentry catheter (Cordis) on indication
  • - ,

    Case 72 – SFA-re-occlusion right

    Case 72 – LEI 22: male, 60 years (HA-V)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Sabine Steiner
    Clinical data
    PAOD Rutherford Class 3, severe claudication right calf
    PTA right SFA 1/2010
    PTA left SFA 12/2013 with DEBs

    Risk factors
    Art. hypertension, HLP, current smoker

    Angio
    Occlusion right mid SFA

    Procedural steps
    1. Left groin retrograde and cross-over access
    - 7F 40 cm Balkin Up & Over sheath (COOK)

    2. Passage of the occlusion
    - 0.018" 12g Victory 0.018" guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" QuickCross support-catheter, 135 cm (SPECTRANETICS)

    3. Atherectomy and PTA of the lesion
    - 7F Tandem Booster-laser (SPECTRANETICS)
    - LegFlow DEB 5/150 mm (CARDIONOVUM)
  • - ,

    Case 73 – Chronic occlusion of right superficial femoral artery

    Case 73 – BK 02: male, 70 years (X-X)
    Operators:
    • Thomas Zeller,
    • Peter Flügel
    Clinical data
    PAOD Rutherford 3, rhagade of left heel
    History: Aneurysma of common iliac arteries
    5/2013: endovascular excluded with Implantation of aorto- bi-iliac endoprosthesis
    19.12.2013: rotarex-thrombectomy after occlusion of left iliac prosthesis leg

    Risk factors
    Hypertension, hypercholesteriemia

    Procedural steps
    1. Antegrade left femoral access
    - 7F 11 cm sheath Avanti (Cordis)

    2. Crossing attempt of left SFA origin
    - 0.014" Radiofocus wire (Terumo) or Pilot 200 (Abbott Vascular)
    - Total Cross support catheter (Medtronic)

    3. Atherectomy & DEB superficial femoral artery
    - Jetstream Navitus 2,1/3 mm (Bayer)
    - 0.014" Grand Slam wire 300 cm (Asahi Intecc)
    - DCB-PTA In.Pact Pacific (Medtronic)
  • - ,

    Case 84a – Abdominal aortic aneurysm 57 mm

    Case 84a – LEI 27a: male, 73 years (J-T)
    Operators:
    • Reza Ghotbi,
    • Andrej Schmidt
    Clinical data
    Progressive abdominal aortic aneurysm
    CAD, PTCA in MI 12/2010
    Arterial hypertension, hyperlipidemia, diabetes mellitus
    Renal insufficiency (GFR 77ml/min)

    Procedural steps
    1. Bifemoral percutaneous approach in local anaesthesia
    - Preclosing with 2 Proglide-closure-devices each side (ABBOTT)

    2. Guidewire-positioning
    - Lunderquist Extra Stiff Wire Guide 180 cm (COOK)

    3. Implantation of a Gore Excluder Iliac branch endoprosthesis (IBE)from left (GORE)

    4. Implantation of the main body
    - C3 Gore Excluder (GORE)

    5. Implantation of a bridging stentgraft between IBE and C3 main body
  • - ,

    Case 84b – Surgical / endovascular repair of a thoracoabdominal aortic dissection

    Case 84b – LEI 27b: male, 35 years (R-S)
    Operators:
    • Farhad Bakhtiary,
    • Michael Borger,
    • Michael Piorkowski,
    • Sven Bräunlich
    Clinical data
    Marfan-syndrome
    Surgical repair of a type-B-dissection 6/2012 with reinsertion of intercostal and visceral arteries
    AV-reconstruction and Hemashield of the ascending aorta 1/2014
    progressive abdominal aneurysm with dissection
    Coiling of the IMA and lumbar arteries 1/2014

    CT
    55 mm dissected abdominal aneurysm
    Origin oft left subclavian artery within aneurysm
    Descending thoracic aorta diameter 42mm

    Procedural steps
    1. Percutaneous approach
    - Preloading with 2 Proglide-closure-devices each groin (ABBOTT)

    2. Guidewire-positioning
    - 0.035" Lunderquist 180 cm (COOK)

    3. Implantation of a thoracic and abdominal stentgraft
    - CTAG (GORE)
    - C3 Excluder bifurcated stentgtaft (GORE)
  • - ,

    Case 74 – Thrombotic occlusion of popliteal artery right

    Case 74 – LEI 23: male, 78 years (H-R)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich,
    • Saulius Korsakas
    Clinical data
    PAD Fontaine III, rest pain foot
    Critical limb ischemia, ABI right 0.3
    Previous implantation of a Zilver-PTX-Stent 1/2012

    Angio
    Occlusion right popliteal artery (new since 1/2012)

    Procedural steps
    1. Antegrade approach
    - 6F sheath, 45 cm (COOK)

    2. Passing the poplitea and tibioperoneal trunk
    - 0.018" V-18 (BOSTON SCIENTIFIC)

    3. Rotarex thrombectomy (STRAUB MEDICAL)

    4. If needed, dilatation of popliteal artery
    - 5/120 mm InPact Pacific drug-eluting balloon (MEDTRONIC)
  • - ,

    Case 92 – Left superficial femoral artery in-stent chronic occlusion

    Case 92 – PAL 13: male, 67 years (F.F.)
    Operators:
    • Antonio Micari,
    • Giuseppe Vadalà
    Clinical data
    PAOD: 2011 left SFA angioplasty and stenting
    December 2013 bilateral severe claudicatio (FWI 100 mts)
    Angiography: right SFA critical stenosis. Left SFA instent reocclusion
    December 2013: Right SFA angioplasty
    ABI: 0.74

    Risk factors
    Hypertension, hyperlipemia, diabetes type II., nicotine abuse

    Procedural steps
    1. Contralateral femoral access and placement of a cross-over sheath
    - JR 5F diagnostic catheter, idrofilic 0.035" Terumo soft wire, 0,035" SupraCore wire (Abbott), 6F 45 cm long Destination sheath (Terumo)

    2. Crossing the occlusion
    - 0.035" stiff wire (Terumo)

    3. Lesion pre-dilatation

    4. Laser debulking
    - Turbotandem (Spectranetics)

    5. Dilatation
    - Inpact Admiral balloons 5.0/120 mm (Medtronic)

    6. Spot stenting if needed
  • - ,

    Case 93 – In-stent reocclusion right SFA

    Case 93 – LEI 30: female, 76 years (E-K)
    Operators:
    • Michael Piorkowski,
    • Johannes Schuster
    Clinical data
    PAOD Rutherford 4, restpain right foot
    PTA left SFA 3/2013, reocclusion 7/2013
    PTA / stent right SFA 5/2012
    PTA / stent right EIA 12/2013
    Diabetes mellitus type 2, art. hypertension, hyperlipidemia

    Procedural steps
    1. Left femoral retrograde and cross-over access
    - 7F 40 cm Balkin Up&Over sheath (COOK)

    2. Guidewire-passage
    - 0.035" (Terumo)
    - QuickCross 0.035" support-catheter, 135 cm (SPECTRANETICS)
    - Command ES 0.014" guidewire, 300 cm (ABBOTT)

    3. Atherectomy
    - 7F Tandem Booster Laser (SPECANETICS)
    - Spiderfilter 6 mm (COVIDIEN)

    4. PTA with DEBs
    - Lutonix 5/120 mm (BARD)
  • - ,

    Case 85

    Case 85 – HEI 07: male, 73 years (H-M)
    Operators:
    • Dittmar Böckler,
    • Hakimi,
    • Bischoff
  • - ,

    Case 75 – In-stent occlusion of the left superficial femoral artery (SFA)

    Case 75 – BK 03: female, 66 years (X-X)
    Operators:
    • Thomas Zeller,
    • Elias Noory
    Clinical data
    PAOD Rutherford 3, claudication after 50 meters left calf
    Recanalization and DES of the distal part,
    DEB-PTA of the mid part of the left SFA 11/2012

    Risk factors
    Diabetes, smoker

    Procedural steps
    1. Antegrade femoral access
    - 6F/8F Avanti sheath (Cordis)
    - Recanalization attempt, 0.018" Radiofocus Glidewire (Terumo), 4x120 mm PacificPlus-Balloon (Medtronic)

    2. Thrombectomy of the SFA
    - 6F/8F Rotarex-Device (Staub Medical)

    3. PTA with DEB and stenting on indication
    - Admiral 5/6x200-250 mm Balloon (Medtronic)
    - In.Pact Pacific 5/6x120 mm DEB-Balloon (Medtronic)
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    Case 94 – Endovenous radiofrequency ablation of varicose veins

    Case 94 – LEI 31: female, 51 years (D-U)
    Operators:
    • Matthias Ulrich,
    • Martin Mory
    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 right lower leg calf with a 7F sheath

    3. Placement of the VNUS Closure (Covidien) 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 catheter

    5. Treatment from proximal to distal

    6. Application of 1% polidocanol foam sclerotherapy (Kreussler) in tributaries distally with use of ultrasound guidance
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    Case 86 – Thoracic aortic aneurysm, short distal neck

    Case 86 – MUN 06: male, 82 years (K-I)
    Operators:
    • Martin Austermann
    Clinical data
    Arterial hypertension
    CAD – MI 1997
    Renal impairment due to nephrectomie right side
  • - ,

    Case 76 – Chronic atheriosclerotic occlusion of left mid superficial femoral artery

    Case 76 – BK 04: male, 54 years (X-X)
    Operators:
    • Thomas Zeller,
    • Uwe Schwarzwälder
    Clinical data
    PAOD Rutherford 2-3
    Calf claudication after 400 meters with life-style limitation left leg

    Risk factors
    Hypertension, hypercholesterinemia, former tobacco abuse
    ABI at rest: 0.92/0.6

    Oscillography
    Left leg: flattend curves at calf & ankle

    Duplex
    Approximately 10 cm long echo dense occlusion of mid SFA

    Procedural steps
    1. Antegrade access left groin
    - 7F 11 cm Avanti sheath (Cordis)
    - Recanalization attempt, 0.018" Radiofocus Glidewire (Terumo), 4 x 120 mm PacificPlus-Balloon (Medtronic)

    2. Crossing attempt
    - 0.018" or 0.035" Radiofocus stiff wire (Terumo)
    - 5F vertebral diagnostic catheter (Cordis)

    3. Directional atherectomy mid SFA
    - 0.014" Galeo ES guidewire (Biotronik)
    - Silverhawk LX-M atherectomy catheter (Covidien)

    4. Drug eluting Balloon angioplasty
    - In.PactAdmiral or Pacific balloon 6/120 mm (Medtronic)
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    Case 95 – Chronic venous insufficiency of the great saphenous vein left leg

    Case 95 – BK 07: male, 64 years
    Operators:
    • Thomas Schwarz
    Clinical data
    CEAP C 4 with skin pigmentation, visible varicose veins of side branches at the calf area
    No acute phlebitis
    Clinical complaints: swelling of the extremity

    Risk factors
    Family history of varicose veins
    Obesity

    Procedural steps
    1. Retrograde access left proximal calf
    - 1470 nm diode laser (Biolitec, Germany)
    - 16 G access cannula
    - 5F Radial fiber Slim (Biolitec, Germany)

    2. Tumescent local anaestesia (ultracain)

    3. Linear endovenous energy density (LEED): 60 Joule / cm vein

    4. Laser energy: 8 Watt

    5. Foam sclerotherapy with 1% polidocanol to treat side branches after laser procedure
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    Case 77 – Anterior tibial artery occlusion left

    Case 77 – LEI 24: male, 77 years (E-A)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Saulius Korsakas
    Clinical data
    PAOD Rutherford 5, gangrene Dig II left foot
    and Minor amputation left Dig II
    Failure to pass the functional ATA-occlusion 1/2014

    Risk factors
    Art. hypertension

    Procedural steps
    1. Antegrade access left groin
    - 5F 55 cm Flexor Check-Flo Introducer (COOK)

    2. Second antegrade recanalization-attempt, in case of failure retrograde
    - 21 Gauge / 4 cm needle (COOK)
    - 0.014" V-14 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Total across support-catheter, 100 cm (MEDTRONIC)
    - Snaring of the retrograde GW to the antegrade sheath

    3. Antegrade angioplasty
    - Chocolate-balloon (TRIREME MEDICAL)
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    Case 78 – Asymptomatic high grade recurrent stenosis right ICA

    Case 78 – MUN 05: male, 60 years (D-F)
    Operators:
    • Arne Schwindt,
    • Najib Jawadi
  • - ,

    Case 96 – Treatement of varicose veins with ClariVein Occlusion Catheter

    Case 96 – LEI 32: female, 62 years (H-C)
    Operators:
    • Matthias Ulrich,
    • Johannes Schuster
    Clinical data
    CVI II (Widmer)
    Dysaesthesia and chronic oedema right lower leg
    Night Cramps in the calf

    Procedural steps
    1. Duplex ultrasound of the varicose veins

    2. Retrograde access GSV right lower leg with a 4F sheath

    3. Placement of the ClariVain Device into the GSV until 1 cm up to the sapheno-femoral junction

    4. Treatment from proximal to distal, simultaneously application of 2% Aethoxysklerol®
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    Case 79 – Symptomatic critical stenosis of the brachiocefalic trunk

    Case 79 – PAL 11: male, 76 years (A-C)
    Operators:
    • Fausto Castriota,
    • Vincenco Pernice,
    • Giuseppe Vadalà
  • - ,

    Case 97 – Chronic total occlusion left SFA

    Case 97 – LEI 33: male, 59 years (D-S)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Saulius Korsakas
  • - ,

    Case 87 – Abdominal aneurysm 61 mm

    Case 87 – MUN 07: male, 75 years (P-H)
    Operators:
    • Bernd Gehringhoff,
    • Najib Jawadi
  • - ,

    Case 80

    Case 80 – BK 05: female, 86 years
    Operators:
    • Thomas Zeller,
    • Aljoscha Rastan
  • - ,

    Case 97b

    Case 97b – LEI 33bis:
  • - ,

    Case 81 – Popliteal aneurysm / Stenosis left SFA

    Case 81 – LEI 25: male, 69 years (K-P)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich,
    • Saulius Korsakas
    Clinical data
    PAOD Rutherford Class 3, severe claudication left calf
    Infrarenal aortic aneurysm (diameter 46 mm)
    Aorto-bifemoral bypass 1998
    Resektion distal SFA (aneurysm) 2007

    Risk factors
    Art. hypertension, HLP

    CT-Angio
    Anastomosis-aneurysms of the aortobifemoral bypass
    Aneurysmatic disease of the right SFA/Apop and left Apop
    High-grade, calcified stenosis left SFA

    Procedural steps
    1. Left groin antegrade access
    - 7F 10 cm sheath (TERUMO)

    2. Balloon-angioplasty of the SFA-stenosis
    - 0.018" SteelCore guidewire, 300 cm (ABBOTT)
    - Armada 35 7/8 mm/40 mm Balloon (ABBOTT)

    3. Stenting
    - Proximal stenosis: SUPERA Interwoven Nitinol-Stent (ABBOTT)
    - Aneurysm: Viabahn covered stentgraft (GORE)

Conference day 4

  • - ,

    Case 99 – Abdominal aortic aneurysm 54 mm

    Case 99 – MUN 08: male, 63 years (N-H)
    Operators:
    • Bernd Gehringhoff
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    Case 102 – Occlusion of the aortic bifurcation and iliac arteries

    Case 102 – LEI 15: male, 54 years (E-R)
    Operators:
    • Dierk Scheinert,
    • Michael Piorkowski,
    • Saulius Korsakas
    Clinical data
    PAOD Rutherford 3, walking capacity 50 meters
    Severe claudication bilateral buttock, thigh, calf
    CAD, PTCA 10/2013

    Risk factors
    Diabetes mellitus type 2, smoker, hyperlipidaemia

    Procedural steps
    1. Left brachial approach
    - 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 300cm guidewires via groin-access (ABBOTT)

    5. PTA of the occlusion
    - Admiral 5/80 mm (MEDTRONIC)

    6. Stenting
    - Aorta: Advanta 12 Covered Stent 12/61 mm (MAQUET)
    - Iliac arteries: Advanta 12 Covered Stents 7/59 mm (MAQUET)
    - EIA bilateral: Complete 9/120 (MEDTRONIC)
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    Case 100 – Typ I a endoleak after EVAR

    Case 100 – LEI 34: male, 63 years (A-S)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski
    Clinical data
    Type I a endoleak after EVAR 10/2013
    Abdominal aneurysm 75mm
    CAD, MI 12/2010, PTCA
    Permanent arterial fibrillation
    Pulmonary hypertension
    Renal insufficiency (GFR 65ml/min)

    Risk factors
    Smoker, hyperlipidaemia

    Procedural steps
    1. Right groin access
    - 16F 30 cm sheath (COOK)

    2. Guidewire
    - 0.035" Lunderquist 180 cm (COOK)

    3. Endovascular Stapler (APTUS)
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    Case 103 – Symptomatic occlusion of the left subclavian artery

    Case 103 – LEI 36: male, 57 years (N-J)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich,
    • Sabine Steiner
    Clinical data
    Subclavian steal syndrom
    Vertigo and claudication both arms, left >> right
    RR brachial right: 180 mmHg systolic
    RR brachial left: 110 mmHg systolic
    Hypertension, hyperlipidemia, diabetes mellitus 2

    Procedural steps
    1. Right femoral access and placement of an 8F sheath
    - 8F Judkins Right guiding catheter (MEDTRONIC)

    2. Left brachial access and placement of a 6F sheath
    - 6F Flexor Check-Flo Performer Introducer Sheath, 55 cm (COOK)

    3. Wiring the occlusion
    - 0.018" Victory 12 or 18 g guide wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Radiofocus Terumo angled stiff guide-wire, 260 cm (TERUMO)

    4. PTA and stent implantation
    - 5.0/40 Mustang balloon (BOSTON SCIENTIFIC)
    - 8.0/28 mm Omnilinc Ballon-Expandable Stent (ABBOTT)
  • - ,

    Case 101 – Juxtarenal aortic aneurysm 54 mm narrow iliac arteries

    Case 101 – MUN 09: male, 60 years (G.-O.L.)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
    Clinical data
    Art. hypertension
    MS
    CAD

    Procedural steps
    1. Percutanous approach both groins
    - Prostar XL (Abbott)

    2. 14F sheath (Cook)

    3. Cut down left axillary artery and double puncture

    4. Placement of two 7F shuttle sheaths

    5. Cannulation of both renal arteries
    - 7F shuttle sheath (Cook)

    6. Placement of Endurant bifurcated endograft (Medtronic) just below the SMA

    7. Placement of the chimney stent-grafts (Advanta-Atrium) in both renal arteries
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    Case 104 – Occlusion left SFA

    Case 104 – LEI 37: male, 71 years (W-B)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Saulius Korsakas