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
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    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)
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    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
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    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
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    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
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    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)