LINC 2014 live case guide

Find all Live Cases and operators listed below.

Conference day 2

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    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)
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    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)
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    Case 61 – Rutherford class 3 left leg: CTO SFA

    Case 61 – MUN 04: male, 69 years (R-W)
    Operators:
    • Bernd Gehringhoff,
    • Najib Jawadi
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    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)
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    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)
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    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
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    Case 41 – Symptomatic PAOD left leg

    Case 41 – BLN 05: female, 45 years (S-V)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
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    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
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    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)
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    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)
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    Case 51 – Varicocele Embolisation

    Case 51 – GAL 04: male, 29 years
    Operators:
    • Gerard O'Sullivan,
    • Anthony Ryan
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    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
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    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
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    Case 65 – Left sided chronic critical limb ischemia

    Case 65 – PAL 09: male, 72 years (N-C)
    Operators:
    • Marco Manzi,
    • Giuseppe Vadalà
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    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)
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    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)
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    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)
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    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)
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    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)
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    Case 66

    Case 66 – GAL 05: female, 43 years
    Operators:
    • Anthony Ryan,
    • Gerard O'Sullivan
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    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)
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    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
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    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
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    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
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    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
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    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)
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    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)
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    Case 45

    Case 45 – HEI 04: male, 73 years (K-S)
    Operators:
    • Alexander Hyhlik-Dürr,
    • Dittmar Böckler,
    • Drosos Kotelis
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    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)
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    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)
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    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)
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    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)
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    Case 46 – Abdominal aortic aneurysm 55 mm

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