LINC 2014 live case guide

Find all Live Cases and operators listed below.

Conference day 3

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    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)
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    Case 89 – Right sided chronic critical limb ischemia

    Case 89 – PAL 12: female, 71 years (C-M)
    Operators:
    • Marco Manzi,
    • Antonio Micari
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    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
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    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)
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    Case 91 – Occlusion left tibio-peroneal-trunk and peroneal artery

    Case 91 – LEI 29: male, 70 years (A-B)
    Operators:
    • Kazushi Urasawa,
    • Johannes Schuster
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    Case 71 – Short distal occlusion left SFA

    Case 71 – LEI 21: male, 78 years (H-M)
    Operators:
    • Sven Bräunlich,
    • Saulius Korsakas
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    Case 98 – Resistent hypertension

    Case 98 – BK 08: male, 77 years
    Operators:
    • Elias Noory,
    • Thomas Zeller
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    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
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    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)
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    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)
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    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
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    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)
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    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)
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    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
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    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)
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    Case 85

    Case 85 – HEI 07: male, 73 years (H-M)
    Operators:
    • Dittmar Böckler,
    • Hakimi,
    • Bischoff
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    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
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    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
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    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
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    Case 97 – Chronic total occlusion left SFA

    Case 97 – LEI 33: male, 59 years (D-S)
    Operators:
    • Andrej Schmidt,
    • Michael Piorkowski,
    • Saulius Korsakas
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    Case 87 – Abdominal aneurysm 61 mm

    Case 87 – MUN 07: male, 75 years (P-H)
    Operators:
    • Bernd Gehringhoff,
    • Najib Jawadi
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    Case 80

    Case 80 – BK 05: female, 86 years
    Operators:
    • Thomas Zeller,
    • Aljoscha Rastan
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    Case 97b

    Case 97b – LEI 33bis:
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    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)