LINC 2015 live case guide

Find all Live Cases and Live Case Centers listed below.

Conference day 1

  • - , Main Arena 2

    Case 11 – Iliofemoral venous intervention

    Center:
    Berne
    Case 11 – BER 01: female, 71 years (B-M)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Past Medical History:
    Iliac vein thrombosis left side in 2012 (May Thurner) treated with CDT (EKOS) and 2 overlapping stents in common and external iliac veins

    VTE-RISK FACTORS
    Chronic venous insufficiency (ulcer, varicose veins), smoking
    Currently no anticoagulation therapy

    PRESENT COMPLAINT
    Chronic venous insufficiency left leg with:
    Mild leg swelling (2 cm plus in thigh circumference) / No venous claudication
    Hyperpigmentation, varicose veins

    DUPLEX
    Popliteal & femoral veins: patent / Common femoral vein: patent
    External and common iliac veins: instent restenosis

    PROCEDURAL STEPS
    1. Local anaesthesia with standby

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

    3. Wire crossage
    - 0.035" stiff angled (TERUMO)

    4. Phlebography, IVUS

    5. Predilatation
    - Atlas Balloon 12–14 mm (BARD), Aspirex 10F (STRAUB MEDICAL) thrombectomy depending on thrombus load

    6. Implantation of dedicated Iliac vein stents over TERUMO stiff angled wire 0.035"
    - Sinus-Obliquus 14–16 mm (OPTIMED),
    - Sinus-XL Flex 14–16 mm (OPTIMED)
    - Vici 14–16 mm (Veniti)

    7. High-pressure postdilation of stents
    - Atlas Balloon 14–16 mm (BARD)
    View image
  • - , Main Arena 1

    Case 01 – Calcified SFA occlusion left

    Center:
    Leipzig
    Case 01 – LEI 01: male , 60 years (U-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Claudication intermittens bilateral,
    150 meter walking capacity, calf-pain left > right
    Art. hypertension, former smoker

    ABI
    Left 0,52; right 0,66

    DUPLEX
    Severely calcified SFA bilateral

    ANGIOGRAPHY
    Short occlusion distal SFA left, severe calcification

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 6F Balkin Up&Over 40 cm sheath (COOK)

    2. Passage of the occlusion
    - 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
    - SUPERA Interwoven Nitinol-Stent (ABBOTT)
    View image
  • - , Main Arena 2

    Case 12 – Acute ilio-femoral deep vein thrombosis

    Center:
    Galway
    Case 12 – GAL 01: male, 56 years old - carpenter
    Operators:
    • Gerard O'Sullivan,
    • Jean Marc Pernes,
    • Tony Lopez
  • - , Main Arena 2

    Case 13 – Iliofemoral venous intervention

    Center:
    Berne
    Case 13 – BER 02: female, 28 years (C-J)
    Operators:
    • Nils Kucher,
    • Torsten Fuß,
    • Frédéric Glause
    CLINICAL DATA
    Past medical history:
    Iliofemoral DVT left side in April 2014 treated conservatively
    VTE-Risk factors: history of distal DVT right leg 2007
    while on oral contraception and smoking
    Currently on anticoagulation therapy, compression stockings

    PRESENT COMPLAINT
    Chronic venous insufficiency left leg with:
    Moderate leg swelling despite compression therapy
    Severe venous claudication

    CT
    No clear signs of May Thurner present / external iliac vein occlusion
    Popliteal and femoral veins postthrombotic, common femoral and iliac veins occluded

    PROCEDURAL STEPS
    1. General anaesthesia, prone position, urinary catheter

    2. Venous access with ultrasound guidance in left popliteal
    - 7F destination sheath

    3. Wire crossage
    - TERUMO 0.035" stiff angled, 4F Berenstein catheter, torque device

    4. Phlebography, IVUS

    5. Predilation
    - Atlas Balloon 12–14 mm (BARD)

    6. Implantation of dedicated Iliac vein stents over TERUMO stiff angled wire 0.035"
    - Sinus-Obliquus 14–16 mm (OPTIMED),
    - Sinus-XL Flex 14–16 mm (OPTIMED)

    7. High-pressure post-dilation of stents
    - Atlas Balloon 14–16 mm (BARD)
    View image
  • - , Main Arena 2

    Case 14 – Endovascular treatment of a complex recurrent thrombosis

    Center:
    Galway
    Case 14 – GAL 02: female, 41 years
    Operators:
    • Gerard O'Sullivan,
    • Jean Marc Pernes,
    • Tony Lopez
    CLINICAL DATA
    Unusual presentation in 2008 with supra-renal IVC thrombosis and extensive right lower extremity DVT
    Suprarenal IVC filter placed
    Successfully treated by catheter directed thrombolysis and placement of tandem 12mm diameter, 90mm long Wallstent
    Patient could not tolerate balloon dilatation beyond 10 mm
    Fully anticoagulated
    Lost to follow up; represented in 2013 with varicose veins RLE. CEAP 4

    PROCEDURAL STEPS
    1. General anaesthetic, urethral catheter, supine position

    2. Mid thigh femoral venous access
    - 5F sheath; ascending venography
    - R IJV access; 55cm long sheath; 8F
    - 5000u IV Heparin
    - Upsize to 10F sheath R FV

    3. Attempt to cross occluded stent in R EIV from below and if necessary above
    - Stif glidewire; back end stiff glidewire; centring balloon technique CTO wire (Asahi Astata 30g with 2.5 mm balloon to back it up).
    - IF we get across; attempt to clear out stent with Rotarex (STRAUB MEDICAL).

    4. Exchange for a 180cm Amplatz wire
    - Pre dilate lesion with a high pressure balloon (BARD Atlas).
    - Stent lesion with a dedicated venous stent
    Veniti Vici 16 mm diameter, 120 mm long

    5. Repeat balloon dilatation to nominal diameter of stent
    - Confirm full stent expansion by IVUS (VOLCANO) and cone beam CT (SIEMENS).
    - Completion venography

    6. Radiofrequency ablation
    - IF ALL ABOVE SUCCESSFUL then; radiofrequency ablation to R GSV throughout its length (ClosureFast, COVIDIEN).

    7. Remove sheaths
    - Class 2 thigh high compression stockings (Jobst) for 6 weeks.
    - Full anticoagulation
    - Overnight thigh high sequential compression device (COVIDIEN).
    - Colour Doppler US day 1; CTV at 6/52
    View image
  • - , Main Arena 1

    Case 02 – SFA occlusion left

    Center:
    Leipzig
    Case 02 – LEI 02: male , 46 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication left leg, walking capacity 150 meters
    PTA of the right external iliac artery in 12/2014
    Thrombendartherectomy left groin 2012
    Failed recanalization-attempt lef SFA elsewhere 11/2014
    Art. hypertension, hyperlipoproteinemia

    ABI
    Left 0.67

    ANGIOGRAPHY
    During PTA right iliac artery: mid SFA-occlusion left, good run-off

    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 occlusion
    - 0.035" Seeker supportcatheter, 135 cm (BARD)
    - 0.035" angled stiff glidewire 260 cm (TERUMO)
    - I n case of failure retrograde approach via the distal SFA

    3. PTA
    - Vascutrak 5.0/250 mm Balloon (BARD)
    - Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)

    4. Stenting on indication
    in case of dissection:
    - INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
    View image
  • - , Technical Forum

    Case 24 – Right ICA postoperative re-stenosis CEA 1997

    Center:
    Berlin
    Case 24 – BLN 03: male, 60 years old (G. F.)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
  • - , Main Arena 1

    Case 02 – SFA occlusion left

    Center:
    Leipzig
    Case 02 – LEI 02: male , 46 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication left leg, walking capacity 150 meters
    PTA of the right external iliac artery in 12/2014
    Thrombendartherectomy left groin 2012
    Failed recanalization-attempt lef SFA elsewhere 11/2014
    Art. hypertension, hyperlipoproteinemia

    ABI
    Left 0.67

    ANGIOGRAPHY
    During PTA right iliac artery: mid SFA-occlusion left, good run-off

    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 occlusion
    - 0.035" Seeker supportcatheter, 135 cm (BARD)
    - 0.035" angled stiff glidewire 260 cm (TERUMO)
    - I n case of failure retrograde approach via the distal SFA

    3. PTA
    - Vascutrak 5.0/250 mm Balloon (BARD)
    - Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)

    4. Stenting on indication
    in case of dissection:
    - INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
    View image
  • - , Technical Forum

    Case 25 – Severe bilateral internal carotid artery stenosis

    Center:
    Cotignola
    Case 25 – COT 03: male, 80 years old (Q. F.)
    Operators:
    • Antonio Micari
  • - , Main Arena 2

    Case 17 – Retrograde recanalization of an SFA occlusion after surgery left groin

    Center:
    Leipzig
    Case 17 – LEI 08: male 60 years (HJ-S )
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Tomohara Dohi
    CLINICAL DATA
    Severe claudication left calf
    Stenting left iliac arteries and patch-plastic left groin 2008
    Unsuccessful recanalization attempt left SFA, failed guiewire-access
    into the SFA-occlusion 11/2014
    Arterial hypertension, diabetes mellitus type 2, smoker
    Renal insufficiency (GFR 56ml/min)

    ABI
    Left 0.46

    ANGIOGRAPHY
    Long occlusion left SFA, ostial stenosis of the deep femoral artery patent stents left iliac arteries.

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 7F Balkin Up & Over 40 cm sheath (COOK)

    2. Retrograde access: puncture of the occluded mid SFA left
    - 18 Gauge 7 cm needle
    - 0.035" stiff angled guidewire 30 cm (TERUMO)
    - 6Fr 10 cm sheath (TERUMO)
    - 5F Judkins Right diagnostic catheter (CORDIS)
    - 0.018" Connect 250 T Guidewire 300 cm (ABBOTT)
    - In case of failure exchange to 0.014" Floppy ES 300 cm guidewire (ABBOTT).
    - Outback Reentry catheter (CORDIS)

    3. Balloon-angioplasty and stenting
    - After snaring of the retrograde guidewire PTA with Savvy 5/120mm Balloon (CORDIS)
    - Smart Control Selfexpanding stent (CORDIS)
    - In case of bleeding at the retrograde access-site or groin-patch: Viabahn 7/100 mm covered stentgraft (GORE)
    View image
  • - , Global Expert Exchange

    Case 31 – Long CTO of left SFA

    Center:
    Sapporo
    Case 31 – SAP 02: male, 64 years (Y-S)
    Operators:
    • Kazushi Urasawa,
    • M. Tan
    CLINICAL DATA
    PAOD Rutherford 3, claudication both legs
    PTA and stenting at bi-lateral iliac arteries at 2009
    Claudication appeared again early last year
    Stenting for bi-lateral EIA and right SFA at 12/2014

    RISK FACTORS
    Ischemic heart disease, hypertension,
    diabetes mellitus type 2, dyslipidemia,
    CKD (hemodialysis dependent)

    ABI
    Right 1.15, left 0.87 (after EVT)

    PROCEDURAL STEPS
    1. Left common femoral access and ipsi-lateral antegrade approach
    - 6F Guiding sheath, Parent-Plus 23 cm (MEDIKIT)

    2. Retrograde puncture of the left distal SFA
    - 20G Introducer Needle (MEDIKIT)
    - Cruise 0.014" 225 cm (NEOS)
    - Promenent-NEO2 60 cm (TOKAI MEDICAL PRODUCTS)

    3. Antegrade wiring
    - 0.014" Harberd (Asahi Intec) supported by Prominent-NEO 135 cm

    4. Retrograde wiring
    - 0.014" Chevalier floppy (CORDIS Endovascular)
    - Wire rendez-vous technique within SFA-CTO

    5. PTA / stenting from antegrade
    - Coyote 3.0 x 220 mm (BOSTON SCIENTIFIC)
    - Sterling 5.0 x 220 mm (BOSTON SCIENTIFIC)
    - Smart Control (CORDIS)
    View image
  • - , Main Arena 1

    Case 03 – Occlusion mid SFA right

    Center:
    Leipzig
    Case 03 – LEI 03: male , 55 years (E-S)
    Operators:
    • Sven Bräunlich,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication intermittens right leg
    walking-capacity 200 meters
    PTA with drug-eluting balloons left SFA 11/2014
    Diabetes mellitus type 2, hyperlipidaemia

    ABI
    Right 0.66

    ANGIOGRAPHY
    10 cm long occlusion mid SFA right

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

    2. Passage of the occlusion
    - 0.035" CXI-support-catheter, straight tip, 135 cm length (COOK)
    - 0.018" Connect Flex guidewire, 300 cm (ABBOTT)

    3. Balloon-angioplasty and stenting
    - Advance 18 5.0/120 mm balloon (COOK)
    - Zilver-PTX 6.0/100 mm (COOK)
    View image
  • - , Main Arena 1

    Case 04 – Long SFA occlusion

    Center:
    Dendermonde
    Case 04 – DEN 01: male, 66 years (J-V)
    Operators:
    • Koen Deloose,
    • Lieven Maene
    CLINICAL DATA
    2008: CABG
    2009: Adenocarcinoma right colon (pT3N1): resection + adj. chemo smoking

    PRESENT STATE
    Claudication right > left after 100 m since 6 months
    DUS: Bilateral SFA occlusion
    CT angio

    PROCEDURAL STEPS
    1. Left CFA retrograde access

    2. Crossover procedure
    - RIM Catheter (COOK) + Roadrunner Uniglide 0.035"/260 cm stiff curved (COOK)

    3. Flexor sheath 6F, 45 cm (COOK)

    4. Roadrunner Uniglide 0.018"/260 cm (COOK) + 0.018" curved CXI Catheter 90 cm (COOK)

    5. Recanalization
    - by preference intraluminal (Plan B: subintimal)

    6. Predilatation
    - Advance 18LP balloon (COOK)

    7. Popliteal artery
    - DCB Advance PTX 0.018" balloon (COOK)

    8. SFA
    - Zilver PTX stent (COOK)
    View image
  • - , Main Arena 2

    Case 19 – Ilio-caval venous intervention and ovarian vein ablation

    Center:
    Berne
    Case 19 – BER 04: female 39 years, (C-M)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Past medical history:
    Bilateral iliofemoral DVT involving infrarenal VCI 2001 treated conservatively
    VTE-Risk factors: oral contraception, Faktor V Leiden
    Currently no anticoagulation therapy, compression stockings
    Endometriosis, WPW syndrome

    PRESENT COMPLAINT
    Chronic venous insufficiency both legs with:
    Mild leg swelling, Moderate venous claudication, cramps
    Severe pelvic congestions syndrome with abdominal and back pain, depending on menstrual cycle.

    DUPLEX
    Popliteal & femoral veins & external iliac veins: patent
    Iliac veins and IVC: postthrombotic high velocity flow without modulation
    MR venography: postthrombotic changes of IVC and left common iliac vein, right ovarian vein ectasia.

    CT
    Right ovarian vein (10 mm), postthrombotic infrarenal IVC

    PROCEDURAL STEPS
    1. General anaesthesia, supine position, urinary catheter

    2. Venous access in both common femoral (10F) and right jugular veins (6F)

    3. Wire crossage IVC from both femoral veins
    - TERUMO 0.035" stiff angled, 4F Berenstein catheter, torque device

    4. Phlebography, IVUS

    5. Right ovarian vein venography & embolization from jugular access
    - pushable Nester coils (COOK)

    6. Predilation IVC
    - Atlas Balloon 14–18 mm (BARD)

    7. Implantation of dedicated vein stents over TERUMO stiff angled wire 0.035" in IVC and kissing stents iliac veins
    - Sinus-XL 18–22 mm (OPTIMED) for IVC,
    - Sinus-XL Flex 14–16 mm (OPTIMED) for iliac veins

    8. High-pressure postdilation of stents
    - Atlas Balloon 14–18 mm (BARD)
    View image
  • - , Technical Forum

    Case 26 – Re-occlusion of left distal SFA and popliteal artery (POP)

    Center:
    Sapporo
    Case 26 – SAP 01: male, 53 years (M-T)
    Operators:
    • Kazushi Urasawa,
    • T. Haraguchi
    CLINICAL DATA
    POAD Rutherford 3, claudication left carf at less than 100 meters
    Stenting for left SFA and PTA for left POP 1/2014
    Claudication appeared again at 12/2014

    DUPLEX
    Dyslipidemia, diabetes mellitus type 2
    ABI: right 1.15, left unmeasureable
    CT images of left femoral artery

    PROCEDURAL STEPS
    1. Left common femoral access and ipsi-lateral antegrade approach
    - 6F Guiding sheath, Parent-Plus 23 cm (MEDIKIT)

    2. Retrograde puncture of the left distal PTA
    - 20G Introducer Needle (MEDIKIT)
    - Cruise 0.014" 225 cm (NEOS)
    - Promenent-NEO2 60 cm (TOKAI MEDICAL PRODUCTS)

    3. Antegrade wiring
    - 0.035" Redifocus small-J (TERUMO) supported by 4F angiographic catheter (CORDIS)
    - 0.014" Astatto XS9-12 (Asahi Intec) supported by Prominent-NEO 135cm (TOKAI MEDICAL PRODUCTS)

    4. Retrograde wiring
    - 0.014" Chevalier floppy (CORDIS Endovascular)
    - Wire rendez-vous technique within CTO lesion

    5. Thrombus aspiration
    - TVAC aspiration catheter (NIPRO)
    - Distal protection by external pressure cuff

    6. PTA/stenting from antegrade
    - Coyote 3.0 x 220 mm (BOSTON SCIENTIFIC)
    - Sterling 5.0 x 220 mm (BOSTON SCIENTIFIC)
    - Smart Control, if necessary (CORDIS)
    View image
  • - , Technical Forum

    Case 27 – SFA CTO

    Center:
    Sapporo
    Case 27 – SAP 01A: male, 91 years (H-Y)
    Operators:
    • Kazushi Urasawa,
    • Ryoji Koshida
    CLINICAL DATA
    PAOD Rutherford 2, claudication right calf at 300 meters

    RISK FACTORS
    Old cerebral infarction

    ABI
    Right 0.69, left 0.92

    PROCEDURAL STEPS
    1. Right common femoral access and ipsi-lateral antegrade approach
    - 6F guiding sheath, Parent-Plus 23 cm (MEDIKIT)

    2. Antegrade wiring
    - 0.014" Halberd (ASAHI INTEC) supported by Prominent-NEO 135 cm (TOKAI MEDICAL PRODUCTS)
    - 0.014" Astato XS9-12 (ASAHI INTEC)

    3. Retrograde wiring
    - 0.014" Cruise (Neos) supported by Prominent 135 cm (TOKAI MEDICAL PRODUCTS)
    - Guidewire rendez-vous technique within SFA-CTO

    4. PTA/Stenting from antegrade
    - Coyote 3.0 x 220 mm (BOSTON SCIENTIFIC)
    - Sterling 5.0 x 220 mm (BOSTON SCIENTIFIC)
    - Smart control, if necessary (CORDIS)
    View image
  • - , Main Arena 1

    Case 05 – Long SFA occlusion left leg

    Center:
    Leipzig
    Case 05 – LEI 04: male, 60 years (R-S)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt,
    • Tomohara Dohi
    CLINICAL DATA
    PAOD with claudication intermittens and restpain at night left leg
    PTA right SFA with drug-eluting balloons 12/2014
    Thrombendartherectomy left common femoral artery 10/2014
    Arterial hypertension
    Hyperlipoprotaeinemia
    Smoker

    ABI
    Left 0.61

    ANGIOGRAPHY
    During PTA right leg: long SFA-occlusion, moderate calcification

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 6F Balkin Up & Over 40 cm sheath (COOK)

    2. Guidewire passage
    - 0.035" QuickCross support-catheter 135 cm (SPECTRANETICS)
    - 0.035" TERUMO glidewire angled stiff, 300 cm (TERUMO)
    - 0.018" Victory 30g, 300 cm (BOSTON SCIENTIFIC)

    3. Predilatation and drug-eluting balloon treatment
    - Pacific 5/120 mm balloon (MEDTRONIC)
    - In.Pact 5.0/120 mm drug-coated balloon (MEDTRONIC)

    4. Stenting on indication
    - Complete 6.0/150 mm Selfexpanding Nitinol-stent (MEDTRONIC)
    View image
  • - , Global Expert Exchange

    Case 32 – Occlusion of the right tibioperoneal trunc

    Center:
    Berlin
    Case 32 – BLN 04: male, 60 years (W-P)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    CLI patient , wound right dig ped I, CTO of the tibioperoneal trunc, recanalisation of the SFA in cross-over technique 12/2014 with stenting, but still not complete healing

    RISK FACTORS
    Abdominal aortic aneurysm 4,0 cm, CAD, CABG in 1999, art. hypertension, hyperlipidaemia, IDDM.

    PROCEDURAL STEPS
    1. Antegrade punctering of the right CFA, insertion of a 4F Fortress 45 cm sheath

    2. Recanalisation of the tibioperoneal trunc
    - 0.018" Advantage wire (TERUMO)

    3. Predilatation
    - Arrow GPS 3 x 40 mm balloon catheter (TELEFLEX)

    4. Angiocontrol of the PTA result via balloon sideport

    5. Secondary stenting
    - 3.5 mm x 31 mm Cre8 BTK drug-eluting stent (ALVIMEDICA)

    6. Manual compression
    View image
  • - , Main Arena 1

    Case 06 – Right superficial femoral artery chronic total occlusion

    Center:
    Cotignola
    Case 06 – COT 01: male, 63 years old (I. E.)
    Operators:
    • Antonio Micari,
    • Alberto Cremonesi,
    • Giuseppe Vadalà
  • - , Technical Forum

    Case 28 – Occlusion of the right iliac arteries, aneurysm left iliac

    Center:
    Leipzig
    Case 28 – LEI 09: male, 76 years (M-M)
    Operators:
    • Dierk Scheinert,
    • Matthias Ulrich,
    • Tomohara Dohi
    CLINICAL DATA
    Restpain right leg, Rutherford class 4
    History of surgical aorto-biiliac prosthesis 1972, report can not be found
    Minor stroke 2011 before CEA of carotid artery stenosis right, art. hypertension

    ABI
    Right 0.4

    CT
    Severe calcification of the aortic bifurcation, 32 mm aneurysm left common iliac artery
    Former aortoiliac bypass can not be seen on CT

    PROCEDURAL STEPS
    1. Retrograde access both common femoral arteries
    - 7F-10 cm sheath (TERUMO)
    Left brachial access:
    - 5F diagnostic pigtail-catheter (CORDIS)
    - 0.035" soft angled short glidewire (TERUMO)
    - 0.035" SupraCore Guidewire 300 cm (ABBOTT)
    - 6F-90 cm Check-Flow Performer Sheath (COOK)

    2. Guidewire passage of the iliac occlusion right
    via brachial access:
    - 5F-125 cm Judkins Right diagnostic catheter (CORDIS)
    - 0.035" stiff angled TERUMO glidewire, 260 cm (TERUMO)
    - or 0.018" Connect 300 cm guidewire (ABBOTT)
    - Snaring of the wire into the retrograde sheath and passage of the contralateral common iliac artery occlusion via the brachial access.

    3. After Guidewire-passage PTA via the femoral access bilateral
    - Admiral 6/40 mm-balloon, 90 cm (MEDTRONIC)

    4. Stenting
    - via left groin: Sinus aortic stent 24-80 mm (OPTIMED)
    Implantation of covered stents into the aortic bifurcation:
    - 9/59 mm Lifestream covered stents (BARD)
    - 9/100 mm Fluency covered stent right external iliac artery (BARD)
    View image
  • - , Global Expert Exchange

    Case 33 – Retrograde recanalization of a tibioperoneal trunk occlusion

    Center:
    Leipzig
    Case 33 – LEI 10: male, 52 years (A-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Critical limb ischemia left with toe-ulcerations Dig 2 and 3
    PTA and stenting left SFA and failed recanalization attempt
    left tibioperoneal trunk 1/2015
    Diabetes mellitus type 2, arterial hypertension
    CAD with PTCA 11/2013
    Former smoker, renal insufficiency with GFR 55ml/min

    ANGIOGRAPHY
    During PTA of left SFA: Occlusion of the tibioperoneal trunk the peroneal and anterior tibial artery

    PROCEDURAL STEPS
    1. Left antegrade access
    ■ 5F – 55 cm Ansel Sheath (COOK)
    Retrograde access to the posterior tibial artery:
    ■ 7 cm 21 Gauge needle (COOK)
    ■ 0.018" Connect Guidewire 300 cm (ABBOTT)
    ■ 0.018" CXC Support-Catheter 90 cm (COOK)

    2. Guidewire exchange
    ■ After retrograde guidewire-passage and snaring from antegarde exchange to 0.014" PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)

    3. PTA and stenting
    ■ MiniTrek RX 4/20 mm PTCA Balloon (ABBOTT)
    ■ Cre8 4.0/48 mm Drug-Eluting Stent (ALVIMEDICA)
    View image
  • - , Main Arena 2

    Case 21 – CTO right distal SFA

    Center:
    Berlin
    Case 21 – BLN 04: male, 59 years old (F. G.)
    Operators:
    • Ralf Langhoff,
    • Normund Jabs
  • - , Main Arena 1

    Case 07 – Long SFA occlusion right

    Center:
    Dendermonde
    Case 07 – DEN 02: male, 83 years (E-V)
    Operators:
    • Koen Deloose,
    • Lieven Maene
    CLINICAL DATA
    1992: Aortobifemoral bypass
    2003: left CAS
    severe COPD
    smoking, hypercholesterolemia, arterial hypertension

    PRESENT STATE
    claudication right leg since 6 months, 50 m
    DUS: bilateral SFA occlusions
    MR angio

    PROCEDURAL STEPS
    1. Right CFA access anterograde
    - 6F BriteTip Sheath (CORDIS) 12 cm

    2. Predilatation
    - Passeo-18 (BIOTRONIK)

    3. Dilatation
    - DCB Passeo-Lux 0.018" (BIOTRONIK)

    4. Stenting
    - Pulsar-18 (BIOTRONIK)
    View image
  • - , Main Arena 1

    Case 08 – In-stent reocclusion left distal SFA / popliteal artery

    Center:
    Leipzig
    Case 08 – LEI 05: male, 72 years (R-T)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Tomohara Dohi
    CLINICAL DATA
    Severe claudication left calf, walking capacity 50 meters
    PTA of a restnosis of the SFA-ostium left with drug.-coated ballon 12/2014
    Stenting left SFA / popliteal artery 10/2013
    Thrombendartherectomy left groin /2013
    CAD and PTCA LAD 9/2013
    Arterial hypertension, diabetes mellitus, type 2, former smoker

    ABI
    Left 0.43

    ANGIOGRAPHY
    In-Stent occlusion distal SFA and P1/P2 popliteal artery left
    P3-segment significantly stenosed

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 7F 55 cm Ansel sheath (COOK)

    2. Guidewire passage
    - 0.035" QuickCross support-catheter 90 cm (SPECTRANETICS)
    - 0.035" Half stiff J-angled 300 cm (TERUMO)
    - exchange to 0.014" Floppy ES Guidewire 300 cm (ABBOTT)

    3. Filter-protection
    - WirionTM EPD-System (GARDIA MEDICAL)

    4. Laser-atherectomy
    - 7F Tandem Booster-Laser (SPECTRANETICS)

    5. PTA with drug-coated balloons
    - LegFlow OTW Drug-Coated Balloon (CARDIONOVUM)
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  • - , Main Arena 2

    Case 22 – Right common and superficial femoral artery severe stenosis

    Center:
    Cotignola
    Case 22 – COT 02: male, 78 years old (M. A.)
    Operators:
    • Giuseppe Roscitano,
    • Antonio Micari,
    • Chiara Grattoni
  • - , Global Expert Exchange

    Case 34 – Percutaneous deep venous arterialization (LimFlow procedure) - RECORDED CASE FROM SINGAPORE

    Center:
    Leipzig
    Case 34 – SIN 01: male 60 years
    Operators:
    • Steven Kum,
    • Andrej Schmidt
    CLINICAL DATA
    Left CLI (non healing forefoot wound)
    SFA TFT DES 8/2010
    SFA TFT Peroneal DEB 7/2011
    SFA Rotarex Peroneal POBA 4/2014
    SFA TFT Peroneal DEB 5/2014
    Failed retrograde DP 9/2014

    RISK FACTORS
    DM hypertension, CAD EF 45%, hyperlipidemia, smoker

    PROCEDURAL STEPS
    1. Antegrade 7F access
    - Retrograde posterior tibial vein (PTV) access (Ultrasound guided) micropuncture followed by COOK 5F x 45 cm Ansel sheath

    2. Antegrade LimFlow ‘Send’ Catheter 7F

    3. Retreograde LimFlow ‘Receive’ Catheter 5F

    4. Align and Crossover

    5. Predilatation crossover point

    6. Stent from TFT to PTV
    - Atrium 5 mm x 38 and Viabahn 5 mm

    7. Percutaneous Reverse Valvulotome
    View image
  • - , Main Arena 1

    Case 09 – Severely calcified restenosis (partially in-stent) left SFA

    Center:
    Leipzig
    Case 09 – LEI 06: male, 72 years (L-K)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf
    Stenting of the SFA left 2009 (Samba-stent)
    Thrombenarthererctomy left groin 2010
    PTA of the right SFA / stenting 1/2015
    CAD, multiple PTCAs
    Chronic heart failure (NYHA II)
    Chronic renal insufficiency (GFR 70ml/min)
    Art. hypertension, diabetes mellitus type 2

    ABI
    Left 0.64; right 0.82 (post stenting)

    ANGIOGRAPHY
    During PTA right SFA: in-stent reocclusion and severe calcification left SFA

    PROCEDURAL STEPS
    1. Right groin and cross-over access
    - 7F 40 cm balkin Up & Over sheath (COOK)

    2. Guidewire passage
    attempt to pass the occlusion from antegrade
    - QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)

    3. In case of failure retrograde stent-puncture
    - 7 cm 18 Gauge needle and
    - QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - Snaring of the guidewire from above

    4. PTA
    - Armada 35 5.0/120 mm Ballon (ABBOTT)
    - Potentially high-pressure balloon: Conquest 6/20 mm (BARD)

    5. Stenting
    - Supera interwoven nitinol-stent (ABBOTT)
    View image
  • - , Main Arena 2

    Case 23 – Ovarian and internal iliac vein embolization

    Center:
    Galway
    Case 23 – GAL 04: female, 36 years
    Operators:
    • Tony Lopez,
    • Gerard O'Sullivan,
    • Jean Marc Pernes
    CLINICAL DATA
    Noticed development of vulval varices after birth 2nd child and became much worse after third. Uncomfortable. Unpleasant.

    PROCEDURAL STEPS
    1. Local anaesthetic, no sedation

    2. S upine position

    3. R IJV access

    4. S elective catheterisation right ovarian, left ovarian and bilateral internal iliac veins

    5. Combination of foam sclerosant and coil (COOK) embolisation

    6. Deliberate dissection orifice right ovarian vein!!
    View image
  • - , Technical Forum

    Case 29 – Right symtomatic internal carotid artery critcal stenosis

    Center:
    Cotignola
    Case 29 – COT 04: female, 73 years old (C. E.)
    Operators:
    • Alberto Cremonesi,
    • Giuseppe Vadalà