LINC 2015 live case guide

Find all Live Cases and Live Case Centers listed below.

Conference day 3

  • - , Technical Forum

    Case 79 – PT and lateral plantar/dorsalis paedis/arch revascularization

    Center:
    Abano Terme
    Case 79 – ABT 02: male, 65 years (S-G)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena
    CLINICAL DATA
    DM, neurovasculopathy

    RISK FACTORS
    I° toe gangrene and calcanear Tuc 1 c lesion; TcPO2: 8 mmHg.
    Hypertension, dyslipidemia
    Ischemic heart disease (previous PTcA)

    PROCEDURAL STEPS
    1. Antegrade US guided left groin approach
    - 6F 11 cm sheath (TERUMO)
    - 4F 110 cm Flexor sheath (COOK) option

    2. Antegrade/retrograde trans tarsal loop passage of the PT occlusion
    - 0.018" V18 300 cm (BOSTON SCIENTIFIC)
    - Pilot 200, 300 cm (ABBOTT)

    3. Wires rendez-vous

    4. Predilatation
    - Ultraverse 1.5 mm x 20 mm (BARD)
    - Ultraverse 2.0 mm x 300 mm (BARD)

    5. Definitive dilatation
    - Lutonix 2.5 mm x 150 mm (BARD)
    View image
  • - , Technical Forum

    Case 80 – Distal 10 cm SFA occlusion left, retrograde recanalization through proximal anterior tibial access

    Center:
    Leipzig
    Case 80 – LEI 28: male 78 years (L-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD with rest-pain left leg, Rutherford class 4, and
    Claudicatio intermittens left calf, walking capacity 100 meters
    Failed antegrade recanalization attempt
    Diabetes mellitus type 2, former smoker

    ANGIOGRAPHY
    10 cm distal SFA-occlusion left, moderat calcification

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

    2. Guidewire passage from antegrade
    - 5F Multipurpose diagnostic catheter 100 cm (CORDIS)
    - 0.035" straight stiff TERUMO glidewire, 260 cm (TERUMO)
    - in case of second failure: retrograde approach via the proximal anterior tibial artery 7 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Conrol Guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" QuickCross 90 cm Supportcahteher (SPECTRANETICS)

    3. After snaring of the guidewire from antegrade PTA
    - Ultraverse 18 Balloon (BARD) and
    - Luminor Drug-coated balloon (iVASCULAR)

    4. Stenting on indication
    - Supera Interwoven Nitinol-Stent (ABBOTT)
    View image
  • - , Technical Forum

    Case 81 – Occlusion of the left tibioperoneal trunk, transpedal recanalization

    Center:
    Leipzig
    Case 81 – LEI 29: male, 71 years (M-C)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD with severe claudication and restpain during night left foot
    PTA / stenting of the popliteal artery left elsewhere and failure to recanalize the tibioperoneal trunk
    Art. hypertension, CAD with CABG 2008, Polymyalgia rheumatica

    ANGIO
    During first rezanalization attempt: perforation after attempt to pass the tibioperoneal trunk occlusion.

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 5F 55 cm Ansel Sheath (COOK)

    2. Retrograde guidewire passage
    - 7 cm 21 Gauge needle to puncture the posterior tibial artery
    - 0.018" V-18 control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 3F pedal sheath (COOK)
    - 0.018" CXI-support-catheter 90 cm (COOK)
    - potentially exchange to a 0.014" CTO-guidewire Winn 200 T (ABBOTT))

    3. PTA
    - Advance Micro 3.0/40 mm 90 cm Balloon (COOK) from retrograde

    4. Stenting
    - After guidewire-passage from antegrade after predilatation from retrogarde implanatation of a Xience Prime 3.5/38 mm drug-eluting stent (ABBOTT)
    View image
  • - , Main Arena 1

    Case 63 - SFA occlusion left SFA TASC II D

    Center:
    Münster
    Case 63 – MUN 06: female - 73 years
    Operators:
    • Arne Schwindt,
    • N. Abu-Bakr
    CLINICAL DATA
    - Claudication left leg with pain free walking distance of 150m (Rutherford III)
    - CVRF: hypertension, former smoker
    - high grade stenosis promixal SFA
    - 12 cm CTO distal SFA
    - Mild Ca+

    ABI LEFT
    - 0.6

    PROCEDURAL STEPS
    - Crossed using the Ocelot Catheter (AVINGER, Redwood City, CA)
    - Real time confirmation of true lumen crossing (avoided disruption of medial/adventitial border)
    - Reduced fluoroscopy using only OCT for crossing)
    - Cap to cap standalone crossing
    - OCT guided Atherectomy using the Pantheris Catheter (not approved for sale, currently under FDA IDE Clinical Trials) (AVINGER, Redwood City, CA)
    - Real time directional cutting targeting plaque
    - Histology of plaque sample reveals 0% adventitia
    - Reduced fluoroscopy using OCT for atherectomy
    - Post Atherectomy DEB using In.Pact Admiral Balloon (MEDTRONIC, Minneapolis, MN)

    POST PROCEDURAL ABI LEFT
    - 1.2
    View image
  • - , Main Arena 1

    Case 64 – Occlusion of the posterior tibial artery

    Center:
    Bad Krozingen
    Case 64 – BK 01: male, 82 years (R-S)
    Operators:
    • Aljoscha Rastan,
    • Elias Noory
    CLINICAL DATA
    Claudication (foot) Rutherford-Becker class 3
    Recanalisation of the femoro-popliteal bypass (P I) 12/2014
    Femoro-popliteal bypass (PTFE) 2008

    RISK FACTORS
    Hypertension, tobacco use

    ABI AT REST
    0.6/1.0

    DUPLEX
    Occlusion of the PTA/ATA

    PROCEDURAL STEPS
    1. Antegrade femoral access right groin
    - 6F 11cm sheath (CORDIS)
    - 5F STR guiding catheter (CORDIS)

    2. Recanalisation of the posterior tibial artery
    - 0.014" Pilot 150 wire (ABBOTT), 0.014" Extra-Support wire (ABBOTT)
    - 0.014" Advantage (TERUMO), 2.0x120mm OTW Amphirion balloon (MEDTRONIC)

    3. Atherectomy
    - Phoenix 1.8 mm (VOLCANO)

    4. (DE-) Postdilatation and stenting on indication
    - 2.5x120 mm Lutonix 14 (BARD)

    5. Optional: tibial access
    View image
  • - , Main Arena 2

    Case 74 – Thoraco-abdominal aortic aneurysm 84 mm

    Center:
    Münster
    Case 74 – MUN 08: female, 76 years old (P. I.)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
  • - , Main Arena 2

    Case 75 – Asymptomatic AAA 5.4 cm

    Center:
    Heidelberg
    Case 75 – HEI 04: male, 79 years (G-K)
    Operators:
    • Dittmar Böckler,
    • Alexander Hyhlik-Dürr,
    • Drosos Kotelis
    CLINICAL DATA
    Asymptomatic AAA 54 mm!
    Asymptomatic aneurysm of the left common iliac artery 26 mm
    Left SFA occlusion

    RISK FACTORS
    Art. hypertension, history of smoking

    PROCEDURAL STEPS
    1. Bifemoral cut-down

    2. 8F sheath placement (TERUMO)

    3. Fusion imaging for endograft navigation using 2-D – 3-D registration

    4. Guidewire insertion (TERUMO)
    - Lunderquist GW 180 cm (COOK)

    5. Stentgraft positioning and deployment
    - 2 Nellix systems (ENDOLOGIX)

    6. Endobag prefilling with saline, angiography

    7. Endobag filling with polymer

    8. Optional secondary fill
    View image
  • - , Main Arena 1

    Case 65 – Occlusion of the right SFA

    Center:
    Bad Krozingen
    Case 65 – BK 02: male, 76 years old (P. W.)
    Operators:
    • Thomas Zeller
  • - , Main Arena 1

    Case 66 – Occlusion of the left SFA

    Center:
    Bad Krozingen
    Case 66 – BK 03 b: male, 67 years old
  • - , Main Arena 2

    Case 75 – Asymptomatic AAA 5.4 cm

    Center:
    Heidelberg
    Case 75 – HEI 04: male, 79 years (G-K)
    Operators:
    • Dittmar Böckler,
    • Alexander Hyhlik-Dürr,
    • Drosos Kotelis
    CLINICAL DATA
    Asymptomatic AAA 54 mm!
    Asymptomatic aneurysm of the left common iliac artery 26 mm
    Left SFA occlusion

    RISK FACTORS
    Art. hypertension, history of smoking

    PROCEDURAL STEPS
    1. Bifemoral cut-down

    2. 8F sheath placement (TERUMO)

    3. Fusion imaging for endograft navigation using 2-D – 3-D registration

    4. Guidewire insertion (TERUMO)
    - Lunderquist GW 180 cm (COOK)

    5. Stentgraft positioning and deployment
    - 2 Nellix systems (ENDOLOGIX)

    6. Endobag prefilling with saline, angiography

    7. Endobag filling with polymer

    8. Optional secondary fill
    View image
  • - , Technical Forum

    Case 82 – Occlusion (in-stent) of the left SFA

    Center:
    Bad Krozingen
    Case 82 – BK 05: male, 65 years (E-G)
    Operators:
    • Aljoscha Rastan,
    • Elias Noory
    CLINICAL DATA
    Claudication Rutherford-Becker class 3
    Recanalization and stenting of the left EIA and SFA 06/2013
    Stenting of the right SFA 09/2013

    RISK FACTORS
    Tobacco use, hypertension, hypercholesterolemia

    ABI AT REST
    Right/left: 0.6/0.3

    DUPLEX
    Left leg: CIA, EIA, CFA, DFA without stenosis.
    Origin of the SFA occluded. Detectable blood flow in the PA (I).

    PROCEDURAL STEPS
    1. Retrograde femoral access (cross-over)
    - 6F and 8F Cross-over sheath Balkin (CORDIS)
    - 0.035" stiff wire (TERUMO)

    2. Recanalization of the SFA
    - 0.018" Advantage (TERUMO), Quick-Cross support-catheter (SPECTRANETICS)

    3. Laser procedure
    - 2.0mm Elite Laser, Turbo-Tandem (SPECTRANETICS)
    - Wirion filter (GARDIA MEDICAL)

    4. DEB postdilatation
    - 5 mm and 6 mm x 120 mm PacificInpact balloon

    5. Stenting on indication
    View image
  • - , Main Arena 1

    Case 67 – Occlusion of the left SFA/PA

    Center:
    Bad Krozingen
    Case 67 – BK 03: male, 81 years (G-S)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    Claudication (left calf) Rutherford-Becker class 3
    Coronary heart disease: DES RCX 02/2005; PCI RCA 09/2001

    RISK FACTORS
    Tobacco, hypertension, diabetes hypercholesterolemia

    ABI AT REST
    Right/left: 0.9/0.4

    DUPLEX
    Left leg: CIA, EIA, DFA without stenosis, distal part of the SFA incl. PA occluded
    Detectable blood flow in the middle part of the PA and the tibio-peroneal trunc

    PROCEDURAL STEPS
    1. Antegrade femoral access
    - 7F sheath (CORDIS)

    2. Recanalization of the SFA/PA
    - 4F vertebralis catheter (CORDIS)
    - 0.035" wire (TERUMO)

    3. Atherectomy
    - Jetstream (BOSTON SCIENTIFIC)

    4. Postdilatation
    - 4/5 mm 120 mm DE-balloon angioplasty, Ranger (BOSTON SCIENTIFIC)

    5. Stenting on indication
  • - , Main Arena 2

    Case 76 – Subacute type B dissection

    Center:
    Leipzig
    Case 76 – LEI 27: male, 61 years (J-G)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Acute type-B-dissection 12/2014
    Art. hypertension
    Smoker

    CT
    Enlargement of the descending thoracic aorta of 1.1 cm within 1 month.

    PROCEDURAL STEPS
    1. Percutaneous access right groin
    - Preclosing with Proglide both sides (ABBOTT)
    - 0.035" Lunderquist guidewire 260 cm (COOK)
    - Calibration-pigtail catheter left groin
    - Temporary pacemaker via right groin for rapid pacing
    - IVUS (VOLCANO)

    2. Implantation of a TAG thoracic stentgraft (GORE)
    View image
  • - , Technical Forum

    Case 83 – Calcified short SFA occlusion left

    Center:
    Leipzig
    Case 83 – LEI 30: male, 50 years (U-K)
    Operators:
    • Sven Bräunlich,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication left calf, walking capacity 50 meters
    Bilateral iliac artery PTA 2014
    CAD with MI and PTCA 2000
    Art. hypertension, diabetes mellitus type 2

    ABI
    Left: 0.62

    ANGIOGRAPHY
    During PTA right iliac arteries: severe calcification left SFA, short distal occlusion.

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 6F 10 cm sheath (TERUMO)

    2. Guidewire passage
    - 0.018" Victory 18g guidewire 300 cm (BOSTON SCIENTIFIC)
    - QuickCross 0.018" 90 cm support-catheter (SPECTRANETICS)

    3. PTA
    - AngioSculpt 5/80 mm (SPECTRANETICS)
    - Drug-coated balloon treatment
    - Drug-coated balloon PTA

    4. Stenting on indication
    View image
  • - , Technical Forum

    Case 85 – Distal AT, dorsalis paedis, arch and lateral plantar revascularization

    Center:
    Abano Terme
    Case 85 – ABT 03: male, 83 years (T-D)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena
    CLINICAL DATA
    DM, neurovasculopathy

    RISK FACTORS
    Right CLI, diffuse onycodisthrophia, I° and II° TUC 1c, TcPO2=22 mmHg
    Hypertension, dyslipidemia, ischemic heart disease, CAF, previous left CFA surgical endoatherectomy

    PROCEDURAL STEPS
    1. Right groin US guided antegrade approach
    - 6F 11 cm sheath (TERUMO)

    2. Antegrade passage of the distal AT/dorsalis paedis occlusion
    - 4F Ber 2, 100 cm (CORDIS),
    - 0.018" 300 cm V18 CW (BOSTON SCIENTIFIC)
    - 0.014" 300 cm V14 (BOSTON SCIENTIFIC)
    - retrograde distal I° digital puncture after failure
    - arch evaluation and possible trans-loop retrograde lateral plantar recanalization

    3. Predilatation
    - Coyote ES 1.5 mm/2 mm x 20 mm

    4. Definitive dilatation
    - Coyote 2.5 mm x 200 mm
    View image
  • - , Technical Forum

    Case 86A – Occlusion of the right PTA

    Center:
    Bad Krozingen
    Case 86A – BK 07A: male, 54 years (F-D)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    Claudication Rutherford-Becker class 3
    Femoro-popliteal Bypass surgery 2005, re-occlusion of the Bypass 2006+2014
    Recanalization+DEB+Stent of the SFA/PA 12/2014

    RISK FACTORS
    Tobacco use

    ABI AT REST
    Right/left: 0.5/1.1

    DUPLEX
    Bypass and PA without stenosis, occlusion of the PTA and ATA.

    PROCEDURAL STEPS
    1. Antegrade femoral access (cross-over)
    - 6F sheath (TERUMO)

    2. Recanalization of PTA
    - 5F STR-catheter (CORDIS), 0.014" Pilot 50/150 wire (ABBOTT), 0.014" Advantage (TERUMO)
    - 2.0 x 120 mm Amphirion-OTW (MEDTRONIC)

    3. Predilatation
    - 2.0 x 120 mm Amphirion-RX (MEDTRONIC)

    4. Dilatation
    - 2.5/3 x 120 mm Lutonix (DE-) balloon (BARD)

    5. Optional
    - DES, retrograde access, re-entry device
    View image
  • - , Technical Forum

    Case 88 – CLI with complex occlusions of all BTK arteries right

    Center:
    Leipzig
    Case 88 – LEI 32: male, 81 years (G-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia, restpain and minor ulcerations forefoot right
    Art. hypertension, CAD with PTCA 2003
    Aortic valve replacement 2013, chronic heart failure, NYHA II-III
    Atrial fibrillation, chronic renal insufficiency GFR (62 m/min)

    ANGIOGRAPHY
    During first rezanalization attempt: occlusion of the distal SFA, popliteal artery and tibioperoneal trunk

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    - 5F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage
    - V-18 Control Guidewire (BOSTON SCIENTIFIC)
    - PPS Arrow Catheter (ARROW)

    3. In case of failure to pass the guidewire from antegrade
    - Retrograde approach via the dorsalis pedis artery: 7 cm 21 Gauge needle
    - 0.018 Connect Guidewire 300 cm (ABBOTT)
    - 3F pedal sheath (COOK)

    4. Guidewire passage from retrograde
    - 0.018" CXI angled support-catheter 90 cm (COOK) potentially exchange to
    - 0.014 Hydro-ST Guidewire 300 cm (COOK) and
    - Advance Micro Balloon 3.0/120 mm (COOK)
    - LegFLow Drug-Coated Balloon (CARDIONOVUM)

    5. Stenting on indication
    View image
  • - , Main Arena 2

    Case 77 – Juxtarenal aortic aneurysm 83 mm

    Center:
    Münster
    Case 77 – MUN 09: male, 70 years old (N. H.)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff,
    • Konstantinos Donas
  • - , Main Arena 1

    Case 69 – TAVR with cerebral protection – patient characteristics

    Center:
    Leipzig
    Case 69 – LEI 24: male, 79 years old
  • - , Main Arena 1

    Case 70 – High grade left internal carotid artery stenosis

    Center:
    Münster
    Case 70 – MUN 07: female, 72 years
    Operators:
    • Arne Schwindt,
    • Simone Hartmann
    CLINICAL DATA
    Asymptomatic, 90% ICA stenosis, vmax in CCD 280cm/sec
    Type III aortic arch

    RISK FACTORS
    Hypertension

    PROCEDURAL STEPS
    1. Femoral approach
    - Cannulation of left common carotid artery with 6F 90 cm Shuttle sheath (COOK) in telescope technique with 5,4 VTEK Slipcath (COOK).

    2. Passage of lesion
    - Epifilterwire (BOSTON SCIENTIFIC)

    3. Implantation of Roadsaver dual layer carotid stent (TERUMO)

    4. Postdilation
    - Sterling RX balloon (BOSTON SCIENTIFIC)
    View image
  • - , Main Arena 1

    Case 71 – Calcified stenosis of the left CFA

    Center:
    Bad Krozingen
    Case 71 – BK 04: male, 70 years old (E. S.)
    Operators:
    • Elias Noory,
    • Aljoscha Rastan
  • - , Main Arena 2

    Case 78 – Thoraco-abdominal aortic nbeurysm 62 mm

    Center:
    Münster
    Case 78 – MUN 10: male, 74 years old (S. C.)
    Operators:
    • Martin Austermann,
    • Bernd Gehringhoff
  • - , Main Arena 1

    Case 72 – Stenosis left common and profunda, occlusion of the superficial femoral artery

    Center:
    Leipzig
    Case 72 – LEI 25: male, 67 years (D-M)
    Operators:
    • Andrej Schmidt,
    • Tomohara Dohi
    CLINICAL DATA
    Critical limb ischemia with ulceration of the lower calf and forefoot
    Chronic heart failure with NYHA II-III
    Art. hypertension, diabetes mellitus type 2, former smoker

    ABI
    Left 0.45

    DUPLEX
    CFA-stenosis and SFA-occlusion

    ANGIOGRAPHY
    CFA-stenosis, PFA-stenosis and SFA-occlusion

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

    2. Filter-protection of the deep femoral artery
    - Spider Filter 7 mm (COVIDIEN)

    3. Atherectomy of the CFA and PFA
    - TurboHawk (LX-M) (COVIDIEN)

    4. Guidewire passage of the SFA-occlusion
    - 0.035" TrailBlazer 135 cm supportcatheter (COVIDIEN)
    - 0.035" stiff angled glidewire 260 cm (TERUMO)
    - Exchange to the Spider-Filter 7 mm (COVIDIEN)

    5. Atherectomy of the SFA
    - TurboHawk (COVIDIEN)

    6. PTA with drug-coated balloons
    - Luminor 35 (iVASCULAR)
    View image