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)
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)
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)
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
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
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)
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)
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
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.
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)
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)
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)
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