LINC 2016 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 1

  • - , Room 2 - Main Arena 2

    Case 10 – BER 01: Iliofemoral venous intervention

    Center:
    Berne
    Case 10 – BER 01: male, 52 years (T-H)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Iliac vein thrombosis left side in 2013 treated with anticoagulation
    Iliac vein thrombosis left side 06/2015
    Mechanical compression of the left iliac vein (ostheosynthesis L4/5)

    PRESENT STATE
    Venous claudication (painfree walking distance 500 m)
    Swelling (2 cm plus in thigh circumference) despite compression therapy
    No skin changes
    No varicose veins

    DUPLEX
    Postthrombotic changes in iliac and femoral veins

    CT
    Mechanical compression of the left iliac vein through ostheosynthetic material

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in left popliteal
    - 10F sheath

    2. Wire crossage
    - Terumo 0.035 stiff angled

    3. Phlebography, IVUS

    4. Predilatation
    - Atlas Balloon 14 mm (BARD)

    5. Implantation of dedicated Iliac vein stents
    - Sinus-Obliquus 14–16 mm (OPTIMED),
    - Sinus-XL Flex 14–16 mm (OPTIMED), or
    - Vici 14–16 mm (VENITI)

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

    Case 01 – LEI 01: Highly calcified distal SFA / A. popliteal occlusion left – Part 1

    Center:
    Leipzig, Dept of Angiology
    Case 01 – LEI 01: male, 72 years (H-L)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Rest pain left foot, Rutherford class 4
    Severe claudication left, walking capacity 100 meters
    Angiography during PTA right iliac arteries after coronary angiography 12/2015

    ABI
    Left 0.42

    RISK FACTORS
    CAD with PTCA 12/2015
    Carotid TEA bilateral (1999 and 2000)
    Permanent atrial fibrillation
    Chronic renal insufficiency GFR 62 ml/min
    Former smoker, art. hypertension, hyperlipidaemia

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - 0.035" SupraCore Guidewire 190 cm (ABBOTT)
    - 7F-40 cm Balkin Up&Over Sheath (COOK)

    2. Guidewire-passage and PTA of the occlusion left SFA/Apop
    - 4.0/80 mm Armada 35 Balloon (ABBOTT)
    - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
    - 6.0/40 mm Armada 35 Balloon (ABBOTT)
    - Conquest High Pressure Balloon (C.R.BARD)

    In case of antegrade failure:
    3. Retrograde approach via the proximal anterior tibial artery
    - 21 Gauge 7 cm Micropuncture needle (COOK)
    - 0.018" Connect Guidewire 300 cm (ABBOTT)
    - 0.018" QuickCross Support-Catheter 90 cm (SPECTRANETICS)

    4. Stenting
    - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinolstent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 01 – LEI 01: Highly calcified distal SFA / A. popliteal occlusion left – Part 2

    Center:
    Leipzig, Dept of Angiology
    Case 01 – LEI 01: male, 72 years (H-L)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Rest pain left foot, Rutherford class 4
    Severe claudication left, walking capacity 100 meters
    Angiography during PTA right iliac arteries after coronary angiography 12/2015

    ABI
    Left 0.42

    RISK FACTORS
    CAD with PTCA 12/2015
    Carotid TEA bilateral (1999 and 2000)
    Permanent atrial fibrillation
    Chronic renal insufficiency GFR 62 ml/min
    Former smoker, art. hypertension, hyperlipidaemia

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - 0.035" SupraCore Guidewire 190 cm (ABBOTT)
    - 7F-40 cm Balkin Up&Over Sheath (COOK)

    2. Guidewire-passage and PTA of the occlusion left SFA/Apop
    - 4.0/80 mm Armada 35 Balloon (ABBOTT)
    - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
    - 6.0/40 mm Armada 35 Balloon (ABBOTT)
    - Conquest High Pressure Balloon (C.R.BARD)

    In case of antegrade failure:
    3. Retrograde approach via the proximal anterior tibial artery
    - 21 Gauge 7 cm Micropuncture needle (COOK)
    - 0.018" Connect Guidewire 300 cm (ABBOTT)
    - 0.018" QuickCross Support-Catheter 90 cm (SPECTRANETICS)

    4. Stenting
    - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinolstent (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 11 – GAL 01: Chronic left iliac reconstruction

    Center:
    Galway
    Case 11 – GAL 01: female, 41 years (N-W)
    Operators:
    • Ian Davidson,
    • Gerard O'Sullivan
    PRESENT STATE
    First DVT in 2009 – just post partum – see CT
    Waited 9 months, attempted endovascular reconstruction – failed.
    Has had 2 more children.
    Symptoms: weight gain, 50 m claudication up hill, heavy dead tired leg.

    RISK FACTORS
    Underlying May Thurner

    PROCEDURAL STEPS
    1. Prep
    - R IJV; left groin and thigh; right groin

    2. UltraSound (SIEMENS) guided access to left profunda and RIJV (COOK Micropuncture set)
    - 10F sheath (COOK) to neck; 5F sheath BRITE TIP (CORDIS) left PFV
    - 5000u IV Heparin
    - Triforce (COOK MEDICAL) to gain access to and attempt to cross left iliac venous occlusion

    3. Wires
    - Hydrophilic 0.035" wire (MERIT MEDICAL)/stiff
    hydrophilic 0.035" wire (MERIT MEDICAL)/
    Roadrunner 0.035" wire (COOK MEDICAL)
    - Asahi Astante 0.014" 30g tip CTO wire with back up 2.5 mm balloon
    - Possibly snare (AndraSnare, ANDRAMED) if needed/
    Lunderquist 0.035" wire 260 cm (COOK MEDICAL) once across

    4. Balloon predilatation
    - BARD Atlas 16/14 mm
    to minimum 16 atm x 30s each zone

    5. Stenting
    - BARD Venovo 16/14/12 from low IVC down
    to either low CFV or else into PFV

    6. Postdilatation
    - BARD Atlas again to same pressures and diameters
    - IVUS (VOLCANO / PHILIPS) to confirm stent apposition and identify any intra-luminal debris
    - Cone Beam CTV (SIEMENS) to confirm stent apposition

    7. Aftercare
    - Thigh high class 2 compression stockings (JOBST)
    - Pneumatic compression boots (COVIDIEN / MEDTRONIC) x 24h until US performed
    - Colour doppler US day 1 post op CTV direct at 6/52
    View image
  • - , Room 3 - Technical Forum

    Case 22 – BLN 01: Tripple protection in a high-grade left ICA stenosis (double filter and micro-mesh stent)

    Center:
    Berlin
    Case 22 – BLN 01: female, 59 years, (E-P)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    RISK FACTORS
    Arterial hypertension (controlled),
    hyperlipidemia (LDL 141mg/dl, Chol. 227mg/dl, HDL 49 mg/dl)

    PROCEDURAL STEPS
    1. Transfemoral retrograde approach
    - 8F short sheath (TERUMO)
    - Diagnostic 5F catheter Weinberg shape (COOK)
    - TERUMO stiff angled 0.035" wire into left ECA

    2. Exchange to
    - Vista Brite Tip IG guiding catheter MPA1 shape into left CCA (CORDIS)

    3. Distal protection
    - Filter Wire EZ (BOSTON SCIENTIFIC) into distal ICA left

    4. Stenting
    - Roadsaver Carotid Micromesh stent (TERUMO) 8 x 25 mm

    5. Carotid postdilatation
    - 5 x 20 mm Paladin balloon with integrated embolic protection (40 micron pore size) (CONTEGO-MEDICAL)

    6. Paladin filter closure and combined filter/balloon-system removal
    - Removal of the distal EPD-Filter Wire EZ
    - Removal of guiding catheter (wire controlled)

    7. Closure of puncture site
    - Angioseal 8F
    Transfer patient ICU
    View image
  • - , Room 2 - Main Arena 2

    Case 12 – LEI 07: Acute early reocclusion left SFA after PTA/Stent

    Center:
    Leipzig, Dept of Angiology
    Case 12 – LEI 07: male, 62 years (PMC-L)
    Operators:
    • Sven Bräunlich,
    • Yvonne Bausback
    CLINICAL DATA
    Severe claudication left calf, walking capacity 120-150 meters
    ABI left 0.63
    PTA and stenting of a short distal SFA-stenosis left 11/2015 elsewhere
    Acute thrombosis of the SFA

    RISK FACTORS
    CAD, MI 2003
    Art. hypertension, diabetes mellitus type 2, former smoker

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA-diagnostic 5F-catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
    - 8F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Passage of the occlusion and percutaneous thrombectomy
    - 0.018" Connect Guidewire 300cm (ABBOTT)
    - 0.018" QuickCross Support-Catheter 135 cm (SPECTRANETICS)
    - Exchange to Rotarex guidewire (STRAUB MEDICAL)
    - 8F Rotarex Thrombectomy Catheter (STRAUB MEDICAL)

    3. PTA with DCBs
    - In.Pact Pacific 5.0/120 mm (MEDTRONIC)

    4. Stenting on indication
    - Epic Selfexpanding Nitinol-Stent (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 02 – LEI 02

    Center:
    Leipzig, Dept of Angiology
    Case 02 – LEI 02
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 13 – LEI 08: In-stent reocclusion left SFA

    Center:
    Leipzig, Dept of Angiology
    Case 13 – LEI 08: male, 70 years (D-K)
    Operators:
    • Matthias Ulrich,
    • Michael Moche
    CLINICAL DATA
    Severe claudication left calf, walking-capacity 150-200 meters since 9/2015
    ABI left 0,67
    Stenting left SFA 08/2014
    Stenting iliac arteries left 2003 and right 12/2015
    CAD with PTCA 2003

    RISK FACTORS
    Art. hypertension, current smoker

    ANGIOGRAPHY
    During PTA right iliac 12/2015: In-stent reocclusion left SFA

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA diagnostic catheter, 5F (CORDIS / CARDINAL HEALTH)
    - 0.035" SupraCore 190 cm Guidewire (ABBOTT)
    - 8F-40 cm Balkin Up&Over Sheath (COOK)

    2. Passage of the in-stent occlusion left SFA
    - Judkins Right 5F-catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" Radiofocus angled stiff glidewire, 260 cm (TERUMO)
    - Exchange to 0.018" Guidewire (STRAUB MEDICAL)

    3. Catheter-thrombectomy
    - 8F Rotarex (STRAUB-MEDICAL)

    4. PTA with drug-coated balloons
    - Lutonix DCBs (C.R.BARD)
    View image
  • - , Room 3 - Technical Forum

    Case 23 – COT 04: Asymptomatic rapid progression of right ICA stenosis

    Center:
    Cotignola
    Case 23 – COT 04: male 78 years (M-T)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    CLINICAL DATA
    Asymptomatic for cerebrovascular events. Recent successful PTA to left ICA
    (December 2015), angiography showed rapid progression of right ICA disease.

    RISK FACTORS
    Diabetes, smoking, hypertension
    Severe asymptomatic right ICA stenosis

    ANGIOGRAPHY
    80% right ICA stenosis (progressed from 50% one year ago)

    PROCEDURAL STEPS
    1. Right femoral approach

    2. MOMA positioning for proximal cerebral protection (MEDTRONIC)

    3. Wire crossing during endovascular clamping

    4. Direct stenting with an Xact-Stent (ABBOTT)

    5. Postdilation with Maverick XI Balloon (BOSTON SCIENTIFIC)

    6. Debris (if any) aspiration and declamping
    View image
  • - , Room 2 - Main Arena 2

    Case 14 – BER 02: Iliofemoral venous intervention – Part 1

    Center:
    Berne
    Case 14 – BER 02: male, 48 years (J-Z)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    MEDICAL HISTORY
    Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
    Permanent neurocognitive deficits
    Ongoing anticoagulation therapy

    RISK FACTORS
    Chronic venous insufficiency left leg with: venous claudication, varicose veins,
    hyperpigmentation, leg swelling
    Villalta-Score: 6 points

    CT
    May Thurner compression of the left common iliac vein

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in left popliteal (10F sheath)

    2. Wire crossage
    - TERUMO 0.035 stiff angled

    3. Phlebography, IVUS

    4. Predilation
    - Atlas Balloon 14 mm (BARD)

    5. Implantation of dedicated Iliac vein stents
    - Sinus-Obliquus 14–16 mm (OPTIMED),
    - Sinus-XL Flex 14–16 mm (OPTIMED), or
    - Vici 14–16 mm (VENITI)

    6. High-pressure postdilation of stents
    - Atlas Balloon 14 mm (BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 15 – GAL 02 - Part 1

    Center:
    Galway
    Case 15 – GAL 02 - Part 1
    Operators:
    • Ian Davidson,
    • Gerard O'Sullivan
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 03 – LEI 03

    Center:
    Leipzig, Dept of Angiology
    Case 03 – LEI 03
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 24 – BLN 02

    Center:
    Berlin
    Case 24 – BLN 02
    Operators:
    • Ralf Langhoff,
    • M. Boral
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 04 – DEN 01: TASC D SFA CTO left

    Center:
    Dendermonde
    Case 04 – DEN 01: male, 83 years (F-P)
    Operators:
    • Koen Deloose,
    • Lieven Maene
    CLINICAL DATA
    2007 CAS Right
    Since 3 months bilateral claudication left > right after <100 m (Rutherford 3)
    Good CFA pulses
    No popliteal/distal pulses

    RISK FACTORS
    Diabetes mellitus type 2, arterial hypertension
    Hypercholesterolemia

    ANGIOGRAPHY
    MR Angio lower limbs

    PROCEDURAL STEPS
    1. Right CFA access - crossover
    - 0.035", 260 cm Glide wire (TERUMO)
    - RIM catheter (COOK MEDICAL)
    - Destination 6F, 45 cm (TERUMO)

    2. Recanalization
    - 0.018", 260 cm Advantage (TERUMO)
    - CXI catheter 0.018", 150 cm (COOK MEDICAL)

    3. Predilatation
    - Advance 18 LP, 5 mm (COOK MEDICAL)

    4. Stenting
    - ZILVER PTX (6 mm – 120 mm) (COOK MEDICAL)

    5. Post-dilatation
    - Advance 35 LP 6 mm (COOK MEDICAL)

    6. Assistance GE Healthcare
    - Vessel assist – "Center Line Tracking"

    7. Plan B
    - Distal puncture + retrograde/bidirectional recanalization
    View image
  • - , Room 2 - Main Arena 2

    Case 14 – BER 02: Iliofemoral venous intervention – Part 2

    Center:
    Berne
    Case 14 – BER 02: male, 48 years (J-Z)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    MEDICAL HISTORY
    Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
    Permanent neurocognitive deficits
    Ongoing anticoagulation therapy

    RISK FACTORS
    Chronic venous insufficiency left leg with: venous claudication, varicose veins,
    hyperpigmentation, leg swelling
    Villalta-Score: 6 points

    CT
    May Thurner compression of the left common iliac vein

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in left popliteal (10F sheath)

    2. Wire crossage
    - TERUMO 0.035 stiff angled

    3. Phlebography, IVUS

    4. Predilation
    - Atlas Balloon 14 mm (BARD)

    5. Implantation of dedicated Iliac vein stents
    - Sinus-Obliquus 14–16 mm (OPTIMED),
    - Sinus-XL Flex 14–16 mm (OPTIMED), or
    - Vici 14–16 mm (VENITI)

    6. High-pressure postdilation of stents
    - Atlas Balloon 14 mm (BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 15 – GAL 02 - Part 2

    Center:
    Galway
    Case 15 – GAL 02 - Part 2
    Operators:
    • Ian Davidson,
    • Gerard O'Sullivan
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 16 – BER 03: Iliofemoral venous intervention

    Center:
    Berne
    Case 16 – BER 03: female, 38 years (A-M)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Past medical history: No personal or familiy history of DVT
    Previously healthy
    Chronic venous insufficiency left leg with:
    Venous claudication (walking distance 600 m)
    Leg swelling (thigh 7 cm plus)
    No varicose veins or skin changes

    DUPLEX/CT
    Stenosis of the external iliac vein left side

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in left popliteal (10F sheath)

    2. Wire crossage
    - TERUMO 0.035 stiff angled

    3. Phlebography, IVUS

    4. Predilation
    - Atlas Balloon 14 mm (BARD)

    5. Implantation of dedicated iliac vein stents
    - Sinus-XL Flex 14 mm (OPTIMED), or
    - Vici 14 mm (VENITI)

    6. High-pressure postdilation of stents
    - Atlas Balloon 14 mm (BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 17 – GAL 03: Failed varicose vein treatment; pelvic vein source

    Center:
    Galway
    Case 17 – GAL 03: female, 40 years (E-S)
    Operators:
    • Gerard O'Sullivan,
    • Ian Davidson
    CLINICAL DATA
    Three children, haemorrhoids and vulval varicosities
    during pregnancy
    Varicose veins left posterior thigh and calf
    treated by foam and RFA in June 2015
    At clinical follow-up 6 weeks satisfactory
    At 6 months ALL recurred

    IMAGING
    Mildly enlarged L ovarian vein
    Tight left common iliac vein compression on MRV
    CDUS – large varicose veins posterior thigh and
    upper calf - extend close to introitus

    PROCEDURAL STEPS
    1. GA
    - R I JV access
    - Selective catheterisation of L ovarian vein: both internal iliac veins;
    possibly right ovarian V
    - Coils (COOK MEDICAL) +/– EMBA medical "hourglass"
    - Foam (Sclerovein 3% diluted 3:1 with air)

    2. IVUS to examine is iliac vein compression syndrome real

    3. I f IVCS suggests it is real the predilate to 16 mm BARD Atlas

    4. Stenting if IVCS is real
    - COOK Zilver Vena 16 mm/VENITI Vici 16 mm/Wallstent 16 mm
    - OPTIMED Sinus Venous/Obliquus 16 mm

    5. Postdilate to 16 mm

    6. Foam sclerotherapy and RFA to thigh veins

    7. Transvaginal US to confirm ablationof all veins at 6/52
    View image
  • - , Room 3 - Technical Forum

    Case 25 – NYC 02: In-stent occlusion with stent fractures RSFA

    Center:
    New York
    Case 25 – NYC 02: female, 65 years, (D-J)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • Vishal Kapur
    CLINICAL DATA
    Subacute onset R leg pain 2 to 3 months, Rutherford Class II, Category III
    US Duplex showed instent occlusion of RSFA
    Failed R Fem pop bypass, multiple PTA and stenting of RSFA
    at outside hospital, failed revascularization of RSFA due to stent fracture

    RISK FACTORS
    Hypertension, dyslipidemia, coronary artery disease,
    polycythemia vera (ongoing work up)

    PROCEDURAL STEPS
    1. Left Common femoral access and up and over
    - 7F Pinnacle destination sheath 45 cm, up and over (TERUMO)
    - If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) and direct stent access

    2. Intra-luminal approach
    - 0.014" 4 Fr Viance catheter, 150 cm (MEDTRONIC)
    - 0.038" Vertip catheter, 125 cm (CORDIS / CARDINAL HEALTH)
    - 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)

    3. Thrombectomy
    - Angiojet Rheolytic aspiration thrombectomy (BOSTON SCIENTIFIC) or
    - PENUMBRA aspiration thrombectomy (PENUMBRA)

    4. Filter placement
    - exchanged with 0.014/Bare wire, 315 cm (ABBOTT VASCULAR)
    - Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)

    5. PTA and Stenting as indicated
    - INPACT drug coated balloons 6.0/120 mm (MEDTRONIC)
    - Supera stenting 5.5/100 mm (ABBOTT VASCULAR)
    View image
  • - , Room 3 - Technical Forum

    Case 26 – DEN 02

    Center:
    Dendermonde
    Case 26 – DEN 02
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 05 – COT 01: Left SFA long occlusion

    Center:
    Cotignola
    Case 05 – COT 01: female, 56 years (L-P)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    CLINICAL DATA
    Severe bilateral claudication
    Previous right SFA and popliteal artery PTA with DEB (December 2015)

    RISK FACTORS
    Smoking, hypertension
    Previous CABG (LIMA to LAD) in 2000
    Severe left leg claudication

    ANGIO
    Left SFA long occlusion

    PROCEDURAL STEPS
    1. Contralateral (right) femoral access and placement of a cross-over sheath
    - 6F 45 cm Destination sheath (TERUMO)

    2. Crossing the occlusion
    - 0.035'' Glidewire (TERUMO)

    3. Lesion predilatation
    - 4.0/120 mm Pacific balloon (MEDTRONIC)

    4. Dilatation
    - 5.0/120 mm Admiral Inpact balloon (MEDTRONIC)

    5. Spot stenting if needed
    View image
  • - , Room 5 - Global Expert Exchange

    Case 31 – BRL 04: DES in a CLI patient with BTK Revascularisation

    Center:
    Berlin
    Case 31 – BRL 04: male, 74 years, (M-S)
    Operators:
    • Ralf Langhoff,
    • Normund Jabs
    CLINICAL DATA
    Bilateral severe claudication left > right since years,
    recently deterioration of walking distance and lesion
    at the the dorsal side of the 2nd toe

    RISK FACTORS
    Hyperlipidemia, former smoker, controlled hypertension,
    MRA with BTK vessel occlusions
    ABI at rest: 0.5 left, 0.64 right

    ABI at rest
    Left 0.5, right 0.64

    PROCEDURAL STEPS
    1. Antegrade access left CFA
    - 4F Fortress sheath (BIOTRONIK)

    2. Approaching the lesion
    - 0.014" wire approach, Advantage wire (TERUMO)
    - Backup with CXI support catheter (COOK)

    3. PTA and stenting of the occluded tibioperoneal trunc
    - 3.0 x 38 mm Cr8 BTK Stent (ALVIMEDICA)

    4. Recanalisation of the anterior tibial artery
    - Primary PTA 2.5 x 200 mm Coyote balloon (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 06 – LEI 04: Occlusion right popliteal artery

    Center:
    Leipzig, Dept of Angiology
    Case 06 – LEI 04: female, 66 years (I-B)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf and restpain during night, Rutherford class 3-4

    ABI
    Right 0.55

    PTA
    Right A.poplitea 3/2013

    DUPLEX
    Moderate stenosis right iliac artery and reocclusion right popliteal artery

    RISK FACTORS
    Art. hypertension, diabetes mellitus type II, former smoker

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - 7F-55 cm Check-Flow-Performer Sheath (COOK)

    2. Passage of the popliteal occlusion right
    - 0.018" Victory 18 30 gr 300 cm guidewire (BOSTON SCIENTIFIC)
    - 0.018" QuickCross Support-Catheter 135 cm (SPECTRANETICS)

    3. Filter-protection placement
    - 4F-90 cm Check-Flo Performer sheath (COOK)
    - Wirion-Protection system (ALLIUM MEDICAL)

    4. Atherectomy
    - HawkOne directional atherectomy system, 6 cm tip (MEDTRONIC)

    5. PTA with Drug-coated balloons
    - In.Pact Pacific 6.0/120 mm (MEDTRONIC)

    6. Stenting on indication
    - Complete SE-Stent (MEDTRONIC)
    View image
  • - , Room 3 - Technical Forum

    Case 27 – BLN 03: SFA combination therapy

    Center:
    Berlin
    Case 27 – BLN 03: male, 75 years ( R-D)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    PAD Rutherford 3 left calf,
    PTA and stenting right SFA occlusion 1/2016

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    ABI
    Right 0.75, left 0.63

    PROCEDURAL STEPS
    1. Transfemoral retrograde approach
    - 6F cross over sheath (Fortress, BIOTRONIK)

    2. Recanalisation left SFA occlusion
    - 35" TERUMO Stiff wire and glidecath catheter

    3. PTA
    - Passeo 18 (BIOTRONIK)

    4. SFA stenting
    - Pulsar 18 (BIOTRONIK)

    5. PTA
    - DEB Passeo 18 Lux

    6. Closure of puncture site
    - Angioseal 6F if possible
    View image
  • - , Room 2 - Main Arena 2

    Case 18 – COT 02

    Center:
    Cotignola
    Case 18 – COT 02
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 5 - Global Expert Exchange

    Case 32 – LEI 10

    Center:
    Leipzig, Dept of Angiology
    Case 32 – LEI 10
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 07 – LEI 05: BTK-occlusion right with critical limb ischemia

    Center:
    Leipzig, Dept of Angiology
    Case 07 – LEI 05: male, 81 years (G-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain right forefoot and minor gangrene Dig I, Rutherford 5
    Recurrent infrainguinal disease right with
    PTA right SFA and BTK-arteries 4/2014 and 2/2015
    Ischaemic cardiomyopathy, NYHA II-III
    CAD with PTCA left main 2/2015
    TAVI 2/2015
    Permanent atrial fibrillation
    PTA right vertebral artery 12/2015

    ABI
    Right: 0.37

    ANGIOGRAPHY
    During vertebral artery PTA 12/2015: occlusion of all 3 BTK-arteries right

    RISK FACTORS
    Arterial hypertension, former smoker, hyperlipidaemia

    PROCEDURAL STEPS
    1. Right antegrade approach
    - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)

    2. Passage of the anterior tibial artery occlusion
    - CXC 0.018” 90 cm Support-Catheter (COOK)
    - 0.018” V-18 Control Guidewire, 300 cm (BOSTON SCIENTIFIC)
    Exchange to:
    - 0.014" Floppy ES 300 cm guidewire (ABBOTT)

    3. PTA and arterial wall-injection of dexamethason
    - Armada 14 3.0/120 mm balloon (ABBOTT)
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
    View image
  • - , Room 3 - Technical Forum

    Case 28 – DEN 03: TASC C SFA lesion right

    Center:
    Dendermonde
    Case 28 – DEN 03: male, 83 years ( F-P)
    Operators:
    • Koen Deloose,
    • Lieven Maene
    CLINICAL DATA
    History: 2007 CAS Right
    Since 3 months bilateral claudication left > right after <100 m (Rutherford 3)
    Good CFA pulses
    No popliteal/distal pulses

    RISK FACTORS
    Diabetes mellitus type 2, arterial hypertension, hypercholesterolemia
    MR Angio lower limbs

    PROCEDURAL STEPS
    1. Left CFA access
    - Glidewire 0.035" (TERUMO)
    - RIM Catheter (COOK MEDICAL)
    - Fortress 6F, 45 cm (BIOTRONIK)

    2. Recanalisation
    - Advantage 0.018", 260 cm (COOK MEDICAL)
    - CXI Catheter 0.018", 150 cm (COOK MEDICAL)

    3. Predilatation
    - Passeo 18 Lux 6 mm (BIOTRONIK)

    4. Stenting
    - Pulsar 18 6 mm (BIOTRONIK)

    5. Postdilatation
    - Passeo 18 6 mm (BIOTRONIK)

    6. GE Healthcare
    - Vessel Assist - Center Line Tracking
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  • - , Room 2 - Main Arena 2

    Case 19 – COT 03

    Center:
    Cotignola
    Case 19 – COT 03
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 20 – BER 04: Pelvic congestion syndrome

    Center:
    Berne
    Case 20 – BER 04: female, 52 years (M-B)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    MEDICAL HISTORY
    Appendectomy and removal of ovarian cyst 1996
    Laparoscopic adhesiolysis and tubal sterilisation 2005
    Last menstrual cycle 03/2015
    Recent gynecologic exam unremarkable

    PRESENT STATE
    Left sided abdominal dull pain, lower quadrant since 6 months
    The pain is worse during defecation
    No pain during or after sexual intercourse or during voiding
    Pain dependence on position (no pain during bed rest, worse while standing and sitting)

    CT
    Prominent left-sided ovarian vein, varicose, parauterine veins

    VENOGRAPHY
    Refluxing left-sided ovarian vein, no reflux in hypogastric and right ovarian vein

    PROCEDURAL STEPS
    1. Venous access in right femoral vein (5F sheath)
    2. Cobra 4F diagnostic catheter
    3. Selective venography of distal left ovarian vein
    4. Foam sclerotherapy of varicose uterine veins
    5. Coil embolization of ovarian veins (0.018, 8-12 mm)
    View image
  • - , Room 3 - Technical Forum

    Case 29 – COT 05

    Center:
    Cotignola
    Case 29 – COT 05
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    New patient! Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 30 – LEI 09: Recurrent stenosis left common carotid artery

    Center:
    Leipzig, Dept of Angiology
    Case 30 – LEI 09: male, 56 years (L-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Recurrent stenosis left common carotid artery at the proximal anastomosis
    of a prosthesis-interposition left CCA after radical neck dissection
    of a parotid cancer left with infiltration of the CCA and radiation therapy 2010
    Fogarty-thrombectomy left CCA and stenting left CCA/ICA 2015
    Minor stroke 2015

    RISK FACTORS
    Facial nerve paresis left since 2015
    Minor paresis right arm since 2015
    Dysarthria
    Former smoker, arterial hypertention, diabetes mellitus type II

    DUPLEX
    High grade recurrent stenosis left proximal common carotid artery

    ANGIOGRAPHY
    90% proximal CCA-stenosis and 70% recurrent stenosis distal to the ICA-stent

    PROCEDURAL STEPS
    1. Right groin retrograde approach
    - Judkins-Right 8F-guiding-catheter (CORDIS)

    2. Placement of a filter
    - Wirion protection device (ALLIUM MEDICAL)

    3. Predilatation, stenting and postdilatation
    - 3.5/20 mm AngioSculpt RX scoring-balloon (SPECTRANETICS)
    - 9.0 or 10/30 mm CGuard carotid embolic prevention system (InspireMD/PENUMBRA)
    - 7.0/20 mm Sterling RX-balloon (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 08 – NYC 01: Severely calcified severe stenosis of LSFA

    Center:
    New York
    Case 08 – NYC 01: female, 83 years, (P-M)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • Vishal Kapur
    CLINICAL DATA
    PAD, Rutherford Class II, category III, claudication of L calf at 1 to 2 blocks,
    ABI R LE - 0.5 and L LE - 0.6
    Jet stream athrectomy, PTA and stenting of RSFA in 09/2015

    RISK FACTORS
    Hypertension, diabetes mellitus type II,
    dyslipidemia, moderate aortic regurgitation

    PROCEDURAL STEPS
    1. Right common femoral access and cross over approach
    - 7F Pinnacle destination sheath 45 cm up and over sheath (TERUMO)

    2. Guidewire passage
    - 0.014" Spartacore wire, 300 cm (ABBOTT VASCULAR)
    - 0.038" Vertebral 135" Tempa Aqua catheter, 125 cm (CORDIS)

    3. Filter placement
    - exchanged with 0.014" Bare wire, 315 cm (ABBOTT VASCULAR)
    - Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)

    4. Athrectomy and thrombectomy, if embolization occurs
    - Jet stream Pathway rotational athrectomy 2.4/3.4 (BOSTON SCIENTIFIC)
    - PENUMBRA aspiration thrombectomy (PENUMBRA)

    5. PTA and stenting on indication
    - IN-PACT drug coated balloons 6.0/120 mm (MEDTRONIC)
    - SUPERA stenting 5.5/150 mm (ABBOTT VASCULAR)
    View image
  • - , Room 1 - Main Arena 1

    Case 09 – LEI 06: Calcified popliteal artery occlusion

    Center:
    Leipzig, Dept of Angiology
    Case 09 – LEI 06: male, 73 years, (S-W)
    Operators:
    • Sven Bräunlich,
    • Yvonne Bausback
    CLINICAL DATA
    Critical limb ischemia with ulceration lateral foot right
    Severe claudication right since years
    ABI right 0.34, Rutherford class 5
    Thrombendartherectomy right groin 2013

    RISK FACTORS
    Diabetes mellitus type 2, art. hypertension, former smoker

    ANGIOGRAPHY
    Severely calcified distal SFA and Apop – occlusion right

    PROCEDURAL STEPS
    1. Right antegrade approach
    - 6F 55 cm sheath (COOK)

    2. Passage of the occlusion
    - Stiff angled Radiofocus guidewire 0.035”, 260cm (TERUMO)
    - Armada 35 balloon 4.0/120mm (ABBOTT)
    In case of failure form antegrade:
    - Retrograde approach vie peroneal or posterior tibial artery

    3. PTA
    - Armada 5/40 and 6/40 mm balloon (ABBOTT)
    - Conquest High Pressure Balloon (C.R.BARD)

    4. Stenting
    - Supera Interwoven Nitinol Stent (ABBOTT)
    View image