CLINICAL DATA
Juxtarenal aneurysm 59 mm max. below a left acc. RA
RISK FACTORS
CAD, art. hypertension, hypertensive heart disease, LE 12/15
PROCEDURAL STEPS
- Percutanous approach both groins Prostar XL (ABBOTT).
- Placement of 14F sheaths (COOK).
- Placement of Endurant bifurcated endograft (MEDTRONIC) just below the LRA.
- Cannulation of the lower left renal artery and placement of the sandwich graft (GORE-Viabahn).
- Extension of the the aortic endograft with an Endurant-tubegraft (MEDTRONIC) in order to complete the sandwich-repair.
- Closure of the groins.
CLINICAL DATA
History: 2008 CAS right, 2010 PTAS popliteal right, 2010 CEA left, 2011
PTCA + CABG, 2015 PTRA bilateral
Present State: non-healing ulcer left leg since 1 month
5. Postdilatation
- Armada 0.018", 5 or 6 mm (ABBOTT VASCULAR)
6. Assistance GE Healthcare
- Vessel assist - "Center Line Tracking"
7. Plan B
- Distal puncture + retrograde / bidirectional recanalization
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Room 2 - Main Arena 2
Case 44 – LEI 15:
Abdominal aortic aneurysm – Part 1
Center:
Leipzig, Dept of Angiology
Case 44 – LEI 15: male, (R-E)
Operators:
Andrej Schmidt,
Daniela Branzan
CLINICAL DATA
Incidental finding of an eccentric AAA, 5.3 cm diameter
RISK FACTORS
CAD with NSTEMI 10/2015, PTCA LAD
Chronic renal insufficiency (GFR 72 ml/min)
Art. hypertention, former smoker
PROCEDURAL STEPS 1. Percutaneous access both groins in local anaesthesia
- 5F-10 cm Radifocus-sheaths (TERUMO)
- 0.035" SupraCore guidewire 190 m (ABBOTT)
- Preloading of 2 Proglide-systems per groin (ABBOTT)
- 0.035" Lunderquist 260 cm guidewires bilateral (COOK)
2. Graft implantation
- Implantation of the Altura Stentgraft system and extension to the hypogastric artery bilateral (LOMBARD MEDICAL)
3. Postdilatation of the whole graft
- Exchange to 12F-12 cm sheath bilateral (COOK)
- Reliant balloons both sides (MEDTRONIC)
Case 51 – MUN 03:
Persisting Type II Endoleak via AMI with aneurysm enlargement
Center:
Münster
Case 51 – MUN 03: male, 83 years (H-K)
Operators:
Arne Schwindt,
N. Varcoe
Varcoe
CLINICAL DATA
EVAR for AAA 2013 with bifurkated stentgraft, initial diameter of AAA 56 mm, in follow-up
CT-angiograms persisting Type II Endoleak via lumbar arteries and inferior mesenteric
artery (IMA). In 2015 enlargement of AAA to 70 mm in maximum axial diameter.
RISK FACTORS
Art. hypertension, former smoker, CHD
PROCEDURAL STEPS 1. Left transbrachial approach
- 6F 70 cm Raabe sheath (COOK) insertion into ostium of superior mesenteric artery
2. Cannulation of middle colic artery
- 0,035" Glidewire and 4F 120 cm Glidecath (TERUMO)
3. Cannulation of IMA and Endoleak
- 0,014" Choice PT II wire (BOSTON SCIENTIFIC)
4. Catheter insertion
- 0,014" Echelon or 0,010" Marathon microcatheter into Endoleak and following angiogram
5. Embolisation of Endoleak with alcohol-colymer
- Onyx 34/34L (MEDTRONIC)
6. After microcatheter removal final angiogram via IMA and hypogastric artery to confirm complete Endoleak embolisation
Case 34 – BER 05:
Complex intervention of IVC and iliac veins
Center:
Berne
Case 34 – BER 05: male, 34 years (R-V)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Past medical history:
Thrombosis of IVC and bilateral Iliac veins 08/2013 treated with anticoagulation
Varicocele, hemorrhoids
Thrombophilia testing negative
Failed endovascular recanalisation attempts in 2015 in two tertiary care hospital
PRESENT STATE
Bilateral venous claudication
Lumbar pain, bilateral swelling despite compression therapy, varicose veins
Currently no anticoagulation therapy
CT: postthrombotic IVC, large hemiazygos vein,
Failed endovascular treatment
PROCEDURAL STEPS 1. Bilateral common femoral vein access, right jugular vein access with ultrasound guidance (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14–18 mm (BARD)
5. Implantation of dedicated Iliac vein stents
over TERUMO stiff angled wire 0.035":
- IVC stents: Sinus XL 22 mm (OPTIMED),
- Kissing Iliac vein stents: Sinus-XL Flex 14–16 mm (OPTIMED)
6. High-pressure post-dilation of stents
- Atlas balloon 14–18 mm (BARD)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 44 – LEI 15:
Abdominal aortic aneurysm – Part 2
Center:
Leipzig, Dept of Angiology
Case 44 – LEI 15: male, (R-E)
Operators:
Andrej Schmidt,
Daniela Branzan
CLINICAL DATA
Incidental finding of an eccentric AAA, 5.3 cm diameter
RISK FACTORS
CAD with NSTEMI 10/2015, PTCA LAD
Chronic renal insufficiency (GFR 72 ml/min)
Art. hypertention, former smoker
PROCEDURAL STEPS 1. Percutaneous access both groins in local anaesthesia
- 5F-10 cm Radifocus-sheaths (TERUMO)
- 0.035" SupraCore guidewire 190 m (ABBOTT)
- Preloading of 2 Proglide-systems per groin (ABBOTT)
- 0.035" Lunderquist 260 cm guidewires bilateral (COOK)
2. Graft implantation
- Implantation of the Altura Stentgraft system and extension to the hypogastric artery bilateral (LOMBARD MEDICAL)
3. Postdilatation of the whole graft
- Exchange to 12F-12 cm sheath bilateral (COOK)
- Reliant balloons both sides (MEDTRONIC)
Case 52 – MUN 04:
Endoleak embolisation of iliac artery aneurysm after iliac-sidebranch endograft
Center:
Münster
Case 52 – MUN 04: male, 63 years (F-D. P.)
Operators:
Arne Schwindt,
N. Varcoe
Varcoe
CLINICAL DATA
2013 Complex EVAR for aorto-biiliac AAA with Zentih bifurcated endograft and bilateral Zenith iliac-sidebranch endografts, 2013 embolisation of Type II Endoleak via AMI. In CT-angiogram aneurysm enlargement of left iliac aneurysm from initially 55mm to 65 mm and persisting type II EL via left deep circumflex iliac artery.
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 35 – LEI 11:
Reocclusion right SFA
Center:
Leipzig, Dept of Angiology
Case 35 – LEI 11: male, 50 years (R-D)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication right calf, painfree walking capacity 50 meters
Rutherford class 3
ABI right 0.63
PTA left SFA 12/2015, PTA right SFA with DCBs 12/2012
RISK FACTORS
Art. hypertension, current smoker
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 7F–40 cm Balkin Up&Over Sheath
2. Guidewire passage
- 0.035" stiff angled Radiofocus guidewire, 260 cm (TERUMO)
- 0.035" Seeker Support-catheter, 135 cm (BARD)
In case of failure to redirect the guidewire back into the true lumen retrograde approach via the distal SFA:
- 21 Gauge 9 cm puncture needle (COOK)
- 0.018" V-18 Control guidewire 90 cm (BOSTON SCIENTIFIC)
3. PTA and stenting
- Armada 35 5.0/120mm (ABBOTT)
- 6.0/250 mm Viabahn (W.L.GORE)
- 7.0/80 mm GORE Tigris Stent across the collateral distal to the occlusion (W.L.GORE)
- Placement of a pigtail catheter via the left groin
- Lunderquist wire right side
- Placement of the main body through the right side directly below the renals - Treovance-Endograft (BOLTON-MEDICAL)
- Probing and positioning of the iliac limb extension contralateral
- Ipsilateral positioning of the iliac endograft
- Postballooning
- Final angiography
- Closing access with Prostar (preclose technique)
Case 54 – LEI 19:
Selective Internal Radiation Therapy (SIRT) for colorectal liver metastases
Center:
Leipzig, Dept of Radiology
Case 54 – LEI 19: male, 57 years
Operators:
Tim Ole Petersen,
Michael Moche,
T. Lincke
CLINICAL DATA
Liver metastases following rectal cancer (T3 N2b M1 G2 KRAS wild type)
Rectum resection 11 month ago, followed by nine cycles of FOLFIRI-Cetuximab
chemotherapy. After initial regressive disease now persisting metastases in the liver.
Hepatic function not impaired.
RISK FACTORS
Art. hypertension
Slight focal cholestasis from tumor mass in liver segment VII
PROCEDURAL STEPS 1. Right femoral approach
- 4F 10 cm sheath (TERUMO)
2. Catheterization of the hepatic artery
- 4F-SIM2 100 cm diagnostic catheter (CORDIS)
3. Placement of the microcatheter precisely in the same position 1 and 2 for the injection of the therapeutic agent
- Microcatheter System 2.7F 130 cm (TERUMO PROGREAT)
4. Selective application of the Yttrium-90 glass microspheres with a dedicated injection system (TheraSphere, BTG)
PROCEDURAL STEPS 1. Left CFA Access
- 0.035" 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
- Armada 0.018", 5 or 6 mm (ABBOTT VASCULAR)
4. Stenting
- Viabahn 5 or 6 mm, 250 mm (GORE)
5. Postdilatation
- Armada 0.018", 5 or 6 mm (ABBOTT)
6. Plan B
Direct Stent Puncture right SFA + Retrograde / Bidirectional Recanalization
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Room 2 - Main Arena 2
Case 46 – BER 06:
Percutaneous EVAR of infrarenal AAA under local anaesthesia
Center:
Berne
Case 46 – BER 06: male, 79 years (F-L)
Operators:
Dai-Do Do,
V. Makaloski
CLINICAL DATA
Asymptomatic infrarenal AAA with progressively increasing diameter
Femorotibial bypass on the right side 2006
Lower extremity chronic venous disorders CEAP C4 on both sides
PTCA 2006
RISK FACTORS
Type 2 diabetes, arterial hypertension, hyperlipidemia,
65-pack-year cigarette smoking history
PROCEDURAL STEPS 1. Percutaneous femoral access in both groins
- Local anaesthesia, retrograde puncture of the CFA on both sides
- 0.035" Radiofocus M stiff guidewire, 180 cm (TERUMO)
- Preclosure of the access sites using ProGlide devices (ABBOTT)
2. Implantation of the INCRAFT®AAA Stent Graft System (CORDIS, CARDINAL HEALTH)
- the delivery system (14-F OD) with the main body inside up to the lower accessory right renal artery, deployment of the main body
- Implantation of the contralateral and then the ipsilateral iliac stentgraft (12-F OD)
3. Sealing ot the percutaneous access sites in both groins
- ballon dilatation of the main body and the iliac limbs: Reliant balloon (MEDTRONIC)
- control angiogram, then withdrawing the delivery system respectively the 12F sheath
- advancing and tying the knots using the knot pusher of the ProGlide system
CLINICAL DATA
Severe claudication right calf, Rutherford class 3
ABI right 0.62
Angiography during PTCA 11/2015:
Long SFA-occlusion right and popliteal artery stenosis right
RISK FACTORS
CAD with NSTEMI 11/2015 and PTCA RCX
Moderate aortic valve stenosis
Former smoker, art. hypertension, diabetes mellitus Type 2
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 6F-40cm Balkin Up&Over Sheath (COOK)
2. Passage of the CTO
- 0.035" Radiofocus glidewire, stiff, angled, 260 cm (TERUMO)
- 0.035" Seeker support-catheter, 135 cm (BARD)
- Exchange to a 0.018" SteelCore guidewire 300 cm (ABBOTT)
Case 57 – LEI 20:
Infrarenal aortic stenosis and bilateral iliac occlusions, Leriche-Syndrome
Center:
Leipzig, Dept of Angiology
Case 57 – LEI 20: male, 68 years (K-A)
Operators:
Andrej Schmidt,
Holger Staab,
Daniela Branzan
CLINICAL DATA
Claudication intermittens, walking capacity 50 meters
Weakness and pain buttock, thigh and calf bilateral
ABI bilateral 0.67
CAD, PTCA 2012 and 2013, cardiomyopathy, EF 45%
Adipositas
Gastric surgery due to perforation 2001
RISK FACTORS
Art. hypertension, hyperlipidemia
PROCEDURAL STEPS 1. Transbrachial approach
- 6F 90 cm Check-Flo performer sheath (COOK)
- 5F 125 cm diagnostic Judkins Right catheter (CORDIS / CARDINAL HEALTH)
- SupraCore 300 cm 0.035" guidewire (ABBOTT)
2. Passage of the occlusions
- Stiff angled 0,035" guidewire, 260 cm (TERUMO)
- Together with 5F-125 cm Judkins Right Catheter
3. Bilateral groin access
- 7F 10 cm Radiofocus sheath (TERUMO)
- Snaring of the antegrade guidewire form above into the groin-sheath or
- Into 6F-Judkins-Right guiding catheter (CORDIS), inserted form below
4. PTA via the groin access bilateral
- SupraCore 300 cm 0,035" guidewire (ABBOTT)
- Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
5. Stenting
- Aorta: Sinus XL Aortic Stent (OPTIMED)
- Common iliac arteries: 8.0/59 mm LifeStream covered Stentgrafts in Kissing technique (C.R.BARD)
- External iliac artery bilateral: 8.0/120 mm Absolute Pro Stent bilateral (ABBOTT)
Case 49 – HEI 02:
Asymptomatic aortoiliac aneurysmal disease – Part 1
Center:
Heidelberg
Case 49 – HEI 02: male, 73 years (G-K)
Operators:
Dittmar Böckler,
Alexander Hyhlik-Dürr,
Bischoff
CLINICAL DATA
Small AAA 31 mm, left common iliac artery 31 mm
and left thrombosed internal iliac artery aneurysm 38 mm
Diagnosed in 9/2105 in an external institution, asymptomatic status
RISK FACTORS
Ascending aneurysm (46 mm)
Ectatic infrarenal aorta (31 mm)
Ectatic popliteal arteries (right 13 mm: left: 14 mm)
Hx of smoking (40 py)
Hx of art. hypertension
ABI 1,0 both sides with palpable pulses
CLINICAL DATA
Severe claudication left calf, walking capacity 200-300 meters
Rutherford class 3, ABI left 0.68
PTA with plane balloon angioplasty left 7/2015
(POBA-arm of a DCB randomized controlled trial)
PTA right SFA 1/2016
CAD
Minor stroke without residual symptoms 2012
RISK FACTORS
Art. hypertension, former smoker
Angiography during PTA right SFA: diffuse restenosis left SFA
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- IMA 5F diagnostic catheter (CORDIS / CARDINAL HEALTH)
- 0.035" soft angled Radiofocus guidewire, 190 cm (TERUMO)
- 0.035" SupraCore Guidewire 190 cm (ABBOTT)
- 6F-40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire-passage and preparation of the lesion
- 0.018" SteelCore Guidewire, 300 cm (ABBOTT)
- FLEX Plaque Modification Catheter (VENTURE MED GROUP)
3. PTA and stenting on indication
- Luminor DCB 5.0/120 mm (iVASCULAR)
- VascuFlex Multi-LOC (B.BRAUN)
Case 49 – HEI 02:
Asymptomatic aortoiliac aneurysmal disease – Part 2
Center:
Heidelberg
Case 49 – HEI 02: male, 73 years (G-K)
Operators:
Dittmar Böckler,
Alexander Hyhlik-Dürr,
Bischoff
CLINICAL DATA
Small AAA 31 mm, left common iliac artery 31 mm
and left thrombosed internal iliac artery aneurysm 38 mm
Diagnosed in 9/2105 in an external institution, asymptomatic status
RISK FACTORS
Ascending aneurysm (46 mm)
Ectatic infrarenal aorta (31 mm)
Ectatic popliteal arteries (right 13 mm: left: 14 mm)
Hx of smoking (40 py)
Hx of art. hypertension
ABI 1,0 both sides with palpable pulses
Case 49b – LEI 17:
Amplatzer Plug implantation for an Endoleak via subclavian artery
Center:
Leipzig, Dept of Angiology
Case 49b – LEI 17: female 73 years (M-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Type II Endoleak after thoracoabdominal Stentgraft via left subclavian artery
Surgical repair of an aneurysm of the ascending aorta 2015
Bypass surgery from right to left common carotid and from left common carotid to left subclavian artery to prepare a landing-zone for a thoracoabdominal stentgraft
No proximal bending / clipping to occlude the left subclavian artery
RISK FACTORS
Art. Hypertension
ANGIOGRAPHY LEFT
Via left brachial artery: large endoleak into the descending thoracic aorta
PROCEDURAL STEPS 1. Left brachial approach
- 6F 55 cm sheath (COOK)
2. Implantation of an Amplatzer Plug 16 mm (ST JUDE MEDICAL) into the proximal left subclavian artery
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