LINC 2018 live case guide

Conference day 2

• 8:00 - 8:15, Room 5 - Global Expert Exchange

  Case 53 – Calcified CTO of the right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 53 – LEI 18: male, 70 years (M-N)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 50 m right, ABI right 0.6, left 0.8
  - PTA/stent of the left SFA 01/2018, of the left CIA 11/2011
  - CEA left 2008, AMI 1998, CABG 02/2017
  
  RISK FACTORS
  Arterial hypertension, former smoker, hyperlipidemia, renal impairment
  
  ANGIOGRAPHY
  During PTA left: severely calcifed occlusion of the right SFA
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Passage of the occlusion right SFA
  - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035" CXC support catheter, 135 cm (COOK)
  In case of failure guidewire passage from antegrade:
  3. Retrograde approach via distal SFA
  - 7 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F-10 cm Radiofocus introducer (TERUMO)
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  4. PTA and treatment with DCB
  - 6.0/40 mm Advance Enforcer balloon (COOK)
  - Luminor DCB 6.0/120 mm (iVASCULAR)
  5. Stenting on indication
  - 7/150 mm iVolution Self-Expanding stent (iVASCULAR)
  

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• 8:08 - 8:33, Room 3 - Technical Forum

  Case 43 – Microwave ablation-HCC

  Center:

  Frankfurt/Main

  Case 43 – FRA 01: female, 76 years (K-M)

  Operators:

  • K. Eichler,
  • Bita Panahi

  CLINICAL DATA
  - HCC-lesion in liver segment 3 in alcoholic liver cirrhosis
  - BCLC B
  - 12/2014 atypical liver resection Seg 7 (G2,pT3a, R0)
  - 09/2016 microwave ablation seg 6
  - 10/2016 microwave ablation seg 8
  
  PRESENT STATE
  - MELD score:6
  - CHILD-PUGH: A
  - No ascites
  
  PROCEDURAL STEPS
  1. Pre-ablation imaging like CT (contrast enhanced)
  2. Local anesthesia, analgosedation
  3. One antenna is placed directly into the lesion
  - EMPRINT CA15L2, Short percutaneous Antenna with thermosphere technology (COVIDIEN)
  - Generator: EMPRINT (COVIDIEN)
  

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• 8:24 - 8:51, Room 1 - Main Arena 1

  Case 30 – Calcified BTK-CTOs left, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 30 – LEI 11: male, 71 yeras (T-K)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 5, D3-ulcerations and rest pain at night, walking capacity 10 m
  - PTA of the left popliteal artery 01/18
  
  RISK FACTORS
  - Diabetes mellitus type 2, arterial hypertension, former smoker
  - ABI right 0.7, left 0.5
  
  ANGIOGRAPHY
  During PTA 01/18: occlusion of ATP and ATA
  
  PROCEDURAL STEPS
  1. Left groin antegrade approach
  - 6F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
  2. Guidewire passage of the occlusion PTA with DCBs
  - 0.014" Command ES guidewire, 300 cm (ABBOTT)
  - 0.018" 90 cm Seeker support catheter (BARD)
  - 0.014" Ultraverse balloon (BARD)
  - Lutonix-BTK DCB (BARD)
  3. In case of dissections after DCB, provisional placement of nitinol "tacks"
  - Tack Endovascular System (Intact Vascular)
  

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• 8:24 - 9:05, Room 2 - Main Arena 2

  Case 38 – Aorto iliac aneurysm - EVAR + Iliac branch device

  Center:

  Paris

  Case 38 – PAR 01: male, 86-years (G-J)

  Operators:

  • Stéphan Haulon

  CLINICAL DATA
  Right nephrectomy, pneumothorax, chronic renal insuffisency MDRD 46 ml/min
  
  RISK FACTORS
  Smoking
  
  PARACLINICS
  - Echocardiography: normal
  - Supra aortic trunks US: normal
  
  PROCEDURAL STEPS
  1. R: ZBIS (COOK) advanced into distal aorta, unsheath until tip of prelaoded catheter is released; advance 260 cm Terumo
  2. L: advance 12F sheath + snare
  3. L: snare 260 Terumo, through-and-through wire, advance 12F dilatator tip to tip of preloaded catheter – secure both ends of Terumo wire with clamps
  4. L: unsheath ZBIS to release internal branch – advance 12F sheath into ZBIS (pull and push), access hypogastric with parallel wire, advance 7F sheath-55 cm and bridging stent
  5. Release through and through wire, pull down ZBIS to position the branch at the IIA origin + bridging stent deployment
  6. Selective angiogram + ZBIS final deployment
  7. L: insert and deploy bifurcated component
  8. R: catheterize contro limb and deploy bridging ZSLE 16 limb
  9. Coda balloon, completion angiogram, CBCT
  

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• 8:49 - 9:14, Room 3 - Technical Forum

  Case 44 – Radioembolization with Therasphere in recurrent liver metastasis of neuroendocrine tumor

  Center:

  Jena

  Case 44 – JEN 02: male, 59 years (J-M)

  Operators:

  • René Aschenbach,
  • R. Drescher

  CLINICAL DATA
  - Liver only metastasis of neuroendocrine tumor, dominant left liver burden
  - No risk factors, left liver first SIRT
  - No extrahepatic disease
  
  PROCEDURAL STEPS
  1. Puncture site: right groin
  - ST. JUDE (ABBOTT)
  2. Placement of coaxial catheter in main hepatic artery
  - Cobra 4F, alternative SIM-1, (CORDIS/ CARDINAL HEALTH)
  3. Placement of microcatheter in left hepatic artery therapy positions according to the evaluation session
  - Progreat 2.7F (TERUMO), alternative wire: Cirrus 14" (COOK)
  4. Radioembolization
  - SIRT with Therasphere® (BTG)
  

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• 9:47 - 10:07, Room 1 - Main Arena 1

  Case 31 – Occlusion of the right popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 31 – LEI 12: male, 68 years (H-A)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 10–15 m, ABI right 0.55, left 0,8
  - PTA/stenting of left SFA and BTK 12/2107
  
  RISK FACTORS
  - Arterial hypertension, hyperlipidemia, diabetes mellitus type 2 with neuro- and angiopathy
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 6F–40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the occlusion
  - 0.035" Halfstiff Terumo 260 cm (TERUMO)
  - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
  3. PTA with scoring ballon
  - 4/40 mm AngioSculpt PTA scoring balloon (SPECTRANETICS-PHILIPS)
  4. PTA with DCBs
  - Stellarex 5.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
  

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• 10:10 - 10:40, Room 2 - Main Arena 2

  Case 39 – Progressive infrarenal AAA

  Center:

  Leipzig, Dept. of Angiology

  Case 39 – LEI 16: male, 63 years (M-B)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  - Progressive asymptomatic AAA, diameter max. 59 mm
  - Coiling of 3 lumbar arteries L2-L3 1/2018
  - PAOD Rutherford 3, PTA left EIA 11/2007 and left SFA 2010
  
  RISK FACTORS
  Artrial hypertension, hyperlipidemia, nicotine abuse (30Y) and renal impairment
  
  PROCEDURAL STEPS
  1. Bifemoral percutaneous approach in local anaesthesia
  - Preclosing with 2 Proglide closure devices both sides (ABBOTT)
  2. Guidewire positioning
  - Lunderquist GW 180 cm (COOK)
  3. Implantation of a bifurcational stentgraft
  - Ovation Stentgraft (ENDOLOGIX)
  Cannulation of the contralateral limb:
  - 5F Amplatz Left diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" soft angled short Radiofocus glidewire (TERUMO)
  4. PTA
  - Proximal seal: Reliant balloon (MEDTRONIC)
  - Graft-bifurcation: 12/40 mm Admiral balloon (MEDTRONIC)
  

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• 10:21 - 10:41, Room 1 - Main Arena 1

  Case 32 – Instent reoclusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 32 – LEI 13: male, 69 years (C-D)

  Operators:

  • Matthias Ulrich,
  • Sven Bräunlich

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 150 m, ABI left 0,6
  - PTA/stent right EIA 12/2017, PTA/stent left SFA 08/2016
  - CAD, PTCA 06/2016
  
  RISK FACTORS
  Hyperlipidemia, nicotine abuse (20PY), arterial hypertension
  
  ANGIOGRAPHY
  During PTA right 12/2017: IRS left SFA
  
  PROCEDURAL STEPS
  1. Right groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 7F-40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the in-stent reocclusion
  - 0.035" Halfstiff Terumo 260 cm (TERUMO)
  - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
  - Exchange to a 0.014" Floppy ES guidewire 300 cm (ABBOTT)
  3. Laser atherectomy
  - 7F Excimer laser with Turbo Elite 2.3 mm cathether (SPECTRANETICS-PHILIPS)
  4. PTA with DCBs
  - Stellarex 6.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
  

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• 10:55 - 11:30, Room 5 - Global Expert Exchange

  Case 54 – CTO of the distal SFA and Apop left

  Center:

  Leipzig, Dept. of Angiology

  Case 54 – LEI 19: male, 62 years (K-M)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Severe claudication left calf, walking capacity 150 meters, ABI 0.5, Rutherford class 3
  - PTA / stenting right SFA 9/2017 elsewhere
  - CAD with MI and PTCA 2002, TIA 9/2017
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, nicotine abuse
  
  PROCEDURAL STEPS
  1. Right groin and cross-over access
  - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Guidewire passage
  - 5.0/100 mm Sterling OTW balloon, 90 cm (BOSTON SCIENTIFIC)
  - 0.018" Victory guidewire, 18 gramm, 300 cm (BOSTON SCIENTIFIC)
  3. Atherectomy for vessel-preparation
  - Diamondback 360 Peripheral Orbital Atherectomy system (CSI CARDIOVASCULAR SYSTEMS)
  - VANGUARD IEP peripheral balloon with integrated embolic protection (CONTeGO MEDICAL)
  4. Direct stenting
  - Eluvia drug-eluting stent (BOSTON SCIENTIFIC)
  

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• 11:08 - 11:33, Room 3 - Technical Forum

  Case 45 – Doxorubicin-DEB-TACE with 40μm Embozene Tandem of recurrent HCC after atypical liver resection 9/2017

  Center:

  Jena

  Case 45 – JEN 03: male, 77 years (M-D)

  Operators:

  • I. Diamantis,
  • René Aschenbach

  CLINICAL DATA
  Singular HCC, intraoperative thermal ablation
  
  PRESENT STATE
  - First diagnosis of HCC in 9/2017,
  - atypical resection, now recurrence,
  - tumor board decission: DEB-TACE
  - Exclusion of extrahepatic disease
  
  PROCEDURAL STEPS
  1. Puncture site: right groin
  - ST. JUDE (ABBOTT)
  2. Placement of coaxial catheter in the main hepatic artery
  - COBRA 4F, alternative SIM-1 4F both (CORDIS/ CARDINAL HEALTH)
  3. Placement of microcatheter in the feeding artery of HCC
  - Progreat 2.7F (TERUMO), alternative wire: Cirrus 14" (COOK)
  4. DEB-TACE
  5. Control angiogram
  6. If necessary additional bland embolization
  - Embozene Tandem 40μm (BOSTON SCIENTIFIC)
  

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• 11:35 - 12:03, Room 2 - Main Arena 2

  Case 40 – Double-Chimney-EVAR for abdominal aortic aneurysm with a PAU at the level of the renal arteries

  Center:

  Münster

  Case 40 – MUN 01: male, 77 years (W-A)

  Operators:

  • Martin Austermann,
  • Marc Bosiers,
  • Konstantinos Stavroulakis

  CLINICAL DATA
  - Art. hypertension
  - PAD
  - COPD
  
  PRESENT STATE
  Growing aneurysm from 35 mm to >50 mm in 3 years
  
  PROCEDURAL STEPS
  1. Cut down left axillary artery and double puncture
  2. Placement of two 7 F Shuttle sheath from above
  3. Percutanous approach both groins Prostar XL 10F (ABBOTT) Placement of 14 F sheaths (COOK)
  4. Cannulation of both renal arteries from above
  5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
  6. Placement of the Chimney stent-grafts in both renal arteries
  - Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group) or Viabahn VBX balloon expandable endoprosthesis (GORE)
  7. Closure of the accesses
  

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• 11:49 - 12:14, Room 3 - Technical Forum

  Case 46 – Conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC)

  Center:

  Frankfurt/Main

  Case 46 – FRA 02: female, 54 years (T-C)

  Operators:

  • T. Gruber-Rouh,
  • B. Bodelle

  CLINICAL DATA
  - 54 year old patient with HCC lesions in liver segments 8, 8/5 and 6
  - 12/2017: TACE
  
  RISK FACTORS
  liver cirrhosis, hepatitis B, BCLC-Stage-B, Type 2 diabetes mellitus, hypertension
  
  PROCEDURAL STEPS
  1. Right retrograde access
  - 5F sheath Introducer 2® (TERUMO)
  2. Catheterization and DSA of celiac trunk plus indirect porotgraphy
  - 5 F Side-Winder catheter (TERUMO)
  - 0.035'' angled guidewire (TERUMO)
  3. Selective catheterization of segmental and subsegmental branches of the hepatic artery in depending on location, size, and arterial feeding vessel of the target tumor
  - 2.8F coaxial microcatheter system Progreat (TERUMO)
  4. Chemoembolization with mitomycin C and lipiodol
  5. Puncture site closure with a percutaneous closure device
  - 6F Angio-Seal™ VIP (ST. JUDE Medical)
  

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• 13:30 - 15:00, Room 3 - Technical Forum

  Case 47 – SFA vessel prep and DCB

  Center:

  Teaneck

  Case 47 – TEA 03: male, 63 years (J-D)

  Operators:

  • John Rundback,
  • Kevin Herman,
  • V. Gallo

  CLINICAL DATA
  - Status post kissing iliac stent placement in 2012
  - now presents with recurrent lifestyle – limiting claudication in the right thigh and calf, failed medical and exercise Rx
  
  RISK FACTORS
  HTN, Dyslipidemia, former 2pk/day smoker stopped 2012
  
  DUPLEX
  1/3/18 Mild right iliac in-stent restenosis and high grade distal right superficial femoral above knee popliteal artery stenosis
  
  PROCEDURAL STEPS
  1. Antegrade right SFA access
  - 6F SlenderTM sheath
  2. Distal filter placement (Medtronic Spider)
  3. Atherectomy, TBD, with filter placement
  4. POBA for additional vessel prep (Medtronic Charger)
  5. DCB (Medtronic In.Pact)
  6. Any necessary additional procedures
  

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• 13:30 - 15:00, Room 3 - Technical Forum

  Case 48 – CLI; Trans-pedal

  Center:

  Teaneck

  Case 48 – TEA 04: female, 85 years (B-C)

  Operators:

  • Kevin Herman,
  • John Rundback,
  • V. Gallo

  CLINICAL DATA
  Left heel and left great toe ulceration and pain at rest now with difficulty ambulating
  
  RISK FACTORS
  DM, HTN, hyperlipidemia, emphysema
  
  HISTORY
  - Revasc of SFA/pop on 1/3/18, Flex peripheral scoring catheter, DCB In.Pact Admiral
  - Failed revascularization of AT from antegrade approach.
  
  PROCEDURAL STEPS
  1. Left groin access
  - 4F Terumo sheath
  2. Angiogram and methylene blue injection into peroneal artery
  3. DP access using US for guidance
  - 4F Pinnacle/Precision or 4F Pedal Access kit
  4. Attempt to cross from retrograde access
  5. Atherectomy
  - Laser (SPECTRANETICS-PHILIPS) vs. Orbital (CSI CARDIOVASCULAR SYSTEMS), either from antegrade or retrograde access
  6. PTA
  - 2 or 2.5 mm x 300 mm catheter
  7. Possible attempt to revascularize the pedal loop
  

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• 13:54 - 14:20, Room 2 - Main Arena 2

  Case 41 – Chronic aortic dissection – false lumen thoraco abdominal aneurysm evolution – 4-vessel FEVAR

  Center:

  Paris

  Case 41 – PAR 02: male, 70 years (J-L-C)

  Operators:

  • Stéphan Haulon

  CLINICAL DATA
  - Acute type A aortic dissection open repair in 2014
  - Aortic arch aneurysm 09/2015: left common carotid subclavian by pass + 2 branches arch endograft
  
  RISK FACTORS
  - Smoking, hypertension, dyslipidemia, BMI >30
  - Obstructive sleep apnea syndrome, transient stroke
  
  PARACLINICS
  - PFT: restrictive syndrome
  - CTscan: thoraco abdominal aneurysm, 70 mm maximal diameter
  - Cardiac stress test: negative
  - Supra aortic trunks US: no significative lesion
  
  PROCEDURAL STEPS
  1. Percutaneous access R and L CFA with Proglide systems; 100ULkg Heparin (Target ACT>250)
  2. R: Dilatators up to 20F, insertion of TEVAR
  3. L: 16F introducer + Pigtail angiocatheter
  4. Aortic angiogram / TEVAR deployment
  5. Insertion of FEVAR delivery system (COOK)
  6. Aortic angiogram / fusion regsitration + FEVAR deployment + access target vessels through fenestrations / bridging stents
  7. ZBIS deployment (COOK)
  6. Bifurcated component deployment
  7. Completion angiogram + non injected CBCT
  

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• 14:45 - 15:00, Room 1 - Main Arena 1

  Case 33 – Long SFA-occlusion left in a CLI-patient

  Center:

  Leipzig, Dept. of Angiology

  Case 33 – LEI 14: male, 63 years (AG-N)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  - Critical limb ischemia left, ulcerations dig 2/3 left, restpain
  - Previous femoro-popliteal bypass surgery left (in-situ) 2007 with bypass-thrombectomy 2017
  - Congestive heartfailure, NYHA III
  - Paroxysmal atrial fibrillation
  - COPD
  
  RISK FACTORS
  Art. hypertension, nicotine abuse
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 6F-40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - 0.035" stiff, angled glidewire, 260 cm (TERUMO)
  - 0.035" Seeker support catheter, 135 cm (BARD)
  3. Angioplasty
  - VascuTrak 5.0/300 mm balloon (BARD)
  - Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)
  4. Stenting on indication
  - LifeStent (BARD)
  

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• 15:08 - 15:29, Room 3 - Technical Forum

  Case 49 – Prostate artery embolization with 250μm Embozene in symptomatic benign prostatic hyperplasia

  Center:

  Jena

  Case 49 – JEN 04: male, 57 years (L-U)

  Operators:

  • Tobias Franiel,
  • René Aschenbach,
  • F. Bürckenmeyer

  CLINICAL DATA
  IPSS: 28, QoL: 6, IIEF-5: 11, prostatic volume: 72 ml, psa: 2.86 ng/l, Qmax: 4.2 ml/s
  
  PRESENT STATE
  - Lower urinary tract symptoms due to BPH, no successful medications for more than 6 month, refusing operative therapy such as TUR
  - Exclusion of prostatic cancer
  
  PROCEDURAL STEPS
  1. Puncture site: right groin
  - ST. JUDE (ABBOTT)
  2. Placement of coaxial catheter in distal aorta
  - RIM 4F (CORDIS) or alternative (MERRIT MEDICAL); Alternative Wire: Cirrus 14" (COOK)
  3. Large-FOV-dyna CT for determination of anatomy and origins of the prostatic arteries
  4. Placement of microcatheter in the left prostatic artery for embolization
  - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT MEDICAL)
  - Embozene 250μm (BOSTON SCIENTIFIC)
  5. Placement of the microcatheter in the right prostatic artery for embolization
  - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT MEDICAL)
  - Embozene 250μm (BOSTON SCIENTIFIC)
  
• 15:53 - 16:14, Room 3 - Technical Forum

  Case 50 – Transjugular intrahepatic portosystemic shunt (TIPSS)

  Center:

  Frankfurt/Main

  Case 50 – FRA 03: female, 59 years (B-H)

  Operators:

  • A. Thalhammer,
  • M. Nour Eldin,
  • S. Fischer

  CLINICAL DATA
  Alcoholic liver cirrhosis with portal hypertension, including refractory ascites and variceal bleeding
  
  RISK FACTORS
  Type 2 diabetes mellitus, hypertension
  
  PROCEDURAL STEPS
  1. Insertion of 10F sheath into the right jugular vein
  - 10F x 17-3%4'' sheath super Arrow-Flex® Psi Set, 45 cm, and tisue dilatator (Arrow International)
  - 0.035'' angled guide wire (TERUMO)
  2. Access to the a hepatic vein (right or middle) by inserting a 5F multi-purpose catheter
  - 5F MP A1 (CORDIS)
  - 0.035'' angled guide wire (TERUMO)
  3. Puncture of the portal vein under ultrasound or fluoroscopic control using a Tips puncture set
  - Tips puncture set with a spezial nitinol guide wire; needle size: ø 1.8 mm x 580 mm, 60° curved (OPTI MED)
  - 0.035'' straight guide wire (stiff type) (TERUMO)
  4. Placement of stiff guide wire and a catheter into the portal venous system to produce a direct portogram and to measure the direct portal pressure
  - 4F Berenstein catheter (ANGIO DYNAMICS)
  - Haemofix-Monitorin Kit Art/Ven BSS
  5. Dilatation of the parenchymateous tract using an angioplasty balloon
  - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
  - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
  - Inflation device (MERIT MEDICAL)
  6. Placement of the 10F sheath into the portal mainstem
  - 10 F Check Flo Performer® introducer (COOK)
  7. Implantation the portovenous PTFE covered stent under fluoroscopic control
  - VIATORR 10 mm x 8 cm/2 cm; 10F (GORE)
  8. Dilatation of stent using an angioplasty balloon
  - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
  - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
  - Inflation device (MERIT MEDICAL)
  9. Direct portography and measure the pressure gradients between the portal vein and the inferior vena cava
  - 5F- MP A1 (CORDIS)
  - F Check Flo Performer® introducer (COOK)
  10. Placement of a central venous catheter in the superior vena cava or right atrium
  - Mahurkar acute dual lumen catheter, 11.5F x 19.5 cm (COVIDIEN)
  
  

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• 15:55 - 16:22, Room 1 - Main Arena 1

  Case 35 – TASD aorto-iliac occlusive disease

  Center:

  Teaneck

  Case 35 – TEA 02: male, 57 years (J-D)

  Operators:

  • Z. Raval,
  • I. Zairis,
  • Kevin Herman

  CLINICAL DATA
  57 yo male with claudication x 1 yr, not improved with Cilostazol, he works in food delivery business and the symptoms have made his work difficult.
  
  RISK FACTORS
  HTN, long time smoker (trying to quit-currently with nicotine patch)
  
  PROCEDURAL STEPS
  1. Bilateral groin access
  2. Will plan for treatment using Endologix AFX Unibody Endograft
  3. Pre-close technique utilizing
  2 Per-Close devices (ABBOTT)
  4. Aortogram to size device
  5. Deploy device, possible extension to cover iliac disease using Ovation limb (ENDOLOGIX)
  6. Alternate plan: b/l groin access and kissing balloon stent graft, VBX (GORE)
  
  

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• 16:42 - 17:09, Room 3 - Technical Forum

  Case 51 – Aorto-iliac occlusion, Leriche-syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 51 – LEI 17: male, 64 years (K-F)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  - Critical limb ischemia, ulcerations left foot
  - Congestive heart-failure, EF 35%, NYHA II
  
  RISK FACTORS
  Diabetes mellitus type 2, art. hypertension, current smoker
  
  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 from below
  4. PTA via the groin access bilateral
  - SupraCore 300 cm 0,035" guidewire (ABBOTT)
  - Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
  5. Implantation of covered stents
  - Viabahn 8.0/150 mm in kissing-technique (GORE)
  - Reinforcement with balloon-expandable stents at the aortic bifurcation:
  - Palmaz Genesis 8.0/79 mm balloon-expandable stents in kissing-technique (CORDIS)
  - Bigraft covered stent for the medial sacral artery (BENTLEY)
  
  

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• 16:50 - 17:18, Room 2 - Main Arena 2

  Case 42 – Preloaded FEVAR for a rapid growing juxtarenal aneurysm 61 mm diameter

  Center:

  Münster

  Case 42 – MUN 02: male, 77 years (B-H)

  Operators:

  • Martin Austermann,
  • Marc Bosiers

  CLINICAL DATA
  Art. hypertension, CAD, PAD
  
  PRESENT STATE
  Rapid growing of a juxtarenal abdominal aortic aneurysm from 45 mm up to 61 mm in 6 month.
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins (Prostar XL, ABBOTT); 14F sheats (COOK) both groins
  2. Change for the Lunderquist-wire (COOK) on the right side and pig-tail-cath on the left side
  3. Angiography to locate CT, SMA and RAs and use of the fusion-technology
  4. Placement of the 3-fenestrated Zenith-endograft (COOK) via the right groin
  5. Cannulation of the renal arteries through the introducer sheath and the fenestrations by using the preloaded wire
  6. Cannulation of the SMA through the left access
  7. Implantation of the bridging stentgrafts (Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group)) after deployment of the Top-Stent and removal of the preloaded wire
  8. Removal of the introducer sheath
  9. Implantation of the bifurcated endograft and the iliac limbs
  10. Closure of the accesses
  

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• 16:52 - 17:15, Room 1 - Main Arena 1

  Case 36 – CFA directional atherectomy with additional DCB angioplasty

  Center:

  Bad Krozingen

  Case 36 – BK 01: female, 64 years (B-R)

  Operators:

  • Aljoscha Rastan

  CLINICAL DATA
  - Claudication Rutherford-Becker class 3
  - DCB angioplasty and stenting of the left popliteal artery 2014
  - Stenting of the right CIA and CIE 2017
  
  RISK FACTORS
  Hypertension, tobacco use, diabetes, hypercholesterolemia
  
  PRESENT STATE
  - ABI at rest: 0.7
  - Duplex ultrasound/angiography: 80% stenosis of the left CFA
  
  PROCEDURAL STEPS
  1. Femoral access (cross-over)
  - 0.035" wire (TERUMO)
  - 7/8F 45 cm sheath (COOK)
  2. Directional atherectomy
  - 0.0014" wire (TERUMO)
  - Spider filter (MEDTRONIC)
  - TurboHawk/ HawkOne (MEDTRONIC)
  3. Post-dilatation
  - DCB (MEDTRONIC)
  4. Stenting on indication
  

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• 17:25 - 17:50, Room 1 - Main Arena 1

  Case 37 – Calcified stenosis left CFA

  Center:

  Leipzig, Dept. of Angiology

  Case 37 – LEI 15: male, 65 years (W-W)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  - Severe claudication left leg, walking capacity 200 meters
  - ABI left 0.53, Rutherford class 3, CAD
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, current smoker
  
  PROCEDURAL STEPS
  1. Right groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 7F-40 cm Balkin Up&Over sheath (COOK)
  2. PTA of the CFA left
  - Admiral balloon 7.0; 8.0/20 mm (MEDTRONIC)
  3. Stenting
  - 7.0/40 or 8.0/40 mm Supera Interwoven Nitinol stent (ABBOTT)
  
  

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