LINC 2019 live case guide

Leipzig, Dept. of Angiology

• Tuesday, January 22nd: 8:14 - 8:45, Room 1 - Main Arena 1

  Case 01 – Calcified SFA-occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 01 – LEI 01: male, 75 years (M-K)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 100 meters,
  ABI right 0.54, Rutherford class 3
  PTA both EIA 10/2014 and left SFA 12/2014
  CAD, AMI 02/2014
  Mild renal impairment
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, former smoker
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - 0.035“ SupraCore guidewire 190 cm (ABBOTT)
  - 7F 40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - Command 18 and Armada 18 balloon (ABBOTT) or
  - 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO)
  3. In case of failure to pass the CTO
  - GoBackTM Crossing Catheter (Upstream Peripheral)
  4. PTA
  - 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
  - Conquest high pressure balloon on indication (BARD)
  5. Stenting
  - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

  View image
• Tuesday, January 22nd: 9:06 - 9:30, Room 1 - Main Arena 1

  Case 02 – Calcified CTO of the left distal SFA and left popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 02 – LEI 02: male, 73 years (W-H)

  Operators:

  • Sven Bräunlich,
  • Axel Fischer

  CLINICAL DATA
  PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0,5
  CAD, ICM (EF 32%), AMI 2014 and 12/2018, CABG 2014, PTCA 12/18
  Renal impairment
  
  RISK FACTORS
  Arterial hypertension, diabetes mellitus type 2 with angio- and neuropathy, hyperlipidemia
  
  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
  - Command 18 and Armada 18 balloon (ABBOTT) or
  - 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO) and
  4.0/120 mm Armada 35 balloon (ABBOTT)
  - 5.0/40 mm Armada 35 balloon (ABBOTT)
  3. Stenting
  - 5.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

  View image
• Tuesday, January 22nd: 9:48 - 10:15, Room 2 - Main Arena 2

  Case 11 – TASC D calcified iliac occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 11 – LEI 06: male, 59 years (L-G)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right, walking-capacity 50-100 meters
  Rutherford class 3, ABI right 0.46
  COPD
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, strong smoker (50PY)
  
  PROCEDURAL STEPS
  1. Right femoral access
  - 7F 25 cm Radiofocus Introducer (TERUMO)
  - 0.035“ SupraCore guidewire 300 cm (ABBOTT)
  Left brachial approach:
  - 6F 90 cm Check-Flo Performer (COOK)
  2. Antegrade and retrograde guidewire passage
  brachial:
  - 5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
  from femoral:
  - 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
  - 0.035“ stiff angled glidewire, 260 cm (TERUMO)
  3. Predilatation and stenting of the aorto-iliac bifurcation
  - Ultraverse or Dorado balloon (BARD)
  - LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
  - Covera Plus vascular covered stent for the external iliac artery (BARD)

  View image
• Tuesday, January 22nd: 10:35 - 10:55, Room 1 - Main Arena 1

  Case 03 – Occlusion of the right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 03 – LEI 03: male, 74 years (P-V)

  Operators:

  • Sven Bräunlich,
  • Manuela Matschuck

  CLINICAL DATA
  PAOD Rutherford 3, walking capacity 100 m, ABI right 0.55, left 0.6
  Failed recanalisation attempt of the right SFA 08/12 elsewhere
  Renal impairment grade 2
  
  RISK FACTORS
  Aterial hypertension, former nicotine abuse (20PY), hyperlipidemia
  
  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 (PHILIPS)
  3. PTA with scoring ballon
  - 4/40 mm AngioSculpt PTA scoring balloon (PHILIPS)
  4. PTA with DCBs
  - Stellarex 5.0/120 mm DCBs (PHILIPS)

  View image
• Tuesday, January 22nd: 13:30 - 15:00, Room 3 - Technical Forum

  Case 23 – Long calcified SFA-occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 23 – LEI 07: male, 61 years (R-F)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Severe claudication left calf, walking capacity 50 meters, ABI left 0.62
  Femoro-popliteal bypass right 2012, thrombendatherectomy left groin 01/2019
  CEA left 11/2012 and right 12/16, CAD, AMI 1997
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, nicotine abuse (80PY), hyperlipidemia
  
  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 (ABBOTT)
  - 7F Balkin Up&Over sheath, 40 cm (COOK)
  2. Antegrade guidewire-passage
  In case of failure from antegrade:
  Retrograde GW-passage via proximal ATA
  - 21 Gauge 9cm needle (B.BRAUN)
  - 0.018” V-18 Control GW, 300cm (BOSTON SCIENTIFIC)
  - 0.018” CXC Support-Catheter, 90cm (COOK)
  3. In case of failure to pass the guidewire
  - retrograde approach via distal SFA or GoBackTM Crossing Catheter (Upstream Peripheral) from antegrade
  4. Tumescent anesthesia of the SFA
  - Bullfrog-Device (MERCATOR)
  5. PTA/ vessel preparation
  - Sterling 5/100 mm balloon (BOSTON SCIENTIFIC)
  - Conquest High pressure balloon on indication (BARD)
  6. Differential stenting
  - Eluvia DES in case of minor recoil (BOSTON SCIENTIFIC)
  - Supera Interwoven Nitinol-Stent in case of severe recoil (ABBOTT)

  View image
• Tuesday, January 22nd: 13:38 - 14:02, Room 1 - Main Arena 1

  Case 04 – Chronic total occlusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 04 – LEI 04: female, 76 years (M-R)

  Operators:

  • Matthias Ulrich,
  • Manuela Matschuck

  CLINICAL DATA
  Severe claudication both calves, walking capacity 20 meters
  Obesitiy, renal impairment G3, ICM, mycardial infarction 2009
  ABI right: 0.53 and left: 0.64
  
  RISK FACTORS
  Arterial hypertension, former smoker
  
  ANGIOGRAPHY
  11/2018: long SFA-occlusions both sides, moderate calcification
  
  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 of the right SFA
  - 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035“ TrailBlazer support catheter, 135 cm (MEDTRONIC)
  - Exchange to 0.018“ SteelCore guidewire (ABBOTT)
  3. PTA with DCBs
  - 5.0 mm Chocolate balloon (MEDTRONIC)
  - 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)
  4. Stenting on indication
  - Complete Selfexpanding Nitinol stent (MEDTRONIC)

  View image
• Tuesday, January 22nd: 15:00 - 16:30, Room 3 - Technical Forum

  Case 24 – Chronic occlusion of the abdominal aorta and aortic bifurcation, Leriche-Syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 24 – LEI 08: male, 46 years (A-G)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford 3 bilateral, ABI bilateral 0.5
  Absolute walking-capacity 100 meters, weakness both thighs/calves
  
  RISK FACTORS
  Art. hypertension, nicotine abuse (30PY)
  
  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 from above into the groin-sheath or
  - Into 6F-Judkins-Right guiding catheter (CORDIS) inserted from below
  4. PTA/thrombectomy via the groin access bilateral
  - Rotarex 10F thrombectomy (STRAUB MEDICAL)
  - SupraCore 300 cm 0,035“ guidewire (ABBOTT)
  - Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
  5. Implantation of covered stents
  - VBX covered stents for both renal arteries (GORE)
  - VBX covered stents bilateral in kissing technique (GORE)

  View image
• Tuesday, January 22nd: 16:30 - 18:00, Room 3 - Technical Forum

  Case 27 – Restenosis of the left common carotid artery after TEA

  Center:

  Leipzig, Dept. of Angiology

  Case 27 – LEI 09: female, 56 years (L-K)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Asymptomatic highgrade stenosis of the the common carotid artery left, dizziness
  M. Hodgkin 1984 with cervical radiation
  CEA right 09/16 and CEA of left common carotid artery 05/17
  
  RISK FACTORS
  Art. hypertension, hyperlipidemia, former smoker
  
  DUPLEX
  4.8 m/sec. Left distal common carotid artery
  
  PROCEDURAL STEPS
  1. Right groin access
  - 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0.015“ SupraCore guidewire (ABBOTT)
  - 7F 90cm Check Flo Performer sheath (COOK)
  2. Cerebral protection
  - Filter-wire EZ (BOSTON SCIENTIFIC)
  3. Predilatation and Stenting
  - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
  - 8/30 mm CGuard stent (InspireMD)

  View image
• Tuesday, January 22nd: 16:36 - 17:02, Room 1 - Main Arena 1

  Case 07 – Chronic CTO left SFA, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 07 – LEI 05: male, 64 years (P-W)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Critical limb ischemia left, ulceration dig 4, Rutherford class 5
  Severe claudication left calf, walking capacity 50–100 meters,
  PTA/stenting left EIA 11/2018
  ABI left: 0.45
  
  RISK FACTORS
  Diabetes mellitus type 2, arterial hypertension, former smoker
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
  2. Passage of the occlusion left 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
  - 9 cm 20 Gauge spinal needle (BD)
  - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F 10 cm Radiofocus introducer (TERUMO)
  - Passeo 18 4.0/40 mm balloon, 90 cm (BIOTRONIK)
  4. PTA
  - Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
  - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
  5. Stenting on indication, spot-stenting
  - Pulsar 18-T3 stent (BIOTRONIK)

  View image
• Wednesday, January 23rd: 8:00 - 8:25, Room 5 - Global Expert Exchange

  Case 53 – CTO, multilevel disease right

  Center:

  Leipzig, Dept. of Angiology

  Case 53 – LEI 17: male, 70 years (B-R)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford class 4, claudication right calf, walking capacity 50 m, restpain during night, ABI right 0.52, EVAR and stenting right renal artery 11/2018, chronic pancreatitis
  Failed recanalization attempt right popliteal 12/18 elsewhere
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Antegrade approach right groin
  - 7F 55 cm Flexor sheath (COOK)
  2. Antegrade guidewire passage
  in case of failure retrograde approach via the proximal anterior tibial artery
  - 2.9F sheath (pedal puncture set) (COOK)
  - 0.014“ CTO-Approach 25 gramm guidewire, 300 cm (COOK)
  - 0.018“ CXI support catheter 90 cm (COOK)
  - Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
  3. Atherectomy of the popliteal artery
  - JetStream atherectomy device (BOSTON SCIENTIFIC)
  4. Angioplasty
  - VascuTrak 4.0/120 mm balloon (BARD)
  - Luminor DCB (iVascular)
  5. Stenting on indication
  - Spot-stenting with Multi Lock (B.BRAUN)

  View image
• Wednesday, January 23rd: 8:45 - 9:05, Room 1 - Main Arena 1

  Case 30 – CLI with CTO BTK left

  Center:

  Leipzig, Dept. of Angiology

  Case 30 – LEI 10: female, 79 years (G-H)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Critical limb ischemia both lower legs with chronic ulcerations, Rutherford class 5
  ABI left 0.34, ABI right 0.45
  Recanalization right peroneal artery 01/07/2018
  PTA SFA/popliteal artery left and PTA anterior tibial right 11/2018
  Amputation forefoot left
  Amputation D1 right
  
  RISK FACTORS
  Diabetes mellitus type 2 with diabetic neuropathy, arterial hypertension, chronic renal impairment
  
  PROCEDURAL STEPS
  1. Antegrade approach left groin
  - 6F 55 cm sheath (COOK)
  2. Guidewire-passage anterior/posterior tibial
  - 0.014“ Command (ABBOTT)
  - 0.014“ PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)
  - In case of failure: retrograde approach
  3. PTA
  - Vessel preparation – scoring balloon (VascuTrak, BARD)
  - Lutonix BTK DCB (BARD)
  4. In case of dissections after DCB, provisional placement of nitinol „tacks“
  - Tack Endovascular System (Intact Vascular)

  View image
• Wednesday, January 23rd: 9:50 - 10:10, Room 2 - Main Arena 2

  Case 40 – Infrarenal AAA

  Center:

  Leipzig, Dept. of Angiology

  Case 40 – LEI 15: male, 77 years (G-G)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  Asymptomatic infrarenal AAA, diameter max. 58 mm
  Coiling of lumbar arteries 12/2018
  
  RISK FACTORS
  Art. hypertension, chronic renal impairment, hyperlipidemia
  
  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)

  View image
• Wednesday, January 23rd: 10:02 - 10:27, Room 1 - Main Arena 1

  Case 31 – Live case from Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 31 – Live case from Leipzig

  Information will follow in due time. Thank you for your understanding.
• Wednesday, January 23rd: 11:00 - 11:20, Room 5 - Global Expert Exchange

  Case 54 – Long occlusion of the left popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 54 – LEI 18: female, 67 years (B-U)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  PAOD Rutherford 3, claudication left calf, walking capacity 30 m
  ABI left 0.3
  Hypotyhreosis
  
  RISK FACTORS
  Arterial hypertension, current smoker, hypelipidemia
  
  PROCEDURAL STEPS
  1. Right groin cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035“ SupraCore guidewire 30 cm (ABBOTT)
  - 6F 55 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the occlusion and 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)

  View image
• Wednesday, January 23rd: 11:13 - 11:38, Room 2 - Main Arena 2

  Case 41 – Live case from Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 41 – Live case from Leipzig

  Information will follow in due time. Thank you for your understanding.
• Wednesday, January 23rd: 12:30 - 13:30, Room 1 - Main Arena 1

  Case 33 – CLI, deep vein arterialization of a "desert foot" left

  Center:

  Leipzig, Dept. of Angiology

  Case 33 – LEI 12: male, 68 years (J-K)

  Operators:

  • Andrej Schmidt,
  • Steven Kum,
  • Daniela Branzan

  CLINICAL DATA
  PAOD Rutherford 5, non-healing forefoot gangrene, mediasclerosis, ABI > 1.4
  PTA left peroneal artery 07/18 and left TPA 08/18
  Terminal kidney disease
  Paroxysmal atrial fibrilation, pacemaker 12/17
  
  RISK FACTORS
  Arterial hypertension, hyperlipdemia, dialysis
  
  PROCEDURAL STEPS
  1. Left groin antegrade access
  - 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
  Left distal venous tibial retrograde access
  - 5F sheath Introducer 2R (TERUMO)
  Arteriography and phlebography to define the optimal level for arterio-venous crossing
  2. Crossing from artery to vein
  - LimFlow Arterial Catheter 7F (LIMFLOW)
  - LimFlow Venous Catheter 5F (LIMFLOW)
  - LimFLow Ultrasound System (LIMFLOW)
  - PT2 0.014“ Guidewire to pass from artery into vein (BOSTON SCIENTIFIC)
  - Predilatation with MiniTrek 3.5/20 mm OTW Coronary Balloon (ABBOTT)
  3. Guidewire passage through vein and vein preparation
  - PT2 0.014“ guidewire (BOSTON SCIENTIFIC) or
  - Command 18 guidewire (ABBOTT)
  - Push Valvulotome 4F (LIMFLOW)
  - 4.0/120 mm Pacific ballon (MEDTRONIC)
  4. Implantation of covered stentgrafts
  - LimFlow Extension stentgrafts 7F 5.5 mm x 150 mm (LIMFLOW) for vein coverage
  - LimFLow Crossing Stentgraft 7F 3.5 x 60 mm (LIMFLOW) for connection artery to vein

  View image
• Wednesday, January 23rd: 14:30 - 14:55, Room 1 - Main Arena 1

  Case 34 – Occlusion of the left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 34 – LEI 13: male, 65 years (G-Z)

  Operators:

  • Matthias Ulrich,
  • Axel Fischer

  CLINICAL DATA
  PAOD Rutherford 3, walking capacity of 40 m, claucation left calf
  ABI left 0.6
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, strong smoker (50PY)
  
  PROCEDURAL STEPS
  1. Right groin cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035“ SupraCore guidewire 30 cm (ABBOTT)
  - 6F-55 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)
  In-case of inability to reenter distal:
  - either retrograde approach via distal SFA or GoBack Crossing Catheter (UPSTREAM PERIPHERAL)
  3. Angioplasty
  - ULTRASCORE Balloon 5.0/100 mm (BARD)
  - Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)

  View image
• Wednesday, January 23rd: 16:48 - 17:13, Room 1 - Main Arena 1

  Case 37 – Live case from Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 37 – Live case from Leipzig

  Information will follow in due time. Thank you for your understanding.
• Thursday, January 24th: 8:00 - 9:30, Room 3 - Technical Forum

  Case 72 – Total occlusion of the left CIA and EIA

  Center:

  Leipzig, Dept. of Angiology

  Case 72 – LEI 25: male, 62 years (RT-V)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford class 3, severe claudication both calves, walking capacity 50 m,
  ABI left 0.3, ABI right 0.6
  COPD, biliar carcinoma 12/17
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, nicotine abuse (40PY)
  
  ANGIOGRAPHY
  Occlusion of left CIA and EIA and of both SFA
  
  PROCEDURAL STEPS
  1. Left femoral access
  - 7F 25 cm Radiofocus Introducer (TERUMO)
  - 0.035“ SupraCore guidewire 300 cm (ABBOTT)
  Left brachial approach:
  - 6F 90 cm Check-Flo Performer (COOK)
  2. Antegrade and retrograde guidewire passage
  brachial:
  - 5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
  from femoral:
  - 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
  - 0.035“ stiff angled glidewire, 260 cm (TERUMO)
  3. Predilatation and stenting of the aorto-iliac bifurcation
  - Ultraverse or Dorado balloon (BARD)
  - LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
  - Covera Plus vascular covered stent for the external iliac artery (BARD)

  View image
• Thursday, January 24th: 8:45 - 9:06, Room 1 - Main Arena 1

  Case 56 – Complex BTK-CTO in a CLI-patient

  Center:

  Leipzig, Dept. of Angiology

  Case 56 – LEI 19: female, 74 years (M-C)

  Operators:

  • Andrej Schmidt,
  • Axel Fischer

  CLINICAL DATA
  Critical limb ischemia, minor gangrene dig 1 left,
  restpain and severe claudication left, ABI left 0.2
  Multiple interventions both legs, D4-Amputation right 11/2018
  
  RISK FACTORS
  Art. Hypertension, diabetes mellitus type 2 with multiple complications
  
  PROCEDURAL STEPS
  1. Antegrade approach left groin
  - 6F 55 cm sheath (COOK)
  2. Guidewire passage antegrade into posterior tibial artery
  - 0.014“ Command (ABBOTT)
  - 0.014“ PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
  - In case of failure: retrograde approach
  3. PTA
  - Vessel preparation – scoring balloon (VascuTrak, BARD)
  - Lutonix BTK DCB (BARD)
  4. In case of dissections after DCB, provisional placement of nitinol „tacks“
  - Tack Endovascular System (Intact Vascular)

  View image
• Thursday, January 24th: 9:40 - 10:10, Room 1 - Main Arena 1

  Case 57 – Subacute occlusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 57 – LEI 20: female, 72 years (R-V)

  CLINICAL DATA
  Critical limb ischemia bilateral, ulcerations both feet (right forefoot, left lateral foot)
  ABI left 0.54, Rutherford class 5
  PTA right SFA 12/2018
  Iliac stenting 2013/2014
  CAD with PTCA 2018
  CEA right internal carotid artery 2015
  Renal transplantation 2006
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2
  
  PROCEDURAL STEPS
  1. Right femoral retrograde and cross-over approach
  - 8F Balkin Up&Over 40 cm sheath (COOK)
  2. Guidewire passage
  - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
  3. Rotarex-thrombectomy
  - 8F (STRAUB MEDICAL)
  4. PTA/stenting on indication
  - Pacific 5/120 mm balloon (MEDTRONIC)
  - Eluvia DES 6.0/120 mm stent (BOSTON SCIENTIFIC) or Zilver PTX (COOK)
• Thursday, January 24th: 10:20 - 10:50, Room 1 - Main Arena 1

  Case 58 – Chronic in-stent reocclusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 58 – LEI 21: male, 65 years (L-P)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  Severe claudication left calf, walking capacity 200 meters
  ABI left 0.68, Rutherford class 3
  PTA/stenting left SFA 2015 (Zilver-PTX)
  PTA right SFA, DCB-treatment 12/2018
  Dilatative cardiomyopathy, EF 35%
  
  RISK FACTORS
  Arterial hypertension, former smoker
  
  ANGIO
  Complete in-stent reocclusion left SFA
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  - 8F Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - 0.018“ Command 18, 300 cm (ABBOTT)
  - 0.018“ Quick-Cross support catheter, 135 cm (PHILIPS)
  3. Thrombectomy
  - Rotarex 8F (STRAUB MEDICAL)
  4. PTA
  - Luminor 5.0/200 mm DCB (iVASCULAR)
  - potentially with filter protection Spider-filter 6 mm (MEDTRONIC)

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• Thursday, January 24th: 10:30 - 12:00, Room 3 - Technical Forum

  Case 75 – Extremely calcified SFA CTO left, "pave and crack"-technique

  Center:

  Leipzig, Dept. of Angiology

  Case 75 – LEI 26: male, 62 years (S-S)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford Class 3, severe claudication left, walking capacity 50m, ABI left 0.45
  PTA both CIA 2012, multiple interventions right,
  failed recanalization attempt left SFA 12/2018
  CAD, CABG 2012, atrial fibrillation, renal impairment
  
  RISK FACTORS
  Arterial hypertension, hyperlipdemia, former smoker (30PY)
  
  ANGIOGRAPHY
  During PTA right 11/17: occlusion of the left SFA and popliteal artery
  
  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)
  - 7F 55 Check-Flo Performer Sheath, Raabe Modification (COOK)
  2. Antegrade guidewire passage
  - 0.035“ Stiff angled glidewire, 260 cm (TERUMO)
  - CXC 0.035“ support catheter, 135 cm (COOK)
  - GoBack Crossing-Catheter (UPSTREAM-PERIPHERAL)
  3. Retrograde guidewire passage
  Access via the proximal anterior tibial artery:
  - 9 cm 20 Gauge Spinal Needle (BD)
  - 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 stenting
  - 6.0/20mm Admiral Xtreme balloon (MEDTRONIC)
  - 7.0/20 Conquest non-compliant high pressure balloon (BARD)
  
  In case of inability to open the balloons fully:
  - Implantation of a Viabahn 6.0/150 mm (GORE)
  - Relining with Supera Interwoven Nitinol stent (ABBOTT)

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• Thursday, January 24th: 12:30 - 13:30, Room 2 - Main Arena 2

  Case 69 – MISACE: Minimal Invasive Segmental Artery CoilEmbolisation

  Center:

  Leipzig, Dept. of Angiology

  Case 69 – LEI 24: male, 67 years, (R-H)

  Operators:

  • Andrej Schmidt,
  • Axel Fischer

  CLINICAL DATA
  Thoracoabdominal aneurysm (max. diameter 61mm), progressive (41mm 2014)
  Open repair of an infrarenal aortic aneurysm 10/2014
  CAD, PTCA 2014
  
  RISK FACTORS
  Arterial hypertension
  
  CT
  Progressive aneurysm, max. diameter 61 mm
  
  IMPORTANT ITEMS
  Endovascular repair planned (CMD, COOK)
  Staged segmental artery coilembolisation
  for prevention of spinal-cord-ischemia planned
  
  PROCEDURAL STEPS
  1. Right femoral approach
  - 6F 25 cm sheath (TERUMO)
  2. Angiography
  of the segmental arteries Th 12 - Th 10 bilateral
  Selection of the arteries to be embolized during the first session
  3. Coilembolisation
  - IMA 6F guiding catheter (MEDTRONIC)
  - SIM-I 5F diagnostic catheter (CORDIS-CARDINAL HEALTH)
  - 0.014“ PT2 guidewire (BOSTON SCIENTIFIC)
  - Progreat Micro Catheter System 2.7F 130 cm (TERUMO)
  - Micro-Coils (COOK)

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• Thursday, January 24th: 13:30 - 17:00, Room 3 - Technical Forum

  Case 79 – Multilevel disease right, CLI, severe calcification

  Center:

  Leipzig, Dept. of Angiology

  Case 79 – LEI 28: male, 75 years (H-L)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Restpain right, ABI 0.23; walking capacity 20 meters
  Rutherford class 4
  CAD, NYHA II
  PTA left BTK-arteries 12/2018
  
  RISK FACTORS
  Arterial hypertension, former smoker
  
  MRA
  Aneurysm of the left popliteal artery (35 mm), popliteal occlusion right
  
  PROCEDURAL STEPS
  1. Right antegrade access
  - 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
  2. Guidewire passage from antegrade
  - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
  - GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
  3. Atherectomy and PTA of the distal SFA-lesions
  - JetStream atherectomy device (BOSTON SCIENTIFIC)
  - RANGER DCB 6 mm (BOSTON SCIENTIFIC)
  4. Guidewire passage of the tibioperoneal-trunk occlusion
  - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
  5. In case of failure: retrograde approach via peroneal artery
  - 7cm 21 Gauge needle (COOK)
  - Pedal access-kit (COOK)
  - Connect 250T guidewire (ABBOTT)
  - CXI 0.018“ Support catheter (COOK)
  6. PTA + Stenting of the TPT
  - MiniTrek 4.0/20 mm OTW-balloon (ABBOTT)
  - Xience Prime 4.0/38 mm DES (ABBOTT)

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• Thursday, January 24th: 13:30 - 17:00, Room 3 - Technical Forum

  Case 78 – Live case from Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 78 – Live case from Leipzig

  Information will follow in due time. Thank you for your understanding.
• Thursday, January 24th: 13:35 - 13:55, Room 1 - Main Arena 1

  Case 60 – Live case from Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 60 – Live case from Leipzig

  Information will follow in due time. Thank you for your understanding.
• Thursday, January 24th: 15:59 - 16:21, Room 1 - Main Arena 1

  Case 63 – Long SFA-occlusion left, moderate calcification

  Center:

  Leipzig, Dept. of Angiology

  Case 63 – LEI 23: male, 53 years (H-B)

  Operators:

  • Matthias Ulrich,
  • Axel Fischer

  CLINICAL DATA
  PAOD Rutherford class 3, claudication left calf, walking capacity 150 m, ABI left 0.65
  Failed recanalization attempt (thrombectomy) 07/18 elsewere
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, current smoker
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
  2. Passage of the occlusion left 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 ATA
  - 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 with DCBs
  - Passeo 18 balloon 5 x 150 mm (BIOTRONIK)
  - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
  5. Stenting on indication
  - Pulsar 18-T3 stent (BIOTRONIK)

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• Friday, January 25th: 9:00 - 13:00, Room 3 - Technical Forum

  Case 81 – Occlusion of the infrarenal aorta and both iliac arteries, Leriche-syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 81 – LEI 29: male, 65 years (K-T)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication and weakness both legs and buttocks, progressive,
  Walking capacity 50 meters, Rutherford class 3
  CAD, PTCA 2010, chronic heart failure, EF 40%
  
  RISK FACTORS
  Art. hypertension, nicotine abuse
  
  CT
  Severely calcified occlusion of the infrarenal aorta and iliac arteries
  
  PROCEDURAL STEPS
  1. Transbrachial bilateral approach
  - 7F 90 cm Check-Flo-Performer sheath (COOK)
  2. Transfemoral retrograde approach
  - 8F 25 cm sheath (TERUMO)
  3. Transbrachial guidewire passage
  - 0.035“ Stiff angled glidewire, 260 cm (TERUMO)
  - 6F 100 cm Multipurpose guiding catheter (MEDTRONIC)
  - 5F 125 cm Judkins Right diagnostic catheter (CORDIS-CARDINAL HEALTH)
  4. Snaring of the gudewire-tip from antegrade into the retrograde femoral sheaths
  - 6F Judkins Right guiding catheter
  5. Renal protection
  - Implantation of 2 covered stents (LifeStream 7/26 mm, BARD)
  6. PTA of the infrarenal occlusion from retrogade
  - 6.0/120 mm Admiral balloons (MEDTRONIC)
  7. Implantation of covered stents
  - BeGraft covered stent (BENTLEY)

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• Friday, January 25th: 9:00 - 13:00, Room 3 - Technical Forum

  Case 82 – Symptomatic occlusion of the left subclavian artery

  Center:

  Leipzig, Dept. of Angiology

  Case 82 – LEI 30: male, 72 years (M-S)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Dizziness, syncope 12/2018
  Recurrent minor strokes 2017,
  Attempt to recanalize the subclavian artery via a femoral approach 12/2018
  CAD, PTCA 2012
  PAOD, stenting iliac arteries right
  Nicotine abuse
  
  DUPLEX
  Occlusion right vertebral artery, high-grade stenosis right internal carotid artery,
  Occlusion left subclavian artery
  
  PROCEDURAL STEPS
  1. Left transbrachial approach
  - 6F 55 cm Flexor Check-Flo Introducer Raabe-configuration (COOK)
  2. Transfemoral retrograde approach
  - 8F 25 cm sheath (TERUMO)
  - 8F Judkins-Right guiding catheter (MEDTRONIC)
  3. Transbrachial and transfemoral guidewire-passage
  - 0.018“ Connect Flex guidewire (ABBOTT)
  4. Snaring of the gudewire-tip from antegrade or retrograde and pull-through-wire
  5. PTA and stenting
  - Pacific 5.0/40 mm balloon (MEDTRONIC)
  - BeGraft covered peripheral stent (BENTLEY)

  View image
• Friday, January 25th: 9:00 - 13:00, Room 3 - Technical Forum

  Case 83 – Reocclusion right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 83 – LEI 31: male, 56 years (G-M)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, ABI 0.67; walking-capacity 150 meters
  Rutherford class 3
  PTA/Stenting ot the infrarenal aorta and iliac arteries 2015
  PTA stenting both SFA 2016
  PTA of a reocclusion left SFA 12/2018
  
  RISK FACTORS
  Art. Hypertension, heavy smoker
  
  PRESENT STATE
  Reocclusion right SFA since 2 months, slow onset of symptoms
  
  PROCEDURAL STEPS
  1. Left retrograde and cross-over approach
  - 7F 40 cm Up&Over sheath (COOK)
  2. Guidewire passage from antegrade
  - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
  - GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
  3. Potentially retrograde stent puncture
  4. Guidewire passage of the tibioperoneal trunk occlusion
  - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
  5. Pre-treatment
  - Rotarex 6F Thrombectomy (STRAUB MEDICAL)
  6. PTA + Stenting
  - RANGER DCB within the stents (BOSTON SCIENTIFIC)
  - Evaluation of the stentfracture and potentially relinining with Supera stents (ABBOTT)
  - Eluvia DES for the proximal SFA (BOSTON SCIENTIFIC)

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