LINC 2017 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 1

  • - , Room 2 - Main Arena 2

    Case 10 – Complex venous intervention of IVC and iliac vein

    Center:
    Bern
    Case 10 – BER 01: male, 37 years, (D-P)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Iliofemoral DVT right side in 2014
    Currently no anticoagulation therapy
    Moderate renal insufficiency (atrophic left kidney)

    RISK FACTORS
    Venous claudication while standing and walking (works as a chef de cuisine)
    Leg swelling right > left
    Hyperpigmentation right lower leg

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in both femoral and right IJ veins
    - 10F sheath

    2. Wire crossage
    - TERUMO 0.035" stiff angled

    3. Phlebography, IVUS

    4. Predilation
    - Atlas Balloon 14–20 mm (C.R. BARD)

    5. Implantation of dedicated Iliac vein stents
    - IVC: Sinus XL 22–24 mm (OPTIMED)
    - Sinus-XL Flex 14 mm (OPTIMED)

    6. High-pressure postdilatation of stents
    - Atlas balloon 14–20 mm (C.R. BARD)
  • - , Room 1 - Main Arena 1

    Case 01 – LEI 01: Severely calcifed SFA-occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 01 – LEI 01: male, 68 years
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 60 meters
    ABI right 0.65
    COPD, GOLD B
    Permanent atrial fibrillation

    RISK FACTORS
    Arterial hypertension, smoker

    ANGIO
    Angiography elsewhere: total occlusion right SFA, calcified

    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 and PTA of the occlusion right SFA
    - 4.0/120 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 failure to pass from antegrade:
    3. Retrograde approach via the distal SFA right
    - 21 Gauge 9 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 Nitinol stent (ABBOTT)
    - Stenting of the SFA-ostium: 7.0/40 mm Absolute stent (ABBOTT)
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  • - , Room 2 - Main Arena 2

    Case 11 – Galway

    Center:
    Galway
    Case 11 – GAL 01: female, 74 years
    Operators:
    • Gerard O'Sullivan
    Information will follow in due time.
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  • - , Room 1 - Main Arena 1

    Case 02 – SFA - PRESTO Technique

    Center:
    Dendermonde
    Case 02 – DEN 01: male, 79 years
    Operators:
    • Koen Deloose,
    • Joren Callaert
    Information will follow in due time.
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  • - , Room 3 - Technical Forum

    Case 22 – Cotignola

    Center:
    Cotignola
    Case 22 – COT 02: female, 73 years
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    Information will follow in due time.
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  • - , Room 2 - Main Arena 2

    Case 12 – Acute on chronic ischemia right leg

    Center:
    Leipzig, Dept. of Angiology
    Case 12 – LEI 05: male, 78 years (M-M)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Very short walking capacity right since few weeks
    Persistent atrial fibrillation
    Diabetes mellitus, type 2
    Nicotin abuse

    IMPORTANT ITEMS
    Angiography: Thrombotic/embolic occlusion right popliteal artery
    Chronic BTK-disease

    1. Right antegrade femoral access
    - 6F 55 cm Check-Flo Performer, Raab Modification (COOK)

    2. GW-passage and thrombectomy
    - Rotarex 6F (STRAUB MEDICAL)

    3. PTA and stenting on indication
    - Lutonix DCB (C.R. BARD)
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  • - , Room 2 - Main Arena 2

    Case 13 – Treatment of Toskana III ISR popliteal artery with rotarex & DEB

    Center:
    Münster
    Case 13 – MUN 02: male, 84 years
    Operators:
    • Arne Schwindt,
    • Stefan Stahlhoff
    Information will follow in due time.
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  • - , Room 2 - Main Arena 2

    Case 14 – Iliofemoral venous intervention

    Center:
    Bern
    Case 14 – BER 02: female, 37 years (E-B)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Acute left-sided iliofemoral deep vein thrombosis in 04/2008

    RISK FACTORS
    Long distance flight, estrogen-containing contraceptives, no known thrombophilia (negative testing)
    Chronic venous insufficiency leg with Villalta Score: 9 points

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

    2. Reconstruction of iliac veins

    3. Predilation
    - Atlas balloon 12–14 mm (C.R. BARD)

    4. Implantation of dedicated iliac vein stents
    - MT stent: Sinus obliquus 14 mm (OPTIMED)
    - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)

    5. High-pressure post-dilation of stents
    - Atlas balloon 14 mm (C.R. BARD)
  • - , Room 1 - Main Arena 1

    Case 03 – TASC D SFA CTO left

    Center:
    Dendermonde
    Case 03 – DEN 02: male, 78 years
    Operators:
    • Koen Deloose,
    • Joren Callaert,
    • Lieven Maene
    Information will follow in due time.
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  • - , Room 2 - Main Arena 2

    Case 15 – Galway

    Center:
    Galway
    Case 15 – GAL 02: male, 50 years
    Operators:
    • Gerard O'Sullivan
    Information will follow in due time.
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  • - , Room 3 - Technical Forum

    Case 23 – Tripple protection approach in a high-grade left ICA stenosis

    Center:
    Berlin
    Case 23 – BLN 01: female, 80 years (Z-C)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    Coronary heart disease, aortocoronary bypass
    PAD, PTA left SFA 2011, right SFA 2015

    RISK FACTORS
    Hypertension, hyperlipidemia

    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 to ICU
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  • - , Room 1 - Main Arena 1

    Case 04 – Treatment of 9 cm long SFA CTO with drug eluting stent

    Center:
    Münster
    Case 04 – MUN 01: female, 76 years (K-M)
    Operators:
    • Arne Schwindt,
    • Özgun Sensebat
    CLINICAL DATA
    PAOD Rutherford IV left leg, rest pain at night, walking distance limited to 50 m
    ABI: right leg 0,9; left leg 0,6

    RISK FACTORS
    CVRF: hyperlipidemia, hypertension, nicotin
    Carotid surgery 2013
    MR-Angiogram: bilateral iliac stenosis, CTO of left SFA 9 cm long

    PROCEDURAL STEPS
    1. Right femoral access and crossover
    - Insertion of 6F 45 cm Destination sheath (TERUMO)

    2. Stent PTA
    - Stent PTA common iliac artery bilateral (Dynamic/BIOTRONIK)

    3. Recanalization left SFA
    - v18 wire (BOSTON SCIENTIFIC) and Quick-cross catheter (SPECTRANETICS)

    4. Predilation
    - 5 x 120 balloon (Advance 18/COOK)

    5. Stent implantation
    - Zilver-PTX drug eluting stent (COOK)

    6. Puncture site closure with CELT 6F VCD
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  • - , Room 2 - Main Arena 2

    Case 14 – Iliofemoral venous intervention

    Center:
    Bern
    Case 14 – BER 02: female, 37 years (E-B)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Acute left-sided iliofemoral deep vein thrombosis in 04/2008

    RISK FACTORS
    Long distance flight, estrogen-containing contraceptives, no known thrombophilia (negative testing)
    Chronic venous insufficiency leg with Villalta Score: 9 points

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

    2. Reconstruction of iliac veins

    3. Predilation
    - Atlas balloon 12–14 mm (C.R. BARD)

    4. Implantation of dedicated iliac vein stents
    - MT stent: Sinus obliquus 14 mm (OPTIMED)
    - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)

    5. High-pressure post-dilation of stents
    - Atlas balloon 14 mm (C.R. BARD)
  • - , Room 2 - Main Arena 2

    Case 15 – Galway

    Center:
    Galway
    Case 15 – GAL 02
    Operators:
    • Gerard O'Sullivan
    Information will follow in due time.
    View image
  • - , Room 2 - Main Arena 2

    Case 16 – Removal of tilted IVC filter (aortic penetration) and reconstruction of the IVC and iliac veins

    Center:
    Bern
    Case 16 – BER 03: female, 48 years (T-B)
    Operators:
    • Nils Kucher,
    • T. Gregory Walker
    CLINICAL DATA
    Protein S deficiency and factor V Leiden mutation
    Ongoing anticoagulation therapy
    Recurrent ilio-femoral thrombosis despite medical therapy
    Implantation of permanent Simon™ filter (2004/USA)

    RISK FACTORS
    Chronic venous insufficiency both legs with:
    venous claudication, varicose veins, hyperpigmentation, leg swelling
    Villalta-score: 6 points

    PROCEDURAL STEPS
    1. Venous access
    - Venous access with ultrasound guidance in both femoral veins (10F sheath)
    - Venous access IJ (18F sheath)

    2. Filter extraction with endobronchial forceps from IJ access
    - Forceps Alligator 2.5 mm x 55 cm hard foreign body double action (KARL STORZ)

    3. Reconstruction of IVC and iliac veins

    4. Predilatation
    - Atlas balloon 14–20 mm (C.R. BARD)

    5. Implantation of dedicated IVC and Iliac vein stents
    - IVC: Sinus XL 22 mm (OPTIMED)
    - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)

    6. High-pressure postdilatation of stents
    - Atlas balloon 14–20 mm (C.R. BARD)
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  • - , Room 2 - Main Arena 2

    Case 17 - Galway

    Center:
    Galway
    Case 17 – GAL 03: female, 82 years
    Operators:
    • Gerard O'Sullivan
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 24 – Flush-occlusion right SFA after CEA right groin

    Center:
    Leipzig, Dept. of Angiology
    Case 24 – LEI 06: male, 57 years (H-F)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 50 meters
    CEA and patch-plastic 9/2014 right groin
    Stenting right SFA 2009
    PTA left SFA (Lithoplasty)
    CAD, MI and PTCA 2009
    Art. hypertension, former smoker

    ANGIO
    Flush-occlusion right SFA, stent within the SFA-occlusion right
    ABI right 0,57

    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 (ABBOTT)
    - 7F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Right SFA CTO-puncture (stent-puncture)
    - 18 Gauge 7 cm needle
    - 0.035" stiff angled Glidewire, 190 cm (TERUMO)
    - 6F – 10 cm Radiofocus-Introducer (TERUMO)

    3. Passage of the CTO
    Retrograde passage into the right CFA:
    - Pioneer-Plus Reentry-system (VOLCANO)
    - 0.014" Floppy ES Guidewire, 300cm (ABBOTT)
    - Snaring if the retrograde guidewire into the the cross-over-sheath

    Final guidewire-passage into the popliteal artery from antegrade:
    - 0.035" siff angled Glidewire 260 cm (TERUMO)

    4. PTA/stenting
    - Armada 35 5.0/100 mm balloon (ABBOTT)
    - Supera Interwoven Nitinol stent (ABBOTT)
    - SFA-ostium: Viabahn 7.0/50 mm (GORE) or Absolute stent (ABBOTT)
    View image
  • - , Room 3 - Technical Forum

    Case 25 – Severe left iliac and femoropopliteal disease in a critical limb ischaemia patient

    Center:
    Cotignola
    Case 25 – COT 03: female, 74 years
    Operators:
    • Antonio Micari
    Information will follow in due time.
    View image
  • - , Room 1 - Main Arena 1

    Case 05 – Chronic total occlusion right SFA, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 05 – LEI 02: male, 64 years (P-S)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    Critical limb ischemia right, ulceration dig 4, Rutherford class 5
    Severe claudication right calf, walking capacity 50 meters, PTA/stenting left SFA 12/2015 for CLI left
    Diabetes mellitus, type 2, art. hypertension, former smoker
    ABI right: 0.2

    ANGIO
    Angiography (during PTA left):
    long CTO right SFA, minimal 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 (ABBOTT)
    - 6F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Passage of the occlusion left SFA
    - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    - 0.035" TrailBlazer supportcatheter, 135 cm (MEDTRONIC)
    - Exchange to 0.018" SteelCore guidewire (ABBOTT)

    3. PTA
    - 5.0/120mm Pacific Plus PTA catheter, 130 cm (MEDTRONIC)
    - 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)

    4. Stenting on indication
    - In case of dissections: provisional placement of nitinol Tacks (INTACT VASCULAR)
    - In case of residual stenosis: Complete-Stent (MEDTRONIC)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 30 – Popliteal reocclusion with impaired single vessel run-off

    Center:
    Berlin
    Case 30 – BLN 03: male, 81 years (HJ-S)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    PAOD, Rutherford 3–4, ABI 0.63 right, 0.93 left, stenting of the distal SFA and P3-segment 2015, peripheral bBypass surgery left leg

    RISK FACTORS
    Art. hypertension, severe atherosclerosis of the aorta, severly impaired walking distance

    PROCEDURAL STEPS
    1. Antegrade access right common femoral
    - 5F Terumo Destination 45 cm

    2. Recanalisation of the occluded stent in the P3 segment

    3. PTA and stenting
    - Cr8 BTK 4 x 38 mm DES (ALVIMEDICA)

    4. Recanalisation of the ATA and peroneal, PTA with 2.5 and 3 mm balloon


    5. Back-up: retrograde access via peroneal artery

    6. Closure of puncture site by manual compression
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  • - , Room 5 - Global Expert Exchange

    Case 31 – Calcified SFA-CTO right

    Center:
    Leipzig, Dept. of Angiology
    Case 31 – LEI 08: male, 64 years (F-B)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    Severe claudication right calf, walking capacity 100 meters
    PTA/stent left SFA 12/2015
    Diabetes mellitus, type 2, insulin-dependent
    Art. hypertension, former smoker

    ANGIO
    Angiography right SFA during PTA/stent left SFA:
    short, moderately calcified SFA-CTO right
    ABI right 0.61

    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 (ABBOTT)
    - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)

    2. Guidewire passage and PTA of the occlusion right SFA
    - 4.0/40 mm Pacific Plus balloon (MEDTRONIC)
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)

    3. Stenting
    - NitiDES drug-eluting stent (ALVIMEDICA)
    View image
  • - , Room 1 - Main Arena 1

    Case 06 – Long segment left SFA occlusion - directional atherectomy and DCB therapy

    Center:
    New York
    Case 06 – NY 01: female, 83 years
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • Farhan Majeed,
    • Rheoneil Lascano
    Information will follow in due time.
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  • - , Room 2 - Main Arena 2

    Case 18 – Carotid artery stenting in high grade asymptomatic right ICA stenosis

    Center:
    Münster
    Case 18 – MUN 03: male, 87 years (S-W)
    Operators:
    • Arne Schwindt,
    • Özgun Sensebat
    CLINICAL DATA
    CVRF: hypertension
    CHD, RCA-PTCA 2016 with DES
    Aortic valve stenosis

    RISK FACTORS
    In CC-Duplex high grade right ICA stenosis with vmax of 290 cm/sec.
    MR-Angiogram: Type II aortic arch, 90% right ICA stenosis

    PROCEDURAL STEPS
    - Right femoral access, aortic arch angiogram, canulation of right common carotid artery with 0,035 Advantage wire (TERUMO) and insertion of 6F 90cm shuttle-sheath (COOK)

    - Angiogram of lesion, placement of 0,014 Choice PT wire (BOSTON SCIENTIFIC) distal to lesion

    - Delivery of Nanoparasol filter (TERUMO) distal to lesion

    - Implantation of Roadsaver micromesh stent (TERUMO)

    - Postdilation of stent (Sterling RX, BOSTON SCIENTIFIC)

    - Filter capture and final angiogram
    View image
  • - , Room 3 - Technical Forum

    Case 26 – Long SFA occlusion right

    Center:
    Berlin
    Case 26 – BLN 02: male , 81 years (D-S)
    Operators:
    • Ralf Langhoff,
    • M. Boral
    CLINICAL DATA
    PAOD Rutherford 3, claudication right calf at 50 meters
    Recanalization SFA stent and PTA with DCB for claudication 11/2016

    RISK FACTORS
    Coronary heart disease, aortocoronary bypass
    Hypertension, hyperlipidimia, diabetes type II
    ABI 0,6 right, 1,0 left after intervention

    ANGIOGRAPHY
    Distal SFA occlusion right side

    PROCEDURAL STEPS
    1. Left femoral access and cross-over approach
    - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)

    2. Recanalisation right SFA
    - 0.018" Advantage glidewire (TERUMO)
    - 0.018" CXI support catheter (COOK)

    Back-up material:
    - Connect 250T CTO-wire (ABBOTT)
    - Outback reentry system (CORDIS)

    3. PTA
    - Passeo18 ballon 3 x 150 mm (BIOTRONIK)
    - 5 mm Passeo18 Lux DEB (BIOTRONIK)

    4. Stenting
    - Pulsar18 stent 5 x 200 mm (BIOTRONIK)

    5. Postdilatation
    - 5 x 200 mm Passeo1 8 balloon (BIOTRONIK)

    6. Puncture site closure
    - Angioseal 6F (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 07 – Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 07 – LEI 03: female, 72 years
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain left foot, Rutherford class 4
    Severe claudication, walking capacity 50 m
    ABI left 0.42
    CAD, PTCA 10/16
    TAVI 03/16

    RISK FACTORS
    Arterial hypertension

    PROCEDURAL STEPS
    - Right croin retrograde and cross-over approach
    - Passage and predilatation of the SFA-occlusion left
    - PTA/Stenting SFA left (ELUVIA)
    View image
  • - , Room 3 - Technical Forum

    Case 27 – Dendermonde

    Center:
    Dendermonde
    Case 27 – DEN 03
    Operators:
    • Koen Deloose,
    • Joren Callaert,
    • Lieven Maene
    Information will follow in due time.
    View image
  • - , Room 2 - Main Arena 2

    Case 19 – Rapid progression of asymptomatic right carotid artery disease

    Center:
    Cotignola
    Case 19 – COT 01: male, 66 years
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    Information will follow in due time.
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  • - , Room 2 - Main Arena 2

    Case 20 – Thoracic inlet syndrome with instent thrombosis

    Center:
    Bern
    Case 20 – BER 04: female, 46 years (D-C)
    Operators:
    • Nils Kucher,
    • Torsten Fuß
    CLINICAL DATA
    Primary (spontaneous) upper extremity deep vein thrombosis 06/15
    (Paget-Schroetter syndrome) --> lysis and anticoagulant therapy
    Known bony exostosis of the first rib and the clavicula --> resection the the first rib and stenting of the subclavian vein in 12/15
    Recurrent swelling of the right arm --> thrombus aspiration in a tertiary care hospital (11/16)

    PRESENT STATE
    Swelling of the right arm since several weeks

    PROCEDURAL STEPS
    1. Venous access with ultrasound guidance in right femoral vein
    - 10F sheath

    2. Wire crossage
    - Terumo 0.035" stiff angled

    3. Phlebography

    4. Predilatation
    - Dorado balloon 10 mm (C.R. BARD)

    5. Implantation of dedicated vein stent (stent-in-stent)

    6. High pressure postdilatation of stent
    - Atlas balloon 12 mm (C.R. BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 21 – Galway

    Center:
    Galway
    Case 21 – GAL 04: female, 36 years
    Operators:
    • Gerard O'Sullivan
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 28 – Symptomatic left ICA disease in a patient with challenging access routes

    Center:
    Cotignola
    Case 28 – COT 04: male
    Operators:
    • Fausto Castriota
    Information will follow in due time.
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  • - , Room 3 - Technical Forum

    Case 29 – Progressive, asymptomatic internal carotid stenosis right

    Center:
    Leipzig, Dept. of Angiology
    Case 29 – LEI 07: male, 71 years (M-Z)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Progressive ICA-stenosis right, peak systolic velocity 5.8 m/sec.
    CAD with CABG 2000
    PTCA stent 12/2016
    Recurrent supraventricular arrythmia, left atrial ablations 2014/2015
    CEA left ICA 2010
    Former smoker

    ANGIOGRAPHY
    Angiography during PTCA 12/2016, short, high-grade stenosis right ICA

    PROCEDURAL STEPS
    1. Right groin access
    - 9F 25 cm Radiofocus Introducer (TERUMO)
    - 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" soft angled Glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore 190 cm guidewire (ABBOTT)

    2. Cerebral protection
    - MoMa proximal protection system (MEDTRONIC)

    3. Predilatation and stenting
    - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
    - 8/30 mm CGuard stent (InspireMD)

    4. Postdilatation
    - Paladin® Carotid Post-Dilatation balloon with integrated embolic protection (CONTEGO MEDICAL)

    5. Aspiration and declamping with the Paladin-filter in place

    6. Retrieval of the Paladin-system
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  • - , Room 1 - Main Arena 1

    Case 08 – Severely calcified SFA-CTO right

    Center:
    Leipzig, Dept. of Angiology
    Case 08 – LEI 04: male, 69 years (R-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 150 meters
    Thromendartherectomy both groins 2014
    Stenting/PTA left SFA 11/2016
    CAD, PTCA 2000, CABG 2000
    Art. hypertension, former smoker

    ANGIOGRAPHY
    Severely calcified distal SFA-CTO right
    ABI right 0.51

    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 (ABBOTT)
    - 7F 55cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)

    2. Passage of the distal SFA-CTO
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
    - 0.018" QuickCross support catheter 135 cm (SPECTRANETICS)

    3. Angioplasty
    - 6.0/60 mm Lithoplasty balloon (SHOCKWAVE MEDICAL)

    4. Stenting only on indication
    - Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 09 – Heavily calcified severe right SFA disease

    Center:
    New York
    Case 09 – NY 02: female, 78 years old (S-P)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • Farhan Majeed,
    • Rheoneil Lascano
    CLINICAL DATA
    Patient presents with right lower extremity ischemic rest pain
    Rutherford grade 2, category 4
    Fontaine stage III
    Symptoms have been getting progressively worse over the last few weeks
    No ischemic ulcers noted.
    ABI: Right ABI 0.38.

    RISK FACTORS
    Hypertension, hyperlipidemia, diabetes mellitus, previous history of tobacco use

    PROCEDURAL STEPS
    1. Left groin access with retrograde cross over approach
    - UF 4F diagnostic catheter (ANGIODYNAMICS)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT)
    - 7 F – 45 cm Pinnacle Sheath (TERUMO)

    2. Passage through the right SFA calcified stenosis
    - 0.018" Trailblazer Vert support catheter, 135 cm (MEDTRONIC)
    - 0.014" Fielder guidewire, 300 cm (ASAHI)

    3. Filter placement
    - Exchange to a Barewire through the support catheter (ABBOTT)
    - Emboshield Nav 6 filter placement (ABBOTT)

    4. Jetstream atherectomy of the right SFA calcified disease
    - Jetstream 2.4/3.4 mm atherectomy (BOSTON SCIENTIFIC)

    5. PTA with a non-compliant balloon
    - Dorado 6 x 200 mm balloon (C.R. BARD)

    6. Stenting and postdilatation
    - 5.5 x 150 mm Supera interwoven self-expanding Nitinol stent (ABBOTT)
    - Dorado 6 x 150 mm balloon (C.R. BARD)
    View image

Conference day 2

  • - , Room 1 - Main Arena 1

    Case 32 – ATA recanalization and dexamethason-injection with a Bullfrog-Device

    Center:
    Leipzig, Dept. of Angiology
    Case 32 – LEI 09: female, 75 years (R-K)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Critical limb ischemia left forefoot, ulceration dig I left
    PTA of a tibioperoneal trunk stenosis left 12/2015, only minor healing tendency
    Diabetes mellitus, type 2

    ANGIOGRAPHY
    Total occlusion of the anterior tibial artery

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

    2. Guidewire passage of the ATA-CTO
    - 0.014" Command ES guidewire, 300 cm (ABBOTT)
    - 3.5/120 mm Armada 14 balloon (ABBOTT)

    3. Arterial wall-injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)

    4. In case of dissections: placement of nitinol-Tacks (INTACT VASCULAR)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 53 – Total occlusion of the common iliac artery

    Center:
    Leipzig, Dept. of Angiology
    Case 53 – LEI 18: male, 62 years
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - Severe claudication right leg, Rutherford class 3
    - Walking capacity 20 meters
    - Diabetes mellitus, type 2
    - ABI right 0.37

    RISK FACTORS
    - Arterial hypertension
    - Diabetes mellitus
    - Smoker

    PROCEDURAL STEPS
    1. Left brachial and bilateral femoral approach
    2. Guidewire passage
    3. Kissing stent (LIFESTREAM covered stant)
    View image
  • - , Room 3 - Technical Forum

    Case 45 – TACE in HCC

    Center:
    Jena
    Case 45 – JEN 01: male, 80 years (M-H)
    Operators:
    • René Aschenbach,
    • F. Bürckenmeyer
    CLINICAL DATA
    80 years old male with weight loss
    CT and MRI proofed HCC in central right liver lobe

    HISTORY
    Child B cirrhosis

    PROCEDURAL STEPS
    1. Canulation celiac trunk with guiding catheter

    2. Large FOV – Dyna-CT for feeder evaluation

    3. Chemoembolisation with doxorubicin
    - Embozene Tandem 40μm
    View image
  • - , Room 3 - Technical Forum

    Case 46 – Chemosaturation of liver metastases

    Center:
    Leipzig, Dept. of Radiology
    Case 46 – LEI 15: male, 82 years (N-C)
    Operators:
    • Jochen Fuchs,
    • Michael Moche
    CLINICAL DATA
    Uveal melanoma 07/2013, enucleation of the right eye 08/2013,
    unresectable liver metastases 03/2016,
    chemosaturation 04/2016, 06/2016, 11/2016, 12/2016

    RISK FACTORS
    Type 2 diabetes mellitus, hypertension

    PROCEDURAL STEPS
    1. Evaluation procedure (some days) prior to treatment:
    - Anatomical mapping
    - Embolization (to avoid reflux or infusion into GI or visceral arteries)

    2. US-guided venous and arterial access to avoid multiple punctures
    Establishment of 10F jugular venous return sheath, 18F femoral venous sheath for the venous isolation catheter and 4F femoral arterial sheath

    3. Full Heparinization (about 30.000 IE) with ACT control (> 450 sec!)
    Arterial catheter placement for Infusion into hepatic artery
    Connection and start of extracorporeal circuit

    4. Isolation of the hepatic veins by inflation of the double balloon catheter
    Check for proper isolation with DSA (no leakage!) and fixation the catheter

    5. Closing the Bypass-line to bring the filters of the extracorporeal circuit online
    CAVE: Watch out for blood pressure drop

    6. Start of arterial infusion of Melphalan (3 mg/kg) with injector (25 ml/min)
    Check intermittently for arterial spasms (if any consider nitroglycerin)
    After Melphalan is fully injected, 30 min wash-out period is applied

    7. Deflation of the balloons and disconnection of the filters
    Removal of arterial and venous catheters
    Removal of the sheaths after coagulation status has been normalized
    View image
  • - , Room 1 - Main Arena 1

    Case 32 – ATA recanalization and dexamethason-injection with a Bullfrog-Device

    Center:
    Leipzig, Dept. of Angiology
    Case 32 – LEI 09: female, 75 years (R-K)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Critical limb ischemia left forefoot, ulceration dig I left
    PTA of a tibioperoneal trunk stenosis left 12/2015, only minor healing tendency
    Diabetes mellitus, type 2

    ANGIOGRAPHY
    Total occlusion of the anterior tibial artery

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

    2. Guidewire passage of the ATA-CTO
    - 0.014" Command ES guidewire, 300 cm (ABBOTT)
    - 3.5/120 mm Armada 14 balloon (ABBOTT)

    3. Arterial wall-injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)

    4. In case of dissections: placement of nitinol-Tacks (INTACT VASCULAR)
    View image
  • - , Room 2 - Main Arena 2

    Case 41 – Münster

    Center:
    Münster
    Case 41 – MUN 05: male, 84 years
    Operators:
    • Theodosios Bisdas,
    • Martin Austermann,
    • Stefan Stahlhoff
    Information will follow in due time.
    View image
  • - , Room 2 - Main Arena 2

    Case 42 – Progressive abdominal aneurysm

    Center:
    Leipzig, Dept. of Angiology
    Case 42 – LEI 14: male, 65 years
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    - Progressive aneurysm of the infrarenal aortic aneurysm, now max. diameter 58 mm
    - Small caliber external iliac arteries bilateral
    - Coiling of lumbar arteries and AMI 01/16
    - Chronical pancreatitis with pseudocysts

    RISK FACTORS
    - Arterial hypertension
    - Current smokera

    PROCEDURAL STEPS
    1. Bifemoral percutaneous approch in local anaesthesia and preclosing with 2 Proglide closure devices
    2. Guidewire positioning
    3. Implantation of a bifurcational stentgraft (OVATION STENTGRAFT)
    4. Postdilatation
    View image
  • - , Room 3 - Technical Forum

    Case 47 – Embolization of persistent type II Endoleak via superior-inferior mesenteric artery and hypogastric artery with alcohol-copolymer

    Center:
    Münster
    Case 47 – MUN 07: male, 69 years (N-K)
    Operators:
    • Arne Schwindt,
    • Özgun Sensebat
    CLINICAL DATA
    EVAR with INCRAFT-Endograft 12/2015 – in follow up aneurysm expansion from initially 53 mm to up to date 58 mm

    IMPORTANT ITEMS
    Mitral and aortic valve insufficency grade 1
    CVRF: arterial hypertension
    Angio-CT 12/2016: persisting flow in the aneurysm sac via IMA and lumbars L4

    PROCEDURAL STEPS
    1. Left transbrachial access, aortic angiogram in oblique projection, canulation of superior mesenteric artery

    2. Insertion of 6F 90 cm shuttle sheath (COOK) into SMA, canulation of middle colic artery with 4F 120 cm glidecath (TERUMO) and choice PT wire (BOSTON SCIENTIFIC)

    3. Insertion of Echelon microcatheter (MEDTRONIC) into endoleak, preparation of catheter with DMSO, embolization of endoleak with Onyx L 34 (MEDTRONIC)

    4. Retrival of microcatheter, selective angiogram of right hypogastric artery; if neccessary selective embolization of lumbar arteries L4 with Onyx L34 in case of remaining endoleak
    View image
  • - , Room 1 - Main Arena 1

    Case 33 – SFA occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 33 – LEI 10: male, 70 years
    Operators:
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 150 meters
    ABI right 0.7

    RISK FACTORS
    - Arterial hypertension
    - Current smoker
    - Hyperlipidemia

    PROCEDURAL STEPS
    - Left groin retrograde and cross-over approach
    - Guidewire passage
    - Predilation with low profile ballon
    - PTA with drug coated ballon
  • - , Room 1 - Main Arena 1

    Case 34 – Viabahn endprosthesis for de novo SFA occlusion

    Center:
    Münster
    Case 34 – MUN 04: male, 79 years
    Operators:
    • Theodosios Bisdas
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 48 – Pre-operative uterine fibroid embolisation

    Center:
    Jena
    Case 48 – JEN 02: female, 44 years (G-D)
    Operators:
    • René Aschenbach,
    • F. Bürckenmeyer
    CLINICAL DATA
    Abdominal pain and abnormal intermenstrual bleeding

    IMAGING
    MRI proofed a 4 cm right-sided uterine fibroid

    PROCEDURAL STEPS
    1. Canulation of both uterine arteries
    - RIM-catheter
    - 2.7F Progeat Microcatheter (TERUMO)

    2. Embolisation
    - Gelatine Sponge/Gelbeads 500-700 μm (VASCULAR SOLUTIONS)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 54 – SFA-occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 54 – LEI 19: female, 71 years (E-D)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right leg, walking capacity 100 meters
    PTA/stenting left SFA 12/2016
    PTA iliac left 12/2015
    Art. hypertension, current smoker

    ANGIOGRAPHY
    During PTA left SFA 12/2016: Long SFA-occlusion right, moderately calcified

    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 (ABBOTT)
    - 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" TrailBlazer support catheter, 135 cm (MEDTRONIC)
    - Exchange to 0.018" SteelCore guidewire (ABBOTT)

    3. PTA and stenting on indication
    - Luminor DCB 5.0/120 mm (iVASCULAR)
    - VascuFlex Multi-LOC (B. BRAUN)
    View image
  • - , Room 1 - Main Arena 1

    Case 35 – In-Stent reocclusion right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 35 – LEI 11: male, 71 years (D-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 150 meters
    PTA with DCB and spotstenting right SFA 12/2014
    PTA and stenting left SFA 11/2014
    CAD with PTCA 2003
    Art. hypertension, current smoker

    ANGIOGRAPHY
    SFA-reocclusion right, Nitinol stent within the occlusion

    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
    GW-passage from antegrade:
    - 0.035" stiff angled Glidewire, 260 cm (TERUMO)
    - 4.0/120 mm Admiral balloon (MEDTRONIC)
    in case of failure to pass from antegrade:
    - puncture of the occluded SFA-stent:
    - same wire and 0.035" TrailBlazer support catheter, 90 cm (MEDTRONIC)
    - snaring of the guidewire into the cross-over sheath and finalization guidewire passage of the occlusion from antegrade

    3. PTA and stenting
    - 6.0/80 mm Admiral balloon (MEDTRONIC)
    - 6.0/250 mm Viabahn (GORE)
    - 6.0/100 mm Tigris stent (GORE)
    View image
  • - , Room 2 - Main Arena 2

    Case 43 – EVAR + left iliac branched device

    Center:
    Lille
    Case 43 – LIL 01: male, 63 years, (L-D)
    Operators:
    • Stephan Haulon
    CLINICAL DATA
    Incidental finding of AAA during work-up for intermittent claudication
    CTA: AAA 51 mm, aneurysm proximal right CIA, dilatation distal left CIA
    Plan: EVAR + left iliac branched device + embolisation right IIA

    RISK FACTORS
    Former smoker, hypertension

    HISTORY
    Aortic valve stenosis, CVA, bilateral inguinal hernia repair, lumbar herniated disc repair

    PRESENT STATE
    Duplex supra-aortic vessels: normal
    Cardiac ultrasound: EF 74%, AS (3.13 cm2), Ao asc 45 mm

    PROCEDURAL STEPS
    1. L: 10F sheath, Lunderquist, dilators (up to 20F) 50 U/kg Heparin

    2. R: 5F55 sheath, TERUMO, SIM, AMI embolized (Amplatzer 6 mm)

    3. R: 10F Right IIA embolized (Coils 10 mm)

    4. R: 10F sheath, wire exchange: starter, TERUMO, Rosen-GW stiff wire (COOK), 12F sheath, 45cm; tip positioned above aortic bifurcation

    5. L: ZBIS advanced into distal aorta, unsheath until preloaded catheter of ZBIS appears; exchange wire of preloaded catheter for 260 cm TERUMO

    6. R: Snare through-and-through (tat)-wire (TERUMO, 0.035") – advance dilator of 12F sheath

    7. R: 12F dilator connects to tip of preloaded catheter – secure both ends with clamps

    8. Position C-arm and open branch of ZBIS (COOK)

    9. Advance 12F dilator into ZBIS (pull & push, 'nobody holds the wire')

    10. Puncture valve of 12F TERUMO/catheter to catheterize IIA, angio

    11. Wire exchange/Rosen

    12. Over Rosen, advance 55 cm 7F sheath into 12F to IIA, tat-wire under tension

    13. Advance bridging stentgraft in 7F sheath

    14. Remove tat-wire

    15. Pull down ZBIS, depending on angle of IIA

    16. Pull back 7F sheath and inflate bridging stent

    17. Advance 7F sheath again into stentgraft – dilate distal seal if required – Angio

    18. Finish deployment of Zbis – release trigger wires

    19. Secure branch/stentgraft with balloon while removing nose cone

    20. Continue with EVAR

    21. R: release proximal stent

    22. L: iliac angiogram

    23. L: contralateral limb insertion holding the main body, deployment

    24. R: finish bifurcated endograft deployment + distal attachment release

    27. R: ipsilateral limb insertion & deployment + IIE stenting (Nitinol stent LUMINEX 10*60 mm)

    28. R+L: CODA balloon (COOK)

    29. L: Long angio catheter/Angiogram +/- non-contrast CBCT

    30. R+L: sheaths retrieval + close groins
    View image
  • - , Room 3 - Technical Forum

    Case 49 – Coiling of lumbal arteries and inferior mesenteric artery befor EVAR

    Center:
    Leipzig, Dept. of Radiology
    Case 49 – LEI 16: male, 68 years
    Operators:
    • Michael Moche,
    • Jochen Fuchs
    CLINICAL DATA
    Incidental finding of an eccentric infrarenal AAA with 5.1 cm diameter
    4.5 mm IMA
    3 mm lumbal artery 3 (already embolised)
    4 mm lumbal artery 5 with common trunc
    Art. hypertension, hyperlipidemia, former smorker

    CT-SCAN
    AAA with max. 51 mm diameter, eccentric, potentially old containt rupture

    PROCEDURAL STEPS
    1. Right groin access
    - 4F sheath CFA
    - 4F sidewinder cath.

    2. Embolisation of IMA
    - 4F sidewinder cath.
    - 5 mm Amplatzer Vascular Plug4 (ST. JUDE/ABBOTT)

    3. Embolisation of lumbal arteries 5
    - VortX Diamond Coils (BOSTON SCIENTIFIC)
    - POD Anchor Coil (PENUMBRA)
    View image
  • - , Room 3 - Technical Forum

    Case 50 – Columbus

    Center:
    Columbus
    Case 50 – COL 04: male, 89 years
    Operators:
    • Mitchell Silver
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 50b – Columbus

    Center:
    Columbus
    Case 50b – COL 05b: female, 62 years
    Operators:
    • Gary Ansel,
    • Charles Botti jr.
    Information will follow in due time.
  • - , Room 1 - Main Arena 1

    Case 36 – Total occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 36 – LEI 12: female, 60 years
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf, walking capacity 10 meters, rest pain
    ABI left 0.31
    PTA of the right EIA 11/16
    Stroke 1995 with residual incomplere hemiparesis left

    RISK FACTORS
    - Arterial hypertension
    - Hyperlipidemia

    ANGIOGRAPHY
    Long SFA and P1-segment occlusion left, moderately calcified

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    2. Guidewire passage
    3. Angioplasty (VASCUTAK)
    4. Stenting on indication
    - In case of dissections: provisional placement of nitinol Tackts (INTACT)
    - In case of residual stenosis after DCB: LifeStent
    View image
  • - , Room 1 - Main Arena 1

    Case 37 – Columbus

    Center:
    Columbus
    Case 37 – COL 01: male, 75 years
    Operators:
    • Gary Ansel,
    • Mitchell Silver
    Information will follow in due time.
    View image
  • - , Room 1 - Main Arena 1

    Case 38 – Columbus

    Center:
    Columbus
    Case 38 – COL 02: female, 56 years
    Operators:
    • Gary Ansel,
    • Charles Botti jr.,
    • J. Phillips
    Information will follow in due time.
    View image
  • - , Room 5 - Global Expert Exchange

    Case 55 – Treatment of the left GSV with ELVeS Radial slim™

    Center:
    Leipzig, Dept. of Angiology
    Case 55 – LEI 20: male, 26 years old, (N-S)
    Operators:
    • Matthias Ulrich,
    • Christina Julia Harzendorf
    CLINICAL DATA
    Chronic venous disease C2EpAs2Pr (CEAP)
    Symptoms: feeling of heaviness and dysesthesia in the left leg

    DUPLEX
    Complete insufficiency of the left great saphenous vein Hach 2
    Side branch varicose veins below the left knee
    Competent deep veins
    No Thrombosis

    PROCEDURAL STEPS
    1. Puncture of the distal GSV with 16G Introducer
    Puncture of sidebranches with 18G Introducer
    Introducing of Laser Fiber (ELVeS Radial slim™ BIOLITEC)
    Ultrasound control of the tip position at GSV junction

    2. Application of the tumescent anesthesia around the left great saphenous vein

    3. Treatment of the left GSV with 10 W/70Joul/cm

    4. Foam sklerotherapy of sidebranches with Aethoxysklerol

    5. Applying compression bandage left leg

    6. Injection of a LMWH for thrombosis prophylaxis
    View image
  • - , Room 3 - Technical Forum

    Case 51 – Restenosis right SFA after DCB-treatment

    Center:
    Leipzig, Dept. of Angiology
    Case 51 – LEI 17: female, 78 years
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    - CLI with ulcer Dig 2 right and restpain
    - PTA with DCBs 3/2016 right SFA
    - PTA left SFA 2/2015
    - CAD, PTCA 2012

    RISK FACTORS
    - Diabetes mellitus, type 2
    - Arterial hypertension
    - Chronic renal impairment (GFR 56 ml/min)

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross-over approach
    2. Guidewire passage of the SFA-restenosis and filter positioning (WIRION protection system)
    3. Atherectomy (JETSTREAM) and PTA with DCBs
    View image
  • - , Room 1 - Main Arena 1

    Case 39 – Total chronic occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 39 – LEI 13: female, 57 years (B-B)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left SFA, walking capacity 100 meters
    PTA with stenting right SFA 1/2016
    PTA with DCBs for restenosis right SFA 12/2016
    PTA/stenting iliac arteries bilateral 2009
    Art. hypertension, smoker

    ANGIOGRAPHY
    During PTA right SFA: total occlusion left SFA
    ABI left 0.67

    PROCEDURAL STEPS
    1. Right 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 (ABBOTT)
    - 6F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Passage of the occlusion left SFA
    - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    - 0.035" CXC support catheter, 135 cm (COOK)
    - Exchange to 0.018" SteelCore guidewire (ABBOTT)

    3. PTA and stenting on indication
    - Luminor DCB 5.0/120 mm (iVASCULAR)
    - VascuFlex Multi-LOC (B. BRAUN)
    View image
  • - , Room 2 - Main Arena 2

    Case 44 – 3-fenestrated endovascular repair of a type Ia Endoleak after EVAR 2008 with preloaded delivery system

    Center:
    Münster
    Case 44 – MUN 06: male, 88 years (E-K-H)
    Operators:
    • Martin Austermann,
    • Theodosios Bisdas,
    • Giovanni Torsello
    CLINICAL DATA
    Rapidly growing abdominal aneurysm up to 9 cm in diameter after EVAR 2008

    RISK FACTORS
    PAD, renal impairment, obesity, art. Hypertension

    PROCEDURAL STEPS
    1. Percutanous approach both groins (Prostar XL, ABBOTT)
    14F sheath (COOK) both groins.

    2. First angiography through the right groin and use of the fusion technique.
    Changing of the left 14F sheath for a 20F sheath in order to test the access

    3. Placement of the 3-fenestrated Zenith-tube-endograft with a double wide scallop (COOK) via the left groin

    4. Cannulation of the renal arteries through the delivery-system by means of the preloaded wire
    Cannulation of the SMA through the fenestration from the right groin

    5. Advancement of 7F sheath into the SMA
    Removal of the preloaded wire and advancement of the 6F sheath into the RA`s

    6. Complete release of the endograft and stenting of the fenestrations with covered stents (Advanta V12, MAQUET) and flairing

    7. Closure of the accesses. (Prostar XL, ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 40 – Columbus

    Center:
    Columbus
    Case 40 – COL 03: male, 79 years
    Operators:
    • Gary Ansel,
    • Michael Jolly
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 52 – Jena

    Center:
    Jena
    Case 52 – JEN 03: male, 57 years
    Operators:
    • Ulf Teichgräber,
    • René Aschenbach
    Information will follow in due time.

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 56 – Multilevel disease with CLI right

    Center:
    Leipzig, Dept. of Angiology
    Case 56 – LEI 21: male, 72 years (P-F)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Critical limb ischemia right leg, restpain, Rutherford class 4
    PTA SFA and popliteal artery right and failed antegrade recanalization
    of a tibioperoneal trunk occlusion right elsewhere 12/2015
    Persistent atrial fibrillation

    ANGIOGRAPHY
    high-grade stenosis SFA and popliteal artery right,
    occlusion of the tibioperoneal trunk
    ABI 0,21

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - 0.035" SupraCore guidewire 190 cm (ABBOTT)
    - 6F-40 cm Balkin Up&Over Sheath (COOK)

    2. Guidewire-passage of the SFA/popliteal stenoses and PTA
    - predilatation with 0.014" NanoCross balloon (MEDTRONIC)

    After failed antegrade GW-passage:
    3. Retrograde passage via the peroneal artery
    - 21 Gauge 7 cm needle (COOK)
    - 0.018" V-18 Controll-GW 300 cm (BOSTON SCIENTIFIC)
    - 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)

    4. PTA with a drug-coated balloon
    - Chocolate Touch 6.0/120 mm (TRIREME MEDICAL)
    View image
  • - , Room 3 - Technical Forum

    Case 73 – Stent reconstruction of aortic bifurcation in a patient with Leriche syndrome

    Center:
    Bad Krozingen
    Case 73 – BK 06: female, 55 years (B-I-M)
    Operators:
    • Thomas Zeller,
    • Elias Noory
    CLINICAL DATA
    Bilateral buttock and leg claudication after 50 to 100 meters (PAOD Rutherford 2 / Fontaine IIb) since a couple of months

    PRESENT STATE
    CVRF: arterial hypertension, ex nicotine
    ABI at rest: right leg: 0.8; left leg: 0.8; post exercise 0.6 / 0.6
    Duplex: distal occlusion of infrarenal abdominal aorta and the origins of both CIAs
    Patent inferior mesenteric artery, bilateral internal and external iliac arteries

    PROCEDURAL STEPS
    1. Retrograde access
    - Insertion of 6F 90 cm shuttle sheath via left brachial artery and insertion of a 23 cm long 7F sheath into each CFA

    2. Antegrade crossing attempt of the aortic occlusion
    - 5F vertebral catheter, 0.035'' Gluidewire (TERUMO) into one of the CIAs

    3. Predilatation
    - 5 mm Admiral balloon (MEDTRONIC)

    4. Retrograde crossing attempt of the contralateral CIA

    5. Predilatation
    - 5 mm Powerflex balloon (CORDIS)

    6. Stenting of distal abdominal aorta
    - Smart 14/40 mm stent (CORDIS)

    7. Stenting of both CIAs
    - Restorer balloon expandable stents (iVASCULAR)
  • - , Room 3 - Technical Forum

    Case 74 – Hybrid operation for ilio-femoral occlusion

    Center:
    Münster
    Case 74 – MUN 13: male, 58 years (H-H)
    Operators:
    • Theodosios Bisdas,
    • Martin Austermann,
    • Stefan Stahlhoff
    CLINICAL DATA
    Rutherford 3 right limb, ABI:0.4, no peripheral pulses

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker (30 p/y)

    PROCEDURAL STEPS
    1. Cut down right groin, Puncture of the CFA and recanalization of the EIA occlusion with a 0.035" wire (Advantage, TERUMO) or an 0.018" wire (V18, BOSTON SCIENTIFIC)
    Use of a Quick Cross catheter (SPECTRANETICS)

    2. Arteriotomy and endarterectomy of CFA and proximal SFA
    Use of a ring stripper and a Forgarty catheter for endarterectomy of the EIA

    3. Stenting of the EIA with a 7 x 80 mm Complete stent (MEDTRONIC)

    4. Patchplasty of the CFA with a Dacron Patch (MAQUET) and control angiography

    5. Wound closure
    View image
  • - , Room 1 - Main Arena 1

    Case 57 – Diffuse occlusion of P3, BTK, and BTA

    Center:
    Abano Terme
    Case 57 – ABT 01: male, 77 years
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    Information will follow in due time.
    View image
  • - , Room 2 - Main Arena 2

    Case 67 – TEVAR of a subacute Type B aortic dissection

    Center:
    Leipzig, Dept. of Angiology
    Case 67 – LEI 25: male, 64 years
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Acute Type-B dissection 6 weeks ago, since then intermittend thoracic pain
    CT 4 weeks later: diameter-increase of the descending aorta of 5 mm
    Coiling of intercostal arteries to reduce the risk of spinal cord ischemia during TEVAR
    Art. hypertension, former smoker

    CT-SCAN
    2 focal dissections of the descending thoracic aorta,
    both have an entry without reentry,
    max. diameter of the aorta 46m

    PROCEDURAL STEPS
    1. Bilateral femoral access
    - Preloading of Proglide-Systems right (ABBOTT)

    2. Positioning of guidewire
    - LunderQuist 0.035" 260 cm (COOK)

    3. Implantation of 2 thoracic stentgrafts
    - Ankura thoracic graft (LIFETECH)
    - Stengraft from left subclavian artery to the celiac trunk
    View image
  • - , Room 3 - Technical Forum

    Case 75 – Abano Terme

    Center:
    Abano Terme
    Case 75 – ABT 02: female, 82 years
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 76 – CLI, popliteal artery occlusion

    Center:
    Leipzig, Dept. of Angiology
    Case 76 – LEI 26: male, 81 years (H-L)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Critical limb ischemia with gangrene dig 4/5 left, Rutherford 5
    Failed recanalization of a popliteal occlusion left
    CEA left femoral bifurcation 1/2017
    CAD, PTCA 2004
    Chronic heart failure, EF 40%
    Diabetes mellitus, type 2
    Chronic renal insufficiency with GFR 55 ml/min

    PRESENT STATE
    Angiography before CEA left groin
    ABI left 1.3, mediasclerosis

    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 (ABBOTT)
    - 6F 55 cm Check-Flow Performer, Raabe Modification (COOK)

    2. Guidewire passage
    second attempt from antegarde:
    - 0.018" Connect Flex guidewire, 300 cm (ABBOTT)
    - 0.018" Seeker support catheter, 135 cm (C.R. BARD)

    In case of failure of GW-passage from antegrade:
    3. Retrograde approach via the posterior 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)

    4. PTA of the distal SFA/popliteal artery occlusion
    - AngioSculpt 4.0/100 mm Scoring balloon (SPECTRANETICS)
    - Stellarex 4.0 or 5.0/120 mm DCB (SPECTRANETICS)

    5. Stenting on indication
    - Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 58 – Excimer laser assisted drug coated balloon recanalisation of popliteal ISR

    Center:
    Bad Krozingen
    Case 58 – BK 01: male, 66 years (K-K)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    Calf claudication left leg after 100m since 3 months (PAOD Fontaine IIb/Rutherford 3)
    Stent recanalisation left popliteal artery 2012
    DCB angioplasty and stent-in-stent angioplasty of left popliteal ISR 01/2016

    PRESENT STATE
    CVRF: arterial hypertension, ex nicotine, hypercholesterinemia
    ABI at rest: right leg: 1.1; left leg: 0.3
    Duplex: instent reocclusion of left popliteal artery

    PROCEDURAL STEPS
    1. Antegrade access, 6F, left CFA

    2. Crossing attempt of the popliteal artery occlusion
    - 0.014'' Advantage 14 GW (TERUMO)

    3. Laser debulking of the occlusion

    - Turbo elite, 2.3 mm (SPECTRANETICS)

    4. Postdilatation
    - 5/100 mm Stellarex DCB (SPECTRANETICS)
  • - , Room 1 - Main Arena 1

    Case 59 – Diffuse subtotal stenosis distal SFA / popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 59 – LEI 22: male, 71 years
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain and Severe claudication left leg, Rutherford class 4
    CAD, PTCA 2012, Chronic heart failure, EF 35%
    Diabetes mellitus, type 2
    Art. hypertension, former smoker

    DUPLEX
    Left distal SFA and popliteal artery with long subtotal stenosis,
    Moderately calcified, diffuse BTK-stenoses
    ABI left 0.32

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - 6F 55 cm Check-Flo Performer, Raabe Modification (COOK)

    2. Guidewire passage
    - PT2 0.014” 300cm guidewire (BOSTON SCIENTIFIC)
    - QuickCross support catheter (SPECTRANETICS)

    3. PTA

    - AngioSculpt scoring balloon 5.0/100 mm (SPECTRANETICS)
    - Exchange to a 0.035" SupraCore guidewire (ABBOTT)
    - Stellarex DCB (SPECTRANETICS)
  • - , Room 2 - Main Arena 2

    Case 68: Bad Krozingen

    Center:
    Bad Krozingen
    Case 68 – BK 05: male, 60 years
    Operators:
    • Martin Czerny
    Information will follow in due time.
  • - , Room 1 - Main Arena 1

    Case 60 – Stent angioplasty of le5 distal SFA with implanta on of a 3-dimensional helical stent

    Center:
    Bad Krozingen
    Case 60 – BK 02: male, 70 years (EW)
    Operators:
    • Elias Noory,
    • P. Krause
    CLINICAL DATA
    Calf claudication left leg after 200m (PAOD Fontaine IIb / Rutherford 3
    Stentangioplastie left renal artery 11/2016
    Rekanalisation (stent & DCB) right SFA 7/2015
    Stent angioplasty CIA&EIA both sides and PTA IIA right 09/201

    PRESENT STATE
    Ex-Nicotine
    Hypertension
    Hypercholesterinemia
    Diabetes mellitus type II
    ABI at rest: 0.5 / 0.6
    Oscillometry: Reduced amplitudes right tigh, calf & ankle
    Reduced amplitudes left calf & ankle
    Duplex:Calcified high grade stenosis of left distal SFA

    PROCEDURAL STEPS
    1. Antegrade access, 6F, left CFA

    2. Crossing of the SFA lesion with a 0.035’’ Glidewire (TERUMO)

    3. Predilatation of distal SFA (Powerflex 5mm, CORDIS)

    4. Implantation of a BioMimics stent 6 or 7 mm (VERYAN)

    5. Postdilatation (6/20mm Powerflex, CORDIS)

    View image
  • - , Room 1 - Main Arena 1

    Case 61 – Münster

    Center:
    Münster
    Case 61 – MUN 08: male, 61 years
    Operators:
    • Arne Schwindt,
    • Stefan Stahlhoff
    Information will follow in due time.
    View image
  • - , Room 1 - Main Arena 1

    Case 61b - Total ATA-occlusion, CLI left forefoot

    Center:
    Leipzig, Dept. of Angiology
    Case 61b - LEI22b: male, 72 years (W-J)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Critical limb ischemia left, gangrene Dig 2-4,
    CAD, PTCA 2012, chronic heart failure, NYHA II-III
    Art. Hypertension, diabetes mellitus type 2
    Previous PTA / stenting BTK for CLI 2010
    Failed recanalization-attempt 1/2017

    ANGIOGRAPHY
    from previous unsuccessful recanalization attempt

    PROCEDURAL STEPS
    1. Left antegrade access
    - 6Fr-55cm Check-Flo Sheath, Raabe Modification (COOK)

    2. Retrograde access via dorsalis pedis artery
    - 2.9 Pedal Introducer Access Set (COOK)

    3. Passage of the occlusion (retrograde)
    - CXI support-catheter, 0.018”, 90 cm (COOK)
    - Hydro-ST 0.014” Guidewire, 300cm (COOK)
    - Approach CTO 25gramm Guidewire, 300cm (COOK)

    4. PTA (BTK-bifurcation in kissing technique)
    - retrograde: Advance Micro Balloon 3.0/120mm, 90cm (COOK)
    - antegrade: Advance LP 3.0/40mm Balloon (COOK)
    View image
  • - , Room 1 - Main Arena 1

    Case 61c – Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 61c – LEI 22c: male, 66 years
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    - CLI, Ulceration D5 right
    - ABI right 0.4

    RISK FACTORS
    - Arterial hypertension
    - Former smoker
    - Diabetes mellitus, type 2

    PROCEDURAL STEPS
    1. Right groin antegrade access
    3. Recanalization of the anterior tibial artery
    3. Retrograde access 3F: dorsalis pedis artery
  • - , Room 1 - Main Arena 1

    Case 62 – Total occlusion of the common iliac artery left

    Center:
    Leipzig, Dept. of Angiology
    Case 62 – LEI 23: female, 70 years (C-L)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left, walking capacity 50-100 meters
    Art. hypertension, nicotine-abuse
    CAD, PTCA 11/2015

    ANGIOGRAPHY ELSEWHERE
    Common iliac artery occlusion left moderately calcified

    PROCEDURAL STEPS
    1. Left femoral access
    - 7F 25 cm Radiofocus Introducer (TERUMO)
    - 0.035" SupraCore guidewire 300 cm (ABBOTT)
    Left brachial approach:
    - 7F 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
    - Armada 35 6/40 mm ballon (ABBOTT)
    - LifeStream covered stent 7/58 bilateral in kissing-technique (C.R. BARD)
    View image
  • - , Room 3 - Technical Forum

    Case 77 – Extremely calcified SFA CTO left, "pave and crack"-technique

    Center:
    Leipzig, Dept. of Angiology
    Case 77 – LEI 27: male, 69 years (S-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain during night and severe calcification left, Rutherford 4
    Failed recanalization attempt left leg 11/2015
    PTA/stenting right SFA-CTO 12/2016
    Art. hypertension, diabetes mellitus, type 2
    Former smoker

    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)

    3. Retrograde guidewire passage:
    Access via the proximal anterior tibial artery:
    - 7 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 4Fr-10cm 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 (C.R. BARD)
    - In case of inability to open the balloons fully implantation of a Viabahn 7.0/100 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 3 - Technical Forum

    Case 78 – Combined antegrade and retrograde recanalisation of right ATA & PTA

    Center:
    Bad Krozingen
    Case 78 – BK 07: male, 62 years, (B-N)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    Non-healing crural ulcer right calf (PAOD Fontaine IV / Rutherford 5)
    11/2016 recanalisation of right SFA, popliteal artery & TPT
    11/2014 recanilsation of right SFA, popliteal artery & TPT (DCB and spot stenting)
    DVT right leg 10/2014

    RISK FACTORS
    CVRF: hyperlipidemia, obesity
    ABI at rest: right leg: 0.6; left leg: 1.0
    Duplex: persistent occlusion of right ATA /& PTA

    PROCEDURAL STEPS
    1. Antegrade sheath insertion 6F, right CFA
    Insertion of a 5F Envoy guiding catheter (CORDIS)

    2. Attempt to antegradely recanalise the PTA (predilatation followed by DCB, Chocolate touch, TRIREME)

    3. Retrograde recanalisation of ATA (predilatation followed by DCB)

    4. Sheath removal in the groin with Femoseal (TERUMO)
    View image
  • - , Room 3 - Technical Forum

    Case 79 – POP-BTK and foot vessels occlusion

    Center:
    Abano Terme
    Case 79 – ABT 03: male, 68 year
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    Information will follow in due time.
    View image
  • - , Room 3 - Technical Forum

    Case 79b – AT-PT and arch occlusion

    Center:
    Abano Terme
    Case 79b – ABT 03b: male, 76 years
    Operators:
    • Marco Manzi
    Information will follow in due time.
  • - , Room 2 - Main Arena 2

    Case 69 – Endovascular repair of an AAA with Endurant Endograft and additional proximal fixation with Heli-FX EndoAnchors

    Center:
    Münster
    Case 69 – MUN 10: female, years (H-R)
    Operators:
    • Martin Austermann,
    • Özgun Sensebat,
    • Stefan Stahlhoff
    CLINICAL DATA
    Growing abdominal aortic aneurysm with conical neck from 4,5 cm to 5,5 cm
    PAD with severe calcified and stenosed iliac arteries

    RISK FACTORS
    CAD – PTCA and PM-Implantation 5/16, chronic heart failure,
    carotid stenosis both sides, PAD – venous bypass 11/06

    PROCEDURAL STEPS
    1. Percutanous approach both groins
    - Prostar XL (ABBOTT)
    - Placement of 14F sheath (COOK)

    2. Placement of Endurant bifurcated endograft (MEDTRONIC) just below the RA`s

    3. Additional fixation of the proximal sealing zone
    - Heli-FX Endoanchors (MEDTRONIC)

    4. Closure of the groin
    - Prostar XL (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 63 – Stentgraft reconstruction of ISR of aortic bifurcation

    Center:
    Bad Krozingen
    Case 63 – BK 03: female, 41 years (G-A)
    Operators:
    • Elias Noory,
    • Aljoscha Rastan
    CLINICAL DATA
    Bilateral PAOD Rutherford 2 / Fontaine IIa
    Bilateral CIA stent-angioplasty 10/2014
    Bilateral chronic venous insufficiency

    PRESENT STATE
    CVRF: ex-smoker, hyperlipidemia, obesity
    ABI at rest: right leg: 0.8; left leg: 0.6
    Duplex: Bilateral high grade ISR at the origin of the CIA

    PROCEDURAL STEPS
    1. Bilateral retrograde access
    - 23 cm long 7F sheath into the CFA (CORDIS)

    2. Crossing of ISR
    - 0.035'' guidewire (TERUMO)

    3. Bilateral stentgraft implantation in a modified kissing stent fashion
    - BeGraft 8 mm (BENTLEY)

    4. Sheath removal
    - Femoseal (TERUMO)
    View image
  • - , Room 2 - Main Arena 2

    Case 70 – Münster

    Center:
    Münster
    Case 70 – MUN 11: male, 88 years
    Operators:
    • Theodosios Bisdas,
    • Stefan Stahlhoff
    Information will follow in due time.
    View image
  • - , Room 2 - Main Arena 2

    Case 71 – FEVAR for dissecting TAAA

    Center:
    Lille
    Case 71 – LIL 02: male, 61, years (H-M)
    Operators:
    • Stephan Haulon
    CLINICAL DATA
    2013: type B aortic dissection, conservative treatment
    Acute tubular necrosis and occlusion right renal artery with atrophic right kidney
    2014 aneurysmatic evolution infrarenal aorta: Open AAA tubular repair
    Aneurysmatic evolution descending thoracic and thoraco-abdominal aorta,
    with a maximum diameter 61 mm
    November 2016: TEVAR
    January 2017: FEVAR

    RISK FACTORS
    Smoker, hypertension

    HISTORY
    Gastric ulcers, pancreatitis, OSA, GORD

    PRESENT STATE
    At present asymptomatic
    Renal function: creatinine 12 mg/l, GFR 64
    Cardiac ultrasound: normal EF, mild AI, otherwise normal
    Duplex carotid arteries: normal
    Spirometry: mild obstructive pattern

    PROCEDURAL STEPS
    1. L: 7F sheath/Lunderquist/dilators (up to 20F) + 100 U/kg Heparin (Target ACT≥250)
    2. L: 20F sheath above the aortic bifurcation
    3. L (through 20F): Two 7F sheaths, one 6F sheath
    4. L (through 20F): Advance marked angio catheter through 7F sheath
    5. R: 10F sheath/Lunderquist/dilators up to 20F
    6. Fluoroscopy to locate fenestrated endograft markers
    7. R: Advanced fenestrated endograft (COOK)
    8. Aortic angiogram/fenestrated endograft deployment
    9. L: Catheterization of the fenestrated endograft lumen through 6F sheath with C2/KMP catheter and TERUMO wire
    10. Advance 6F sheath to the endograft lumen
    11. C2/RIM/DAV + TERUMO/Roadrunner through 6F for renal artery catheterisation
    12. Renal angiogram +/- nitro injection
    13. Exchange TERUMO for a Rosen
    14. Advance 6F to the renal artery
    15. Advance stent into the parking position
    16. L: Through last 7F sheath advance C2+ TERUMO to catheterize fenestrated endograft lumen
    17. Advance 7F below the fenestration of SMA
    18. C2/VS1 + TERUMO/Roadrunner through 7F sheath to catheterize SMA
    19. Vessel angiogram to check position in main trunk
    20. Exchange TERUMO for Amplatz (BOSTON SCIENTIFIC) wire
    21. Advance 7F in the target vessel
    22. Advance stent into parking position
    23. 16-19 for the coeliac trunk
    24. R: Release reducing ties / proximal attachment and distal attachment
    25. R: Nose capture & retrieval under fluoroscopy/Molding with CODA balloon (COOK)
    26. L: Renal artery stent deployment (1/3 aortic lumen) after 6F retrieval
    27. L: Flare the stent inside the aortic portion with 10–20 mm balloon
    28. L: Advance 6F in the renal stent/selective angiogram
    29. L: SMA stent deployment (1/3 aortic lumen) after 7F retrieval
    30. L: CT stent deployment (1/3 aortic lumen) after 7F retrieval
    31. L: Flare the stent inside the aortic portion with 10-20 mm balloon
    33. R: Remove fenestrated device delivery system
    34. L: Pull back 20F sheath in common iliac
    35. Continue with EVAR procedure
    36. CODA balloon at the level of overlaps (COOK)
    37. L: Long angio catheter/Angiogram +/- non-contrast CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 64 – Münster

    Center:
    Münster
    Case 64 – MUN 09: female, 60 years
    Operators:
    • Arne Schwindt,
    • Stefan Stahlhoff
    Information will follow in due time.
    View image
  • - , Room 1 - Main Arena 1

    Case 65 – Directional atherectomy & DCB of right CFA

    Center:
    Bad Krozingen
    Case 65 – BK 04: female, 56 years (B-M)
    Operators:
    • Aljoscha Rastan,
    • Thomas Zeller
    CLINICAL DATA
    PAOD Rutherford 2 / Fontaine IIb right leg
    Recanalisation left CIA 12/2016
    Stent reconsruction of aortic bifurcation 2014

    PRESENT STATE
    CVRF: ex-smoker, hyperlididemia
    ABI right leg: 0.6; left leg: 1.0
    Duplex: high grade stenosis of right CFA

    PROCEDURAL STEPS
    1. Left transbrachial retrograde access
    - 6F 90 cm shuttle sheath (COOK)

    2. Filter placement
    - 6 mm Spider filter (MEDTRONIC) distal right SFA

    3. Directional atherectomy
    - Turbohawk SX-C (MEDTRONIC)

    4. Drug coated balloon angioplasty
    - 7/40 mm Inpact Pacific (MEDTRONIC)

    5. Stenting on indication
    View image
  • - , Room 2 - Main Arena 2

    Case 72 – Münster

    Center:
    Münster
    Case 72 – MUN 12: female, 52 years (S-M)
    Operators:
    • Martin Austermann,
    • Theodosios Bisdas,
    • Giovanni Torsello
    Information will follow in due time.
    View image
  • - , Room 1 - Main Arena 1

    Case 66 – Popliteal occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 66 – LEI 24: female, 79 years (A-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain left foot, Rutherford class 4
    PTA/stenting aortic bifurcation 11/2016
    D iabetes mellitus, type 2
    Art. Hypertension

    ANGIOGRAPHY
    During PTA of the aortic bifurcation:
    moderately calcified distal SFA/P1-occlusion left

    PROCEDURAL STEPS
    1. Antegrade approach left
    - 7F 55 cm Check-Flo Sheath, Raabe Modification (COOK)

    2. Guidewire passage
    - 5.0/40 mm Pacific Plus balloon, 90 cm (MEDTRONIC)
    - 0.018" Victory guidewire, 18 gramm, 30 cm (BOSTON SCIENTIFIC)

    3. PTA and stenting
    - 6.0/40mm Pacific Plus balloon, 90 cm (MEDTRONIC)
    - Supera Interwoven Nitinol stent (ABBOTT)
    View image

Conference day 4

  • - , Room 1 - Main Arena 1

    Case 80 – 4-fenestrated endovascular repair of a 7 cm post-dissection TAAA

    Center:
    Münster
    Case 80 – MUN 14: male, 76 years, (W-H)
    Operators:
    • Martin Austermann,
    • Theodosios Bisdas,
    • Stefan Stahlhoff
    CLINICAL DATA
    Post-dissection thorakoabdominal aneurysm with a diameter of 7 cm
    Aszendens and aortic arch repair by frozen elefant trunk in the acute phase and endovascular extension to open the true lumen but still increase of the still perfused false lumen.

    RISK FACTORS
    Art. hypertension, CAD

    PROCEDURAL STEPS
    1. Percutanous approach both groins (Prostar XL, ABBOTT) 14F (COOK) both groins
    Careful cannulation of the true lumen

    2. Angiogaphy to locate CT, SMA and RRA coming out of the true lumen and use of fusion technology

    3. Changing the left 14F sheath for a 22F sheath
    Placement of three 5F sheaths into the 22F sheath and pre-cannulation of the right renal artery and SMA by using fusion technology.

    4. Placement of the 4-fenestrated Zenith-endograft (tube) (COOK) via the right groin
    Cannulation of the SMA and RRA through the fenestrations

    5. Advancement of 7 and 8F sheaths into the target vessels
    Complete release of the endograft and stenting of the fenestrations for the SMA and RRA with covered stents (Advanta V12-MAQUET) and flairing
    Cannulation of the CT and stenting

    6. Cannulation of the fenestration for the LRA, perforation of dissectionmembrane and cannulation of the LRA coming out of the false lumen and implantation of another bridging stentgraft (Advanta V12)

    7. Placement of the distal bifurcated graft and the iliac extensions
    Closure of the accesses
    View image
  • - , Room 3 - Technical Forum

    Case 83 – Severely calcified SFA occlusion, "pave and crack"-technique

    Center:
    Leipzig, Dept. of Angiology
    Case 83 – LEI 29: female, 65 years (H-T)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Critical limb ischemia right, ulcerations dig 2 / 3, Rutherford 5
    Endstage renal failure, chronic hemodialysis until 1997
    Renal transplantation 1997
    Art. Hypertension

    PRESENT STATE
    CO2-angiography
    ABI right: mediasclerosis

    PROCEDURAL STEPS
    1. Left 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-55 cm Check-Flo Sheath, Raabe Configuration (COOK)

    2. Antegrade guidewire passage
    - 0.035" Stiff angled Glidewire, 260 cm (TERUMO)
    - CXC 0.035" support catheter, 135 cm (COOK)

    In case of guidewire passage failure:
    3. Retrograde approach via the distal SFA
    - 9 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Control guidewire, 300 cm (BOSTIN SCIENTIFIC)

    4. PTA and stenting
    - 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
    - 7.0/20 Conquest non-compliant high-pressure balloon (C.R. BARD)
    - In case of inability to open the balloons fully implantation of a Viabahn 7.0/100 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 81 – FEVAR of a juxtarenal aneurysm

    Center:
    Leipzig, Dept. of Angiology
    Case 81 – LEI 28: male, 67 years
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Incidental finding of a juxtarenal aortic aneurysm
    with progression to 61 mm max. diameter
    Accessory renal arteris on both sides
    Coiling of intercostal and lumbar arteries before FEVAR
    to reduce the risk of spinal ischemia
    Coiling of the accessory right renal artery
    CAD, PTCA 2012 heart failure, EF 40%
    Thyreoidectomy 1/2017

    IMPORTANT ITEMS
    CT-scans and Stentgraft-plan

    PROCEDURAL STEPS
    1. Bilateral femoral access and left axillar percutaneous access
    - Preloading of Proglide-Systems (ABBOTT) for all 3 access-sites

    2. Implantation of the CMD thoracoabdominal stentgraft (JOTEC)

    3. Implantation of E-ventus covered stents into the visveral arteries (JOTEC)

    4. Implantation of the bifurcated component with extension into the common iliac arteries
    View image
  • - , Room 3 - Technical Forum

    Case 85 – Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 85 – LEI 31: female, 60 years
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    - Asymptomatic highgrade stenosis of the ostium of the common carotid artery left
    - Duplex-sonography because of recurrent dizziness: severe flow-disturbance of the proximal common carotid artery and slow flow

    RISK FACTORS
    - Arterial hypertension
    - Diabetes mellitus, type 2
    - Former smoker

Live case transmission centers

During LINC 2017 more than 90 live cases will be performed from 13 national and international centers.

All live case transmissions are coordinated, filmed, and produced by the mediAVentures crew, using the latest in high definition television and wireless technology.

• University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
University Hospital Leipzig, Department of Radiology, Leipzig, Germany
• Policlinico Abano Terme, Abano Terme, Italy
• Heartcenter Bad Krozingen, Bad Krozingen, Germany
• Sankt-Gertrauden-Hospital, Berlin, Germany
• Bern University Hospital, Heart- and Vascular Center, Bern, Switzerland
• OhioHealth Research Institute, Columbus, USA
• Villa Maria Cecilia, Cotignola, Italy
• AZ Sint-Blasius, Dendermonde, Belgium
• Galway University Hospitals, Galway, Ireland
• University Hospital Jena, Jena, Germany
• Centre Hospitalier Régional Universitaire de Lille, Lille, France
• St. Franziskus Hospital, Münster, Germany
• Mount Sinai Hospital, New York, USA