LINC 2020 live case guide

During the Leipzig Interventional Course 2020
more than 70 interventional and surgical live cases
are scheduled to be performed and transmitted
to the auditorium.

 

 

LINC 2020 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 1

  • - , Room 1 - Main Arena 1

    Case 01 – Long SFA-reocclusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 01 – LEI 01: male, 59 years (K-A)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 3, severe claudication right calf,
    walking capacity 150m, ABI right 0.65
    PTA with DCBs 10/18
    Osteoporosis

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker (40PY)

    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
  • - , Room 2 - Main Arena 2

    Case 09 – Pelvic congestion syndrome

    Center:
    Zürich
    Case 09 – ZUE 01: female, 38 years (B-S)
    Operators:
    • Nils Kucher,
    • Dai-Do Do,
    • F. Baumann
    CLINICAL DATA
    Left lower abdominal pain radiating to left proximal thigh; aggravated by menstrual cycle
    Painful varicose veins vulva and left thigh
    Left-sided venous claudication

    IMAGING
    Ultrasound & MR findings:
    - May-Thurner compression
    - Retrograde flow left internal iliac vein
    - No evidence for nutcracker anatomy
    - Left pudendal vein feeding varicose thigh veins

    PROCEDURAL STEPS
    1. Local anesthesia left groin, supine position
    2. Ultrasound-assisted venous access (common femoral vein), insertion 10F sheath
    3. Phlebography / IVUS
    4. Sinus obliquus stent (OPTIMED)
    View image
  • - , 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, 67 years (H-F)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford III left, painfree walking distance 10 m, ABI left: 0.3
    CAD, CABG 2017, terminal kidney disease (dialysis)

    RISK FACTORS
    Arterial hypertension, 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
    – 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
    – Retrograde approach via left peroneal artery
    4. Vessel preparation/ PTA
    – 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
    – Conquest high pressure balloon on indication (BARD/ BD)
    5. Stenting
    – 5.5/120 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 10 – Acute left leg DVT

    Center:
    Galway
    Case 10 – GAL 01: female, 54 years (P-C)
    Operators:
    • J. Ward,
    • Gerard O'Sullivan
    CLINICAL DATA
    54 year old lady, normally fit and well, acute onset left leg pain – actually started in the groin, moved inferiorly, went to see family doctor in am; immediately referred to radiology

    IMAGING
    US scan shows acute left leg DVT, CTPA clear, CTV images to follow

    PROCEDURAL STEPS
    1.Prone, 10F sheath
    2.Initial very gentle venography – 10 cc of dilute contrast
    3. IVUS, then stiff glide wire (Merit Medical) into IVC
    4.Deploy VETEX (VETEX Medical) thrombectomy device, cranial to caudal action x 2
    5.Aspiration – 8F 55 cm Hockey Stick (CORDIS) +/- 7F 90 cm desitination catheter (TERUMO)
    6.IVUS to identify remaining thrombus v underlying lesion
    7.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds
    8.Stents 14 - 16 mm diameter (BARD/BD Venovo, or COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous)
    9.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds
    10.IVUS and one final venogram
    View image
  • - , Room 2 - Main Arena 2

    Case 11 – Chronic occlusion of the abdominal aorta, Leriche-Syndrome

    Center:
    Leipzig, Dept. of Angiology
    Case 11 – LEI 06: female, 59 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 5 left, ulceration Dig. 5 left, ABI right 0.22, left 0.33
    Severe claudication both calves, absolute walking capacity 30–50 meters

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2, nicotine abuse (35PY)

    CT
    Chronic, thrombus-containing occlusion of the infrarenal aorta and severe stenosis both iliac arteries

    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
    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
  • - , Room 3 - Technical Forum

    Case 17 – Symptomatic high-risk carotid artery disease

    Center:
    Bergamo
    Case 17 – BG 03: male, 82 years (P-R)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    No relevant prior vascular history
    One month ago transient ischemic attack with left-sided hemyparesis

    RISK FACTORS
    Hypertension, hypercholesterolemia

    IMAGING
    DUS: 85% RICA stenosis with significant flow acceleration
    CT angio: sub-occlusive right ICA disease with presence of thrombus

    PROCEDURAL STEPS
    1. Right femoral access (9F)
    2. Selective right carotid cannulation
    – JR4 guiding cathether (CORDIS/CARDINAL HEALTH)
    3. Proximal protection
    – MOMA 9F (MEDTRONIC)
    4. Lesion crossing
    – 0.014‘‘ guidewire
    5. Direct stenting
    – C-Guard double mesh stent (Inspire MD)
    6. Postdilatation
    – 5.0 mm Ultrasoft balloon (BOSTON SCIENTIFIC)
    7. Debris aspiration (if any)
  • - , Room 2 - Main Arena 2

    Case 12 – Chronic post thrombotic syndrome left leg

    Center:
    Galway
    Case 12 – GAL 02: female, 51 years (E-C)
    Operators:
    • J. Ward,
    • Gerard O'Sullivan
    CLINICAL DATA
    DVT x 3; Factor V Leiden deficiency; venous claudication on hills at 50 m; weight gain 9 kg, no ulcers, minimal oedema when wearing stockings; fully anticoagulated

    RISK FACTORS
    Factor V Leiden

    PROCEDURAL STEPS
    1. 3 point access RIJV, L FV, R CFV
    2. General anaesthetic, urethral catheter
    3. Full anticoagulation
    4. Cross lesion using multiple obliques – Cxi (COOK), Rubicon (BSCI); Roadrunner wire (COOK)
    5. IVUS to confirm position and to confirm dominant inflow inferiorly
    6. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum
    7. Stents 14 – 16 mm diameter (COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous or Bard Venovo)
    8. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum
    9. IVUS to confirm full stent expansion
    10. One final venogram to show rapid flow
    View image
  • - , Room 1 - Main Arena 1

    Case 03 – Subacute occlusion of the right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 03 – LEI 03: male, 63 years (A-F)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    PAOD Rutherford 3, walking capacity 100 m, ABI right 0.49
    PTA/stent left SFA 12/2019

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, former smoker (30PY)

    PROCEDURAL STEPS
    1. Left groin and cross-over approach
    – Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    – 0.035'' SupraCore guidewire 30 cm (ABBOTT)
    – 7F - 40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage of the occlusion
    – 0.018'' Command 18 300 cm (ABBOTT)
    – 0.035'' QuickCross support catheter, 135 cm (PHILIPS)
    – Exchange to a 0.014'' Floppy ES guidewire 300 cm (ABBOTT)
    – Confirm intraluminal position with Vision PV 0.14 IVUS (PHILIPS)
    3. Laser atherectomy
    – 7F Turbo Power Laser with Turbo Elite 2.3 mm catheter (PHILIPS)
    4. PTA with DCBs
    – Stellarex 5.0/120 mm or 6.0/120 mm DCBs (PHILIPS)
    5. Stenting on indication:
    - Tack Endovascular System (INTACT VASCULAR INC.)
    View image
  • - , Room 2 - Main Arena 2

    Case 13 – Heart failure and post-thrombotic syndrome

    Center:
    Zürich
    Case 13 – ZUE 02: male, 66 years, (P-vM)
    Operators:
    • Nils Kucher,
    • Dai-Do Do,
    • F. Baumann
    CLINICAL DATA
    High-risk PE requiring CPR and systemic thrombolysis following hernioplasty, 03/2019
    Complications: active retroperitoneal bleeding, sepsis, renal failure, IVC Optease filter thrombosis with massive bilateral DVT of entire deep veins below the IVC filter
    Current medical condition: Dyspnea NYHA II-III, post-thrombotic syndrome with permanent leg swelling and venous claudication (particularly left side)

    IMAGING
    Echocardiography 11/2019: Normal LV function, normalized RV size and function, no indirect signs of pulmonary hypertension
    Ultrasound 11/2019 and Chest-CT 07/2019: Patent common femoral veins, patent external iliac veins, post-thrombotic common iliac veins, occluded infrarenal IVC, patent suprarenal IVC

    PROCEDURAL STEPS
    Cardiopulmonary exercise test 11/2019: Max VO2: 53%

    PROCEDURAL STEPS
    1. General anesthesia, urinary catheter, supine position
    2. Ultrasound-assisted access from:
    bifemoral
    – common femoral vein: left 10F sheath, right 16F sheath
    right jugular vein
    – 10F sheath
    3. Angioplasty of iliac veins and infrarenal IVC
    4. Extraction Optease Filter
    5. Reconstruction IVC and iliac veins
    – Venovo stents (BARD/ BD)
    View image
  • - , Room 3 - Technical Forum

    Case 18 – Progressive carotid artery stenosis left, high grade bilateral vertebral stenosis

    Center:
    Berlin
    Case 18 – BLN 02: male, 79 years (W-G)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    Stenting of the right carotid artery in 2007 without any restenosis
    Known carotid artery stenosis on the left side with rapid progression within 6 months from 60 to 80%

    RISK FACTORS
    Art. hypertension, hypercholesterinemia

    DUPLEX
    PSVR >4 m/s left ICA, no restenosis in the right CAS

    PROCEDURAL STEPS
    1. Transfemoral access
    – short 8F TERUMO sheath right
    2. Selective engaging of the left CCA
    – Weinberg Catheter (COOK)
    3. Teleskoping of the left ECA
    – Stiff glidewire 260 cm, angled tip (TERUMO)
    – 8F Vista Brite TIP IG MP shape guiding catheter (CORDIS)
    4. Distal protection
    – Filterwire EZ (BOSTON SCIENTIFIC)
    5. Predilatation
    – Maverick 3.0 x 20 mm balloon (BOSTON SCIENTIFIC)
    6. Stenting
    – 8 x 25 mm Roadsaver Micromesh stent (TERUMO)
    7. Postdilatation
    – 5 x 20 mm Emerge balloon (BOSTON SCIENTIFIC)
    8. Postprodecural DAS
    9. Vessel closure
    – Angioseal 8F (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 03b – LEI 03b

    Center:
    Leipzig, Dept. of Angiology
    Case 03b – LEI 03b
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 19 – Multifocal SFA lesions and popliteal occlusion, left

    Center:
    Berlin
    Case 19 – BLN 03: male, 59 years (T-S)
    Operators:
    • Ralf Langhoff,
    • David Hardung
    CLINICAL DATA
    Stenting of a left side, high-grade CIA stenosis in 2019
    Still dramatically impaired walking distance due to popliteal occlusion
    ABI: 0.5 left, ABI: 0.9 right

    RISK FACTORS
    Arterial hypertension, smoking, hyperlipidemia

    IMAGING
    Duplex and Angio show popliteal occlusion and SFA stenosis

    PROCEDURAL STEPS
    1. Antegrade access
    – 6F short Prelude Introducer sheath (Merit medical)
    2. Wire passage
    – 0.018''Advantage wire (TERUMO)
    – Backup: Halberd wire 0.018'' or 0.014'' (Asahi)
    3. Support catheter
    – Carnelian 0.018'' (BIOTRONIK)
    4. Predilatation
    – 3 x 150 mm PTA balloon (vessel preparation)
    5. P TA in the SFA and popliteal
    – Sequent OTW 5 x 150 mm balloon (B.Braun)
    6. Focal/ spot stenting of SFA and Politeal artery
    – Multi-LOC Stent as needed (6 stents maximum) (B.BRAUN)
    or using the new 2-LOC
    or 3-LOC in 30 or 40 mm length as a focal stent
    7. Postdilation with a standard PTA balloon
    8. Vessel closure
    – Angioseal 6F (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 05 –Symptomatic occlusive early restenosis of right SFA

    Center:
    Bergamo
    Case 05 – BG 02: male, 67 years, (G-B)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    CLINICAL DATA
    No CV history
    Previous right SFA PTA with plain balloon
    During the last 3 months severe right leg claudication (walking distance 70 m)

    RISK FACTORS
    Hypertension, hypercholesterolemia, previous history of smoking

    DUPLEX
    Distal right SFA occlusion with flow demodulation in BTK vessels

    PROCEDURAL STEPS
    1. Femoral access (7F)
    2. Lesion crossing
    – 0.018‘‘ Control Wire + BerII 4F catheter
    3. Wire exchange
    – 0.018‘‘ wire with 0.014‘‘ wire Choice PT (BOSTON SCIENTIFIC)
    4. Embolic protection
    – Distal 6.0 mm Spider FX (MEDTRONIC)
    5. Directional atherectomy
    – HawkOne (MEDTRONIC)
    6. Balloon dilatation
    – 5.0 mm Inpact Admiral drug-coated balloon (MEDTRONIC)
    7. Postdilatation if needed
    View image
  • - , Room 3 - Technical Forum

    Case 20 – CTO of the proximal SFA right

    Center:
    Leipzig, Dept. of Angiology
    Case 20 – LEI 07: male, 68 years, (V-S)
    Operators:
    • Matthias Ulrich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford 3 right, walking capacity 150m
    DCB-PTA right 11/2017, ABI right 0.66
    Multiple interventions left SFA (stent, PTA, DCB) COPD

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, nicotin abuse (50PY)

    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. Passage of the occlusion right SFA
    – 0.035'' Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    – 0.035'' CXC support catheter, 135 cm (COOK)

    In case of failure guidewire passage from antegrade:
    3. Retrograde approach via distal SFA
    – 7 cm 21 Gauge needle (COOK)
    – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    – 4F 10 cm Radiofocus introducer (TERUMO)
    – Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
    4. Vessel preparation
    – Pacific 2.0/120 mm balloon (MEDTRONIC)
    – VascuTrak 5.0/120 mm balloon (BARD/BD)
    5. Stenting on indication
    – 5 mm or 6 mm Biomimics 3D stent (VERYAN MEDICAL)
    View image
  • - , Room 1 - Main Arena 1

    Case 06 – 3-vessel disease BTK right

    Center:
    Leipzig, Dept. of Angiology
    Case 06 – LEI 04: male, 78 years (A-T)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia right, rest-pain right forefoot
    Walking capacity 50 meters, ABI right 0.49

    Imaging
    Duplex: occlusion of all BTK-arteries
    DSA: TPT-occlusion, long occlusions of the ATA and PTA

    PROCEDURAL STEPS
    1. Antegrade access right
    – 6F 55 cm sheath Flexor Check-Flo Introducer Raabe Modification (COOK)
    2. Guidewire passage of the TPT
    – 0.014'' Command ES (ABBOTT) or
    – 0.014'' Winn 200 T (ABBOTT)
    3. Atherectomy of the TPT
    – TurboHawk SX-C (MEDTRONIC)
    potentially also atherectomy of the ATA-origin
    4. Balloon dilatation of the TPT and ATA
    – Amphirion Deep (MEDTRONIC)
    5. Stenting on indication:
    - Tack Endovascular System (INTACT VASCULAR INC.)
    View image
  • - , Room 3 - Technical Forum

    Case 21 – Symptomatic right carotid artery disease in a patient with known history of cardiovascular disease

    Center:
    Bergamo
    Case 21 – BG 04: female, 69 years, (A-M)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    Previous CABG (LIMA to LAD, VG to posterolateral branch) + ascending aorta repalcament (2015)
    Previous multiple PCI (the last one in 2017 to LCx artery)
    Currently asymptomatic for angina, negative stress echo in 2019
    In December 2019 episode of left-sided hemiparesis with full neurological recovery

    RISK FACTORS
    Hypertension, hypercholesterolemia

    IMAGING
    DUS: severe right carotid artery stenosis with flow acceleration up to 473 cm/sec

    PROCEDURAL STEPS
    1. Radial access (6F)
    2. Right carotid artery selective cannulation
    – IM guiding catheter
    3. Support guidewire
    – 0.035‘‘ Supracore wire in ECA
    4. Sheath placement
    – Destination 6F long 90 cm sheath (TERUMO)
    5. Filter placement
    – Spider FX filter (MEDTRONIC) in RICA
    6. Direct stenting
    – Roadsaver double mesh stent (TERUMO)
    7. Postdilatation
    – 5.5 mm Ultraverse balloon (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 07 – LEI 05

    Center:
    Leipzig, Dept. of Angiology
    Case 07 – LEI 05
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 15 – Pelvic congestion and post-thrombotic syndrome

    Center:
    Zürich
    Case 15 – ZUE 03: female, 43 years (S-K)
    Operators:
    • Nils Kucher,
    • F. Baumann
    CLINICAL DATA
    Pregnancy-induced right-sided iliofemoral DVT 01/2018
    Conservative treatment with LMWH and compression stockings
    Persistant venous claudication and leg swelling as well as lower abdominal pain with aggravation during menstruation cycle
    Endovascular reconstruction of right ilio-femoral veins 11/2019 using Venovo & BlueFlow stents

    PRESENT STATE
    Follow-up in outpatient clinic 12/2019:
    Leg symptoms completely resolved
    Lower abdominal pain unchanged

    IMAGING
    Duplex: confirmed patency of venous stents
    MR-imaging: enlarged ovarian veins

    PROCEDURAL STEPS
    1. Local anesthesia right jugular vein, supine position
    2. Ultrasound-assisted access
    – 5F sheath
    3. Venography of ilio-femoral stents
    4. Selective Valsalva venography left ovarian and parauterine veins
    – 5F Kobra catheter (COOK)
    5. Selective injection of Aethoxysclerol (3%) foam to parauterine veins during Valsalva
    6. Coil embolization of left ovarian vein
    – Nester 12 mm coils (COOK)
    7. Final venogram to confirm ovarian vein occlusion
    View image
  • - , Room 2 - Main Arena 2

    Case 16 – GAL 04

    Center:
    Galway
    Case 16 – GAL 04
    Operators:
    • J. Ward,
    • Gerard O'Sullivan
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 22 – Total occlusion of the left CIA and EIA

    Center:
    Leipzig, Dept. of Angiology
    Case 22 – LEI 08: female, 55 years (B-A)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 3, claudication left calf, walking capacitiy 50m, ABI left 0.45

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, nicotine abuse (35PY)

    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:
    v5F 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/BD)
    – LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD/BD)
    – Covera Plus vascular covered stent for the external iliac artery (BARD/BD)
    View image
  • - , Room 3 - Technical Forum

    Case 23 – Severe right leg claudication in a patient with history of heavy smoking

    Center:
    Bergamo
    Case 23 – BG 05: male, 69 years (G-Z)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    Previous coronary angiogram (abnormal stress test) showing unobstructed coronary arteries
    Severe right leg claudication (90 m) much impairing quality of life
    Quit smoking 1 year ago

    RISK FACTORS
    Mild hypertension, dyslipidemia

    IMAGING
    DUS: flow demodulation in right CFA compatible with iliac occlusion
    Angio MRI: right distal common iliac occlusion

    PROCEDURAL STEPS
    1. Left femoral access (6F)
    2. Cross-over approach
    – 45 cm Destination sheath (TERUMO)
    3. Right femoral access
    – Back-up, 4F sheath
    4. Lesion crossing from cross-over system
    – 0.018‘‘ Control wire or hydrophilic 0.035‘‘ wire (TERUMO)
    5. Predilatation
    6. Stenting with self-expandable stent
    – Everflex (MEDTRONIC)
    7. Postdilatation
    View image
  • - , Room 1 - Main Arena 1

    Case 08 – BLN 01

    Center:
    Berlin
    Case 08 – BLN 01
    Operators:
    • Ralf Langhoff,
    • Mehmet Boral
    Detailed information will be shown in the video itself!

Conference day 2

  • - , Room 5 - Global Expert Exchange

    Case 50 – Calcified distal SFA-occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 50 – LEI 17: female, 73 years (K-R)
    Operators:
    • Sven Bräunlich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford 5, ulceration dig. 1 right, severe claudication right calf, walking capacity 20 m, ABI right 0.45
    Amputation Dig. 5 right 2015

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Left groin and cross-over approach
    – Judkins Right 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
    – 0,035'' SupraCore guidewire 30 cm (ABBOTT)
    – 6F-40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    – 0.035'' stiff, angled glidewire, 260 cm (TERUMO)
    – 0.035'' Seeker support catheter, 135 cm (BARD/ BD)
    3. Angioplasty
    – UltraScore 5.0/300 mm balloon (BARD/BD)
    – Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD/ BD)
    4. Stenting on indication
    – LifeStent (BARD/ BD)
    View image
  • - , Room 2 - Main Arena 2

    Case 33 – MUN 01

    Center:
    Münster
    Case 33 – MUN 01
    Operators:
    • Martin Austermann,
    • E. Beropoulis,
    • Y. Shehada
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 39 – Percutaneous CT-guided microwave ablation of hepatocellular carcinoma post TACE

    Center:
    Frankfurt/Main
    Case 39 – FRA 01: male, 81 years (K-H)
    Operators:
    • M. Nour Eldin,
    • Bita Panahi
    CLINICAL DATA
    Histologically confirmed HCC lesion in Segment 5
    Highly differentiated HCC, no liver cirrhosis
    Initial tumor stage: T3 Nx M0. Etiology NASH, no extrahepatic metastases
    3 cycles of TACE were carried out for downsizing

    PROCEDURAL STEPS
    1. Revision of the previous images for confirmation of the size and location of the lesion
    2. Non contrast enhanced CT of the liver for planning
    3. Surface marking of the location of the lesion as well as the site of puncture on the skin
    4. Sterile covering followed by infiltration of the local anesthetic
    Conscious sedation would be given
    5. Stepwise insertion of the Microwave antenna (COVIDIEN¨ SYSTEM) within the lesion
    6. The energy required for ablation will be given to induce complete ablation of the lesion
    Intermittent CT images to observe the changes during the ablation procedure
    7. After applying the required energy for ablation, needle track ablation will be done followed by removal of the antenna
    8. Transfer of the patient to the recovery room for clinical observation
  • - , Room 1 - Main Arena 1

    Case 24 – LEI 09

    Center:
    Leipzig, Dept. of Angiology
    Case 24 – LEI 09
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 40 – Holmium 166-SIRT of intrahepatic cholangiocellular carcinoma of the left liver lobe

    Center:
    Jena
    Case 40 – JEN 02: male, 75 years (K-U)
    Operators:
    • René Aschenbach,
    • R. Drescher
    CLINICAL DATA
    iCCC, Grade II of the left lobe, not resectable due to advanced liver fibrosis

    IMPORTANT ITEMS
    ITB waived at first line therapy resection
    Intra-operative advanced fibrosis
    Liver surgeons stated this as not resectable
    ITB reviewed the case and recommended SIRT (probably radio-segmentectomy if possible)

    PROCEDURAL STEPS
    1. Right groin puncture
    – 5F sheath (TERUMO)
    2. Access to liver
    – 5F Cobra catheter (BOSTON SCIENTIFIC)
    3. Access to tumor
    – Microcatheter Progreat (TERUMO)
    4. Application of estimated activity
    – QuiremSpheres/Holmium 166 (TERUMO)
    5. Vascular closure device of the right groin
    – Exoseal (CORDIS)
    View image
  • - , Room 1 - Main Arena 1

    Case 25 – Calcified SFA-occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 25 – LEI 10: male, 77 years (N-B)
    Operators:
    • Sven Bräunlich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford class 3, severe claudication left, walking capacity 50 m, ABI 0.5
    Multiple interventions both SFA

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over approach
    – 7F 55 cm Check-Flo Performer, Raab Modification (COOK)
    2. Passage of the occlusion left SFA
    – 0.018'' V-18 or Victory guidewire (BOSTON SCIENTIFIC)
    – 0.018'' Rubicon support catheter (BOSTON SCIENTIFIC)
    3. Guidewire passage and filter placement
    – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    4. Atherectomy
    – 2.4/3.4 mm JetStream atherectomy device (BOSTON SCIENTIFIC)
    5. PTA with DCBs and/or stenting
    – Ranger DCB balloon (BOSTON SCIENTIFIC)
    – Eluvia drug-eluting stent (BOSTON SCIENTIFIC)
    View image
  • - , Room 2 - Main Arena 2

    Case 34 – Symptomatic infrarenal aortic aneursym

    Center:
    Leipzig, Dept. of Angiology
    Case 34 – LEI 13: female, 75 years (R-S)
    Operators:
    • Andrej Schmidt,
    • J. Rusinovich
    CLINICAL DATA
    Symptomatic infarenal aortic aneurysm (max. diam. 47 mm)
    Occasionally back-pain and abdominal pain

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Bilateral femoral percutaneous access
    – Preloading of Proglide-Systems (ABBOTT)
    2. Coilembolisation of lumbar segmental arteries before EVAR
    – 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)
    – Microvascular Plugs (MEDTRONIC) and Amplatzer Plug for the IMA (ABBOTT)
    3. Implantation of stentgraft system
    – Altura Ultra Low Profile stentgraft system (LOMBARD MEDICAL)
    View image
  • - , Room 3 - Technical Forum

    Case 41 – FRA 02

    Center:
    Frankfurt/Main
    Case 41 – FRA 02
    Operators:
    • M. Nour Eldin,
    • E. Emara
    Detailed information will be shown in the video itself!
  • - , Room 5 - Global Expert Exchange

    Case 51 – Directional atherectomy of CFA and DFA origin left

    Center:
    Leipzig, Dept. of Angiology
    Case 51 – LEI 18: female, 63 years (P-D)
    Operators:
    • Matthias Ulrich,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford 3, severe claudication left > right, walking capacity 20 m, ABI left 0.45, ABI right 0.7
    Aorto-bifemoral bypass (on CFA) 2007, failled recanalization attempt left elsewere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, former smoker, diabetes mellitus type 2

    IMAGING
    Angiography 01/20: midgrade infrarenal aortic stenosis, high grade stenosis of distal bypass-anastomosis and DFA left, SFA-occlusions both sides

    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 placement of an embolic protection
    – Command 18 guidewire, 300 cm (ABBOTT)
    – Placement of a SpiderFX 6 mm Embolic Protection System (MEDTRONIC)
    3. Atherectomy
    – Directional atherectomy with HawkOne (MEDTRONIC) of CFA and DFA origin
    4. PTA with DCB
    – 5 or 6 mm IN.PACT Admiral balloon (MEDTRONIC)
    5. Stenting on indication:
    - Tack Endovascular System (INTACT VASCULAR INC.)
    View image
  • - , Room 3 - Technical Forum

    Case 42 – DEB-TACE of hepatocellular carcinoma HCC of the left lobe

    Center:
    Jena
    Case 42 – JEN 03: male, 64 years (H-D)
    Operators:
    • René Aschenbach,
    • Florian Bürckenmeyer
    CLINICAL DATA
    22 mm HCC in the left lobe, bridging to transplant, liver cirrhosis Child-PUGH B7, in-side MILAN, no extrahepatic disease, no macrovascular invasion

    IMAGING
    Typical appearence in CT Scan, in-side Milan, no extrahepatic disease

    PROCEDURAL STEPS
    1. Right groin puncture
    – 5F sheath (TERUMO)
    2. Access to hepatic
    – 5F Cobra catheter (BOSTON SCIENTIFIC)
    3. Access to feeding vessel
    – OccluSafe Micro-Catheter (TERUMO)
    4. Inflation of Ballon on MicroCath to drop the arterial stump pressure
    5. Embolization with doxorubicin loaded particels
    – Embozene Tandem 40 μm (Varian Medical Systems)
    – Doxorubicin load: 50 mg/ml
    6. Embolization up to complete filling of tumor
    7. Control angiography with proof of stasis
    8. Vascular closure
    – Exoseal 5F (CORDIS)
    View image
  • - , Room 1 - Main Arena 1

    Case 26 – PAR 01

    Center:
    Paris
    Case 26 – PAR 01
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 35 – MUN 02

    Center:
    Münster
    Case 35 – MUN 02
    Operators:
    • Martin Austermann,
    • E. Beropoulis,
    • Y. Shehada
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 43 – FRA 03

    Center:
    Frankfurt/Main
    Case 43 – FRA 03
    Operators:
    • M. Nour Eldin,
    • E. Emara
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 44 – KGP 04

    Center:
    Kingsport
    Case 44 – KGP 04
    Operators:
    • Chris Metzger,
    • M. Aziz
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 45 – Subtotal asymptomatic restenosis of the left ICA after CEA

    Center:
    Leipzig, Dept. of Angiology
    Case 45 – LEI 15: female, 71 years (G-U)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Asymptomatic highgrade stenosis of the internal carotid artery left, dizziness
    Mamarian carcinoma 2016 (surgery and radiation)
    CEA left 09/18, stroke 2013

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, renal impairment G3

    DUPLEX
    4.2 m/sec, left distal internal carotid artery

    PROCEDURAL STEPS
    1. Right groin access
    – 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
    – 0.035'' SupraCore guidewire (ABBOTT)
    – 7F 90 cmTuohy-Borst sheath (COOK)
    2. Cerebral protection
    – Filter-wire EZ (BOSTON SCIENTIFIC)
    3. Predilatation and stenting
    – 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
    – 8/20 mm Roadsaver Carotid stent (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 28 – JEN 01

    Center:
    Jena
    Case 28 – JEN 01
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 36 – LEI 14

    Center:
    Leipzig, Dept. of Angiology
    Case 36 – LEI 14
    Operators:
    • Andrej Schmidt,
    • Manuela Matschuck
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 27 – Occlusion left tibial anterior artery, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 27 – LEI 11: male, 79 years (W-K)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford 5, non-healing forefoot ulcerations, severe claudication left, walking capacity 20 m, ABI left 0.2
    PTA left peronal artery 12/19 with no clinical improvement

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, diabetes mellitus

    PROCEDURAL STEPS
    1. Antegrade access left groin
    – 6F 55 cm Check-Flow Performer (COOK MEDICAL)
    2. Guidewire passage anterior tibial artery
    – 0.014'' Command (ABBOTT)
    – 0.014'' PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
    In case of failure: retrograde approach
    3. Vessel preparation
    – 2.5/100 m Amphirion Deep ballon catheter (MEDTRONIC)
    4. PTA with Sirolimus coated balloon
    – 3.0/40 mm MagicTouch SCB balloon (CONCEPT MEDICAL)
    5. Stenting on indication:
    - Tack Endovascular System (INTACT VASCULAR INC.)
    View image
  • - , Room 2 - Main Arena 2

    Case 37 – FEVAR for type 1a endoleak post EVAR

    Center:
    Paris
    Case 37 – PAR 02: male, 66 years
    Operators:
    • Stéphan Haulon,
    • D. Fabre,
    • A. Girault,
    • P. Charbonneau,
    • A. Schwein
    CLINICAL DATA
    Previous EVAR for AAA

    PRESENT STATE
    71 mm AAA

    PROCEDURAL STEPS
    1. L: Advance 18F 33cm GORE Dryseal sheath in the LCFA over Lunderquist – 1 x 6F 55 cm and 1 x 7F 55 COOK Ansel sheaths
    100 U/kg Heparin (Target ACT³250)
    L (through one of the 6F): advance long pigtail catheter
    R: 10F sheath/Lunderquist/dilators up to 20
    2. Fluoroscopy to locate fenestrations gold markers
    R: Advanced fenestrated endograft – Aortic angiogram – fusion mask registration – fenestrated endograft deployment
    3. R: Rosen wire advanced through preloaded catheter – Exchange preloaded catheter for a 6F-90cm COOK Ansel Shuttle sheath – Exchange Rosen for a Stealcore 0.018 - 300 cm wire – Retrieve 6F to the level of the fenestration – Retrieve the 6F dilator – Puncture valve – DAV + TERUMO/Roadrunner through 6F for renal artery catheterisation – Renal angiogram – Exchange TERUMO for Rosen – Retrieve Stealcore
    wire – Advance 6F into the renal artery – Advance BENTLEY Begraft bridging stent to parking position
    4. Same for controlateral renal artery
    5. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen steps (cont.): – Advance 6F below the fenestration (SMA/CT) – USL + TERUMO/ Roadrunner through 6F sheath to catheterise target vessel (SMA/CT) – Vessel angiogram / Exchange TERUMO for Rosen wire – Advance 6F into target vessel – Advance BENTLEY Begraft bridging stent to parking position
    6. R: Release diameter-reducing ties – proximal and distal attachments – Nose retrieval under fluoroscopy
    7. L: SMA/CT stent deployment (3-4 mm protruding in the aortic lumen) after sheath retrieval – Flare the aortic portion of stent with 10-20 mm balloon – Advance the sheath in the SMA/CT stent/angiogram (SMA: exchange Rosen for TERUMO wire)
    8. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval – Flare the aortic portion of stent with 9-20 mm balloon – Advance 6F back into the renal stent – angiogram
    9. R: Remove nose under fluoroscopy / Remove fenestrated device delivery system
    L: Withdraw sheaths in 18F – insert and deploy bifurcated device and iliac limbs
    10. CODA balloon to mold overlaps and distal sealing zones
    Pigtail catheter – Angiogram + non-contrast CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 29 – KGP 01

    Center:
    Kingsport
    Case 29 – KGP 01
    Operators:
    • Chris Metzger,
    • M. Aziz
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 47 – FRA 04

    Center:
    Frankfurt/Main
    Case 47 – FRA 04
    Operators:
    • M. Nour Eldin,
    • Bita Panahi
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 46 – Prostate artery embolization

    Center:
    Jena
    Case 46 – JEN 04: male, 61 years
    Operators:
    • Tobias Franiel,
    • René Aschenbach
    CLINICAL DATA
    Lower urinary tract symptoms (LUTS)
    IPSS 19, mainly obstructive symptoms (0-30)
    QoL 5 (0-6), IIEF-5 25
    Prostate volume 75 ml, PSA 2,4 ng/ml
    Qmax 8,9ml/s
    Residual urinary volume 30ml
    Unsuccessful medication therapy for at least 6 mo
    Counselling about urol. alternative treatments

    PROCEDURAL STEPS
    1. Cone beam CT
    2. Identification of prostate arteries and their origin
    3. Cannulation of prostate arteries (left side first)
    4. Guiding catheter: 4F RIM 65 cm (Merit Medical)
    alternative 4F SIM1 65 cm (Merit Medical)
    5. Microcatheter: Progreat 2.7F 130 cm (TERUMO)
    alternative Progreat 2.0F 130 cm (TERUMO)
    6. Embolic agent: Embozene 400 μm (Boston Scienfic)
    7. Microcoils for embolization of possible accessory and collateral arteries: Azur18 helica 2 mm x 2 cm (TERUMO)
  • - , Room 1 - Main Arena 1

    Case 30 – KGP 02

    Center:
    Kingsport
    Case 30 – KGP 02
    Operators:
    • Chris Metzger,
    • M. Aziz
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 31 – Long SFA-occlusion right in a CLI-Patient

    Center:
    Leipzig, Dept. of Angiology
    Case 31 – LEI 12: female, 74 years (S-P)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer,
    • Sandra Düsing
    CLINICAL DATA
    Critical limb ischemia, minor gangrene dig 1 - 4 right, restpain and severe claudication right, ABI right 0.3
    PTA right EIA and CFA 12/19
    CAD, stroke 10/2019, COPD, MGUS

    RISK FACTORS
    Heavy smoker (50PY), arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left femoral access and cross-over approach
    – 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
    2. Passage of the occlusion right SFA
    – 0.018'' Command guidewire (ABBOTT)
    – 0.018'' Carnelian support catheter, 135 cm (BIOTRONIK)
    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
    – Pulsar 18-T3 stent (BIOTRONIK)
    View image
  • - , Room 3 - Technical Forum

    Case 48 – JEN 05

    Center:
    Jena
    Case 48 – JEN 05
    Operators:
    • René Aschenbach,
    • Ioannis Diamantis
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 38 – Growing left hypogastric artery aneurysm due to type II EL

    Center:
    Münster
    Case 38 – MUN 03: male, 69 years (BF-J)
    Operators:
    • Arne Schwindt,
    • Angeliki Argyriou,
    • A. Sohr
    CLINICAL DATA
    October 2016 emergency EVAR (Endurant MEDTRONIC) for ruptured AAA with overstenting of left hypogastric artery aneurysm, surgigal graft interposition for left CFA aneurysm

    PRESENT STATE
    Growing of left hypogastric from 5.5 cm 2016 to 70 mm January 2020, CT angiograms show type II EL via left inferior hypogastic artery

    PROCEDURAL STEPS
    1. Duplex guided antegrade puncture of proximal left CFA insertion of 5F 10 cm sheath (TERUMO) into profunda artery
    2. Cannulation of left internal circumflex artery with 4F Glidecath (TERUMO)
    3. Angiography and cannulation of pelvic collaterals to hypogastric aneurysm with 0,014'' wire (CONNECT, ABBOTT) and 0,014'' Microcatheter (ECHELON, MEDTRONIC)
    4. Catheter flush with DMSO and embolization of EL with alcohol coplymer (ONYX, MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 32 – KGP 03

    Center:
    Kingsport
    Case 32 – KGP 03
    Operators:
    • Chris Metzger,
    • M. Aziz
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 49 – LEI 16

    Center:
    Leipzig, Dept. of Angiology
    Case 49 – LEI 16
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    Detailed information will be shown in the video itself!

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 52 – ABT 01

    Center:
    Abano Terme
    Case 52 – ABT 01
    Operators:
    • Marco Manzi,
    • Cesare Brigato,
    • Efrem Gomez Jabalera
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 67 – Long, moderately calcified SFA-occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 67 – LEI 26: male, 61 years, (K-W)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 3, claudication left calf, walking capacity 150m, ABI left 0.63

    RISK FACTORS
    Hyperlipidemia, current smoker

    PROCEDURAL STEPS
    1. Right groin and cross-over access
    – IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
    – 0.035'' angled soft Radiofocus guidewire, 190 cm (TERUMO)
    – 0.035'' SupraCore guidewire, 190 cm (ABBOOTT)
    – 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Passage of the occlusion left SFA
    – 0.018'' Advantage guidewire (TERUMO)
    – 0.018'' CXI support catheter (COOK)
    in case of failure:
    – GoBack crossing catheter (UPSTREAM PERIPHERAL)
    3. Vessel preparation left SFA with scoring balloon
    – UltraScore 5.0/300 mm balloon (BARD/BD)
    4. Primary stenting
    – 6 mm Eluvia DES (BOSTON SCIENTIFIC)
    View image
  • - , Room 2 - Main Arena 2

    Case 62 – MUN 05

    Center:
    Münster
    Case 62 – MUN 05
    Operators:
    • Martin Austermann,
    • S. Mühlenhöfer,
    • Y. Khatadba
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 53 – CTO of the right anterior tibial artery, CLI-patient

    Center:
    Leipzig, Dept. of Angiology
    Case 53 – LEI 19: male, 76 years (W-M)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Critical limb ischemia, ulceration dig 2 right,
    restpain and severe claudication right, ABI right 0.2
    PTA/stent right popliteal artery 12/19 with no clinical improvement
    CAD, AMI 2010, CABG 2010

    RISK FACTORS
    Arterial hypertension, diabetes mellitus type 2, hyperlipidemia

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    – 6F 55 cm sheath (COOK)
    2. Guidewire passage antegrade into anterior 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/ BD)
    – Lutonix BTK DCB (BARD/ BD)
    4. Stenting on indication:
    - Tack Endovascular System (INTACT VASCULAR INC.)
    View image
  • - , Room 1 - Main Arena 1

    Case 54 – Chronic in-stent reocclusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 54 – LEI 20: male, 70 years (P-H)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    Severe claudication left, ABI 0.65; walking capacity 100 meters
    Rutherford class 3
    PTA/stenting left CIA and left SFA 07/19
    Stroke 1997

    RISK FACTORS
    Heavy smoker (50PY), arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    – 8F Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    – 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
    – 0.018'' Quick-Cross support catheter, 135 cm (PHILIPS)
    3. Thrombectomy
    – Rotarex 8F (STRAUB MEDICAL)
    4. PTA with DCBs
    – Ranger DCB 5 mm (BOSTON SCIENTIFIC)
    View image
  • - , Room 3 - Technical Forum

    Case 68 – ABT 03

    Center:
    Abano Terme
    Case 68 – ABT 03
    Operators:
    • Marco Manzi,
    • Cesare Brigato,
    • Efrem Gomez Jabalera
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 55 – LEI 21

    Center:
    Leipzig, Dept. of Angiology
    Case 55 – LEI 21
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 63 – PAR 03

    Center:
    Paris
    Case 63 – PAR 03
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 56 – LEI 22

    Center:
    Leipzig, Dept. of Angiology
    Case 56 – LEI 22
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 64 – MUN 06

    Center:
    Münster
    Case 64 – MUN 06
    Operators:
    • Martin Austermann,
    • S. Mühlenhöfer,
    • Y. Khatadba
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 57 – CLI, deep vein arterialization of a "desert foot" right

    Center:
    Leipzig, Dept. of Angiology
    Case 57 – LEI 23: male, 76 years (E-K)
    Operators:
    • Daniela Branzan,
    • Andrej Schmidt
    CLINICAL DATA
    PAOD Rutherford 5, non-healing forefoot ulcerations, mediasclerosis, ABI > 1.4
    PTA right popliteal artery 12/19 and proximal ATA
    Cholangiocarcinoma with metastasis 02/18

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Right groin antegrade access
    – 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
    2. Right distal venous tibial retrograde access
    – 5F sheath Introducer 2¨ (TERUMO)
    3. Arteriography and phlebography to define the optimal level for arterio-venous crossing
    4. 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)
    5. 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)
    6. 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
  • - , Room 3 - Technical Forum

    Case 69 – ABT 04

    Center:
    Abano Terme
    Case 69 – ABT 04
    Operators:
    • Marco Manzi,
    • Cesare Brigato,
    • Efrem Gomez Jabalera
    Detailed information will be shown in the video itself!
  • - , Room 3 - Technical Forum

    Case 70 – Severely calcified CTO of the left distal SFA and left popliteal artery, "pave and crack"-technique

    Center:
    Leipzig, Dept. of Angiology
    Case 70 – LEI 27: male, 73 years (K-W)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0.45
    Multiple interventions right SFA and popliteal artery, D1-amputation right 10/19
    CAD, ICM (EF 20%), AMI 2001, CABG 2001, ICA-occlusion left

    RISK FACTORS
    Arterial hypertension, current smoker, diabetes mellitus type 2, hyperlipidemia

    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:
    – 9 cm 20 Gauge Spinal Needle (BD)
    – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    – 4F 10 cm Radiofocus Introducer (TERUMO)
    – GoBack crossing catheter (UPSTREAM PERIPHERAL)
    4. PTA and Stenting
    – 5.0/20 mm and 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
    – 6.0/20 Conquest non-compliant high pressure balloon (BARD/BD)
    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)
    View image
  • - , Room 1 - Main Arena 1

    Case 58 – LEI 24

    Center:
    Leipzig, Dept. of Angiology
    Case 58 – LEI 24
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    Detailed information will be shown in the video itself!
  • - , Room 1 - Main Arena 1

    Case 59 – OCT-guided atherectomy of popliteal stent ISR followed by DCB

    Center:
    Münster
    Case 59 – MUN 04: male, 52 years (W-K)
    Operators:
    • Arne Schwindt,
    • Angeliki Argyriou,
    • A. Sohr
    CLINICAL DATA
    1990 Luxation trauma of right knee with emergency distal origin saphenous vein bypass, knee TEP Oct/2018, Sept 2019 Rutherford IV right leg, advanced ante- & retrograde recanalization of chronic occluded popliteal bypass and stent PTA with three 5.5 mm Supera stents

    PRESENT STATE
    After symptom free interval recurrent claudication and restpain right leg, CCDuplex shows TOSAKA II ISR of the popliteal vein graft with vmax of 350 cm/sec, drop of ABI from >1 in September to 0.4 right leg January 2020

    PROCEDURAL STEPS
    1. Duplex guided antegrade puncture of right CFA, insertion of 5F 10 cm sheath (TERUMO) angiogram of right leg
    2. Change to 7F 40 cm sheath (Destination, TERUMO), placement of 4 mm filter in TP trunc (Spider, MEDTRONIC)
    3. OCT-guided directional atherectomy of ISR with 7F Pantheris (Avinger)
    4. Antirestenotic therapy with Passeo Lux DCB (Biotronik)
    5. Filter recovery and closure of access site with Angioseal VCD (TERUMO) - 10 mm CONQUEST high pressure balloon
    View image
  • - , Room 2 - Main Arena 2

    Case 65 – FEVAR for type 5 thoraco abdominal aortic aneurysm

    Center:
    Paris
    Case 65 – PAR 04: male, 85 years
    Operators:
    • Stéphan Haulon,
    • D. Fabre,
    • P. Charbonneau,
    • A. Girault
    CLINICAL DATA
    Lumbar spine surgery for herniated disc (1993)
    Aorto bi-femoral bypass for an infrarenal AAA (1998)
    Bilateral femoral arteries angioplasty and stenting, L CFA endarterectomy (2012)
    Urothelial cancer resected in 2011, colon polypectomy in 2003
    Chronic kidney disease (GFR 48 ml/min), hypertension, dyslipidemia

    PRESENT STATE
    ASA 3, ECG: sinus, TTE: LVEF: 65%, normal

    PROCEDURAL STEPS
    1. L: Advance 16F 30 cm GORE Dryseal sheath in the LCFA over Lunderquist – 2x 6F-55 cm COOK Ansel sheaths
    100 U/kg Heparin (Target ACT³250)
    L (through one of the 6F): advance long pigtail catheter
    R: 10F sheath/Lunderquist/ dilators up to 20
    2. R: Deployment of proximal TEVAR, just above the celiac trunk
    3. Fluoroscopy to locate fenestrations gold markers
    R: Advanced fenestrated endograft – Aortic angiogram – fenestrated endograft deployment
    4. R: Rosen wire advanced through preloaded catheter – Exchange preloaded catheter for a 6F-90 cm COOK Ansel Shuttle sheath – Exchange Rosen for a Stealcore 0.018- 300 cm wire – Retrieve 6F to the level of the fenestration – Retrieve the 6F dilator – Puncture valve – DAV + TERUMO/Roadrunner through 6F for renal artery catheterisation – Renal angiogram – Exchange TERUMO for Rosen – Retrieve Stealcore wire – Advance 6F into the renal artery – Advance BENTLEY Begraft bridging stent to parking position
    5. Same for controlateral renal artery
    6. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen – Advance 6F below the fenestration (SMA/CT) – USL + TERUMO/ Roadrunner through 6F sheath to catheterise target vessel (SMA/CT) – Vessel angiogram – Exchange TERUMO for Rosen wire – Advance 6F into target vessel – Advance BENTLEY Begraft bridging stent to parking position
    7. R: Release diameter-reducing ties – proximal and distal attachments – Nose retrieval under fluoroscopy
    8. L: SMA/CT stent deployment (3-4 mm protruding in the aortic lumen) after 6F retrieval – Flare the aortic portion of stent with 10-20 mm balloon – Advance 6F in the SMA/CT stent/angiogram (SMA: exchange Rosen for TERUMO wire)
    9. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval – Flare the aortic portion of stent with 9-20 mm balloon – Advance 6F back into the renal stent – angiogram
    10. R: Remove nose under fluoroscopy / Remove fenestrated device delivery system
    L: Withdraw 6F sheath in 16F – Insert and deploy bifurcated device and iliac limbs
    11. CODA balloon to mold overlaps and distal sealing zones
    Pigtail catheter – Angiogram + non-contrast CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 60 – Calcified occlusion of the left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 60 – LEI 25: male, 62 years (R-A)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    PAOD Rutherford 3 left, walking capacity 100 m, claudication left calf, ABI left 0.57
    PTA of a 8 cm long profunda femoris occlusion right 10/2019 and right SFA 12/19
    CAD, ICM (EF 35%), CABG and aortic valve replacement 09/19, atrial fibrillation, pacemaker 09/19

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker (40PY)

    PROCEDURAL STEPS
    1. Right groin and cross-over approach
    – Judkins Right 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
    – 0,035'' SupraCore guidewire 30 cm (ABBOTT)
    – 7F-40 cm Balkin Up&Over sheath (COOK)
    2. 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 occluded SFA
    – 7 cm 18 Gauge needle (COOK)
    – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    – 4F-10 cm Radiofocus Introducer (TERUMO)
    – GoBack crossing catheter (UPSTREAM PERIPHERAL)
    4. PTA with normal and high pressure balloons
    – 6.0/ 20 mm Admiral Xtreme balloon (MEDTRONIC)
    – 7.0/ 20 mm Conquest non-compliant high pressure balloon (BARD/ BD)
    5. Stenting
    – 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)
    – Eluvia drug-eluting stent for proximal SFA (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 61 – ABT 02

    Center:
    Abano Terme
    Case 61 – ABT 02
    Operators:
    • Marco Manzi,
    • Cesare Brigato,
    • Efrem Gomez Jabalera
    Detailed information will be shown in the video itself!
  • - , Room 2 - Main Arena 2

    Case 66 – MUN 07

    Center:
    Münster
    Case 66 – MUN 07
    Operators:
    • Martin Austermann,
    • E. Beropoulis,
    • Y. Shehada
    Detailed information will be shown in the video itself!

Conference day 4

  • - , Room 1 - Main Arena 1

    Case 71 – Proximal and distal extension of a 4-branched thoracoabdominal endograft by TEVAR and IBD on the right side

    Center:
    Münster
    Case 71 – MUN 08: male, 66 years, (V-W)
    Operators:
    • Martin Austermann,
    • E. Beropoulis,
    • Y. Khatadba
    CLINICAL DATA
    CAD-stent-PTCA 1/12, arterial hypertension

    CLINICAL HISTORY
    2003: Open repair of a AAA by replacement with a monoiliac graft
    Preexisting occlusion of the left iliac artery
    2014: BEVAR for a proximal anastomitic aneurysm and a TAAA type 4 in combination with a cross-over bypass

    PRESENT STATE
    New aneurysm of the thoracic aorta above the graft and growing Iliac aneurysm below the graft
    Stenosis of the proximal SFA

    PROCEDURAL STEPS
    1. Left axillary access 5 F sheath via cut down
    2. Cut down right groin below the cross over bypass
    Placement of a 14F sheath (COOK)
    Cannulation of the aorta up to the aortic valve and change for a Lunderquist wire (COOK)
    3. Implantation of the thoracic endograft TGM 37 37 15 E (GORE)
    4. Implantation of the IBD ZBIS 12 62 41 (COOK)
    5. Closure of the groins in order to avoid SCI
    6. Placement of the the 12F Flexor sheath from above
    7. Bridging of the hypogastric branch (Advanta GETINGE, VBX or Viabahn GORE)
    8. Endovascular treatment of the SFA stenosis through the bypass
    9. Closure of the axillary access
    View image
  • - , Room 1 - Main Arena 1

    Case 72 – Subacute type-B-dissection, STABILISE-therapy

    Center:
    Leipzig, Dept. of Angiology
    Case 72 – LEI 28: male, 57 years (A-G)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Subacute type-B-dissection, progressive dilatation of the descending thoracic aorta
    EVAR 2019 elsewhere
    Coilembolisation of segmental arteries to reduce the risk of spinal ischemia during Stabilise therapy
    Implantation of a thoracic dissection stentgraft 1/2020

    PROCEDURAL STEPS
    1. Access right groin
    – 16F sheath (COOK) right groin after preloading of Proglide systems (ABBOTT)
    2. Confirmation of guidewire position in the true lumen by IVUS
    – Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
    3. Stent implantation
    – Dissection Endovascular stent (COOK)
    4. Postdilatation of the dissection stent
    – Reliant balloon (MEDTRONIC)
    View image
  • - , Room 3 - Technical Forum

    Case 74 – Calcified occlusion of the right distal SFA and right popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 74 – LEI 30: female, 72 years (D-M)
    Operators:
    • Matthias Ulrich,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford 4, restpain and severe claudication right calf, walking capacity 10 m, ABI right 0.2, failed recanalization attempt 09/19 elsewhere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Left groin and cross-over approach
    – Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    – 0.035'' SupraCore guidewire 30 cm (ABBOTT)
    – 7F-40 cm Balkin Up&Over sheath (COOK)
    2. Second attempt of guidewire passage from antegrade
    – 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
    – GoBack crossing catheter (UPSTREAM PERIPHERAL) or retrograde approach via anterior tibial artery in case of failure to pass
    3. Vessel preparation
    – UltraScore 5.0/300 mm scoring balloon (BARD/ BD)
    – 4.0 - 6.0 mm Armada 35 balloon (ABBOTT)
    – Conquest high pressure balloon on indication (BARD/ BD)
    4. Stenting
    – Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 3 - Technical Forum

    Case 75 – Occlusion left popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 75 – LEI 31: male, 68 years (R-H)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 4, severe claudication left and rest-pain, walking capacity 20 m, ABI left 0.43
    Failed recanalization attempt left, elsewhere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, nicotine abuse

    PROCEDURAL STEPS
    1. Right groin and cross-over approach
    – Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    – 0.035'' SupraCore guidewire 30 cm (ABBOTT)
    – 7F-40 cm Balkin Up&Over sheath (COOK)
    2. Second attempt of guidewire passage of the occlusion from antegrade
    – Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
    3. In case of failure to pass with a GW from antegrade
    – GoBack crossing catheter (UPSTREAM PERIPHERAL)
    or retrograde approach via peroneal artery:
    – 21 Gauge 9 cm needle (B. Braun)
    – 0.018Ó V-18 Control GW, 300 cm (BOSTON SCIENTIFIC)
    – 0.018Ó CXC support catheter, 90 cm (COOK)
    4. Laser atherectomy
    – 7F Turbo Power Laser with Turbo Elite 2.3 mm cathether (PHILIPS)
    5. PTA with DCBs
    – 5.0/80 mm and 6.0/80 mm iLuminor DCB (iVASCULAR)
    6. Stenting
    – Supera Interwoven Nitinol stent in case of severe recoil (ABBOTT)
    View image