LINC 2013 live case guide

Conference day 4

• 9:05 - 9:50, Main Arena 1

  Case 89 – Type A dissection with growing thoraco-abdominal false lumen aneurysm

  Center:

  Münster

  Case 89 – MUE 08: male, 57 years (M-G)

  Operators:

  • Martin Austermann,
  • Bernd Gehringhoff

  Clinical data
  Dilatative cardiomyopathy with impaired left ventricular function, CAD
  Chronic obstructive pulmonary disease (GOLD 4)
  Replacement aortic valve and ascending aorta 2003
  Aortic arch replacement with elefant trunk 2008
  TEVAR 2009
  TIA 2004
  Diabetes mellitus, arterial hypertension, obesity
  Hostile abdomen
  
  Procedural steps
  1. 14 F sheath (COOK) both groins and cannulation of the true lumen
  
  2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA
  
  3. Implantation of a tapered thoracic endograft
  
  4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side
  
  5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing
  
  6. Implantation of the iliac branched device (ZBIS – COOK) on the right side
  
  7. Placement of the aortic bifurcated device through the left side
  
  8. Placement of the bridging limb through the right side
• 10:00 - 10:22, Main Arena 1

  Case 90 – EVAR of an Abdominal Aortic Aneurysm

  Center:

  Leipzig

  Case 90 – LEI 50: male, 76 years (R-F)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan,
  • Bernd-Michael Harnoss

  Clinical data
  Progression of an abdominal aneurysm,
  56mm diameter.
  Arterial hypertension, CAD, PTCA 2002
  COPD
  
  Procedural steps
  1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
  
  2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)
  
  3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)
  
  4. Ovation Main Body (TRIVASCULAR) via right groin
  
  5. Bilateral implantation of limb-extensions
  
  6. Post-dilatation with Reliant-Balloon (MEDTRONIC)
• 10:00 - 11:00, Main Arena 1

  Case 91 – Suprarenal abdominal aortic aneurysm

  Center:

  Leipzig

  Case 91 – LEI 51: male, 65 years (G-G)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan,
  • Michael Piorkowski,
  • Bernd-Michael Harnoss

  Clinical data
  Progressive suprarenal aneurysm (max diameter 65 mm)
  Aortic valve replacement with aortic arch replacement (Hemashield-prosthesis, Elephant trunk) due to Type-A-Dissection and implantation of 2 Gore-TAG-Endoprostheses in to the descending aorta (2007)
  Arterial hypertension, hyperlipidemia, nicotine abuse
  
  Procedural steps
  1. Surgical cut down left subclavian artery and implantation of a 12F sheath
  
  2. Preloading of the left common femoral artery with the Proglide system (ABBOTT)
  
  3. Pullthrough of a Lunderquist Extra-Stiff 0.038" guide wire (COOK)
  
  4. Implantation of a 4-Vessel T-branched Tube-graft (ATRIUM/Maquet Getinge Group, COOK)
  
  5. Implantation of covered stents ( Advanta V12, ATRIUM) into the visceral and renal arteries via the subclavian approach
  
  6. Reinforcemant of the Advanta-Stents by Self-expanding Nitinol Stents (Zilver-Stents, COOK)
• 11:47 - 12:18, Main Arena 1

  Case 89 – Type A dissection with growing thoraco-abdominal false lumen aneurysm

  Center:

  Münster

  Case 89 – MUE 08: male, 57 years (M-G)

  Operators:

  • Martin Austermann

  Clinical data
  Dilatative cardiomyopathy with impaired left ventricular function, CAD
  Chronic obstructive pulmonary disease (GOLD 4)
  Replacement aortic valve and ascending aorta 2003
  Aortic arch replacement with elefant trunk 2008
  TEVAR 2009
  TIA 2004
  Diabetes mellitus, arterial hypertension, obesity
  Hostile abdomen
  
  Procedural steps
  1. 14 F sheath (COOK) both groins and cannulation of the true lumen
  
  2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA
  
  3. Implantation of a tapered thoracic endograft
  
  4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side
  
  5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing
  
  6. Implantation of the iliac branched device (ZBIS – COOK) on the right side
  
  7. Placement of the aortic bifurcated device through the left side
  
  8. Placement of the bridging limb through the right side
• 12:00 - 13:00, Main Arena 1

  Case 93 – Symptomatic occlusion of the left subclavian artery

  Center:

  Leipzig

  Case 93 – LEI 53: male, 67 years (R-P)

  Operators:

  • Andrej Schmidt,
  • Dierk Scheinert

  Clinical data
  Subclavian steal syndrom
  Vertigo and claudication left arm
  Stenocardia (CABG with LIMA – bypass 2006)
  RR brachial right: 160 mmHg systolic
  RR brachial left: 100 mmHg systolic
  Hypertension, hyperlipidemia, diabetes mellitus 2
  
  Procedural steps
  1. Right femoral access and placement of a 6F sheath
  - 5F JR Catheter (CORDIS)
  - 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
  - 0.035" Supra Core guide-wire, 190 cm (ABBOTT)
  - 7F Flexor Check-Flo Performer Introducer Sheath, 90 cm (COOK)
  
  2. Left brachial access an d placement of a 6F sheath
  - 6F Flexor Check-Flo Performer Introducer Sheath, 55 cm (COOK)
  
  3. Wiring the occlusion
  - 0.018" V-18 Control guide wire, 300 cm (BOSTON SCIENTIFIC)
  - 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
  
  4. PTA and stent implantation
  - 5.0/20 Admiral OTW PTA balloon Catheter (MEDTRONIC)
  - 8.0/18 mm Assurant Cobalt Iliac Ballon-Expandable Stent (MEDTRONIC)