LINC 2015 live case guide

Find all Live Cases and Live Case Centers listed below.

Leipzig

33 livecase(s)
  • Tuesday, January 27th: - , Main Arena 1

    Case 01 – Calcified SFA occlusion left

    Center:
    Leipzig
    Case 01 – LEI 01: male , 60 years (U-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Claudication intermittens bilateral,
    150 meter walking capacity, calf-pain left > right
    Art. hypertension, former smoker

    ABI
    Left 0,52; right 0,66

    DUPLEX
    Severely calcified SFA bilateral

    ANGIOGRAPHY
    Short occlusion distal SFA left, severe calcification

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 6F Balkin Up&Over 40 cm sheath (COOK)

    2. Passage of the occlusion
    - 0.035" stiff angled Terumo guidewire, 300 cm (TERUMO)
    - Armada 35 5/120 mm Balloon (ABBOTT)
    - Exchange to a 0.018" SteelCore guidewire (ABBOTT)

    3. Stenting
    - SUPERA Interwoven Nitinol-Stent (ABBOTT)
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 02 – SFA occlusion left

    Center:
    Leipzig
    Case 02 – LEI 02: male , 46 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication left leg, walking capacity 150 meters
    PTA of the right external iliac artery in 12/2014
    Thrombendartherectomy left groin 2012
    Failed recanalization-attempt lef SFA elsewhere 11/2014
    Art. hypertension, hyperlipoproteinemia

    ABI
    Left 0.67

    ANGIOGRAPHY
    During PTA right iliac artery: mid SFA-occlusion left, good run-off

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the occlusion
    - 0.035" Seeker supportcatheter, 135 cm (BARD)
    - 0.035" angled stiff glidewire 260 cm (TERUMO)
    - I n case of failure retrograde approach via the distal SFA

    3. PTA
    - Vascutrak 5.0/250 mm Balloon (BARD)
    - Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)

    4. Stenting on indication
    in case of dissection:
    - INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 02 – SFA occlusion left

    Center:
    Leipzig
    Case 02 – LEI 02: male , 46 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication left leg, walking capacity 150 meters
    PTA of the right external iliac artery in 12/2014
    Thrombendartherectomy left groin 2012
    Failed recanalization-attempt lef SFA elsewhere 11/2014
    Art. hypertension, hyperlipoproteinemia

    ABI
    Left 0.67

    ANGIOGRAPHY
    During PTA right iliac artery: mid SFA-occlusion left, good run-off

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach with 6F sheath
    - 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

    2. Passage of the occlusion
    - 0.035" Seeker supportcatheter, 135 cm (BARD)
    - 0.035" angled stiff glidewire 260 cm (TERUMO)
    - I n case of failure retrograde approach via the distal SFA

    3. PTA
    - Vascutrak 5.0/250 mm Balloon (BARD)
    - Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)

    4. Stenting on indication
    in case of dissection:
    - INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
    View image
  • Tuesday, January 27th: - , Main Arena 2

    Case 17 – Retrograde recanalization of an SFA occlusion after surgery left groin

    Center:
    Leipzig
    Case 17 – LEI 08: male 60 years (HJ-S )
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Tomohara Dohi
    CLINICAL DATA
    Severe claudication left calf
    Stenting left iliac arteries and patch-plastic left groin 2008
    Unsuccessful recanalization attempt left SFA, failed guiewire-access
    into the SFA-occlusion 11/2014
    Arterial hypertension, diabetes mellitus type 2, smoker
    Renal insufficiency (GFR 56ml/min)

    ABI
    Left 0.46

    ANGIOGRAPHY
    Long occlusion left SFA, ostial stenosis of the deep femoral artery patent stents left iliac arteries.

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 7F Balkin Up & Over 40 cm sheath (COOK)

    2. Retrograde access: puncture of the occluded mid SFA left
    - 18 Gauge 7 cm needle
    - 0.035" stiff angled guidewire 30 cm (TERUMO)
    - 6Fr 10 cm sheath (TERUMO)
    - 5F Judkins Right diagnostic catheter (CORDIS)
    - 0.018" Connect 250 T Guidewire 300 cm (ABBOTT)
    - In case of failure exchange to 0.014" Floppy ES 300 cm guidewire (ABBOTT).
    - Outback Reentry catheter (CORDIS)

    3. Balloon-angioplasty and stenting
    - After snaring of the retrograde guidewire PTA with Savvy 5/120mm Balloon (CORDIS)
    - Smart Control Selfexpanding stent (CORDIS)
    - In case of bleeding at the retrograde access-site or groin-patch: Viabahn 7/100 mm covered stentgraft (GORE)
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 03 – Occlusion mid SFA right

    Center:
    Leipzig
    Case 03 – LEI 03: male , 55 years (E-S)
    Operators:
    • Sven Bräunlich,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication intermittens right leg
    walking-capacity 200 meters
    PTA with drug-eluting balloons left SFA 11/2014
    Diabetes mellitus type 2, hyperlipidaemia

    ABI
    Right 0.66

    ANGIOGRAPHY
    10 cm long occlusion mid SFA right

    PROCEDURAL STEPS
    1. Left groin retrograde cross-over approach
    - 6F Balkin Up & Over 40 cm sheath (COOK)

    2. Passage of the occlusion
    - 0.035" CXI-support-catheter, straight tip, 135 cm length (COOK)
    - 0.018" Connect Flex guidewire, 300 cm (ABBOTT)

    3. Balloon-angioplasty and stenting
    - Advance 18 5.0/120 mm balloon (COOK)
    - Zilver-PTX 6.0/100 mm (COOK)
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 05 – Long SFA occlusion left leg

    Center:
    Leipzig
    Case 05 – LEI 04: male, 60 years (R-S)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt,
    • Tomohara Dohi
    CLINICAL DATA
    PAOD with claudication intermittens and restpain at night left leg
    PTA right SFA with drug-eluting balloons 12/2014
    Thrombendartherectomy left common femoral artery 10/2014
    Arterial hypertension
    Hyperlipoprotaeinemia
    Smoker

    ABI
    Left 0.61

    ANGIOGRAPHY
    During PTA right leg: long SFA-occlusion, moderate calcification

    PROCEDURAL STEPS
    1. Right groin retrograde cross-over approach
    - 6F Balkin Up & Over 40 cm sheath (COOK)

    2. Guidewire passage
    - 0.035" QuickCross support-catheter 135 cm (SPECTRANETICS)
    - 0.035" TERUMO glidewire angled stiff, 300 cm (TERUMO)
    - 0.018" Victory 30g, 300 cm (BOSTON SCIENTIFIC)

    3. Predilatation and drug-eluting balloon treatment
    - Pacific 5/120 mm balloon (MEDTRONIC)
    - In.Pact 5.0/120 mm drug-coated balloon (MEDTRONIC)

    4. Stenting on indication
    - Complete 6.0/150 mm Selfexpanding Nitinol-stent (MEDTRONIC)
    View image
  • Tuesday, January 27th: - , Technical Forum

    Case 28 – Occlusion of the right iliac arteries, aneurysm left iliac

    Center:
    Leipzig
    Case 28 – LEI 09: male, 76 years (M-M)
    Operators:
    • Dierk Scheinert,
    • Matthias Ulrich,
    • Tomohara Dohi
    CLINICAL DATA
    Restpain right leg, Rutherford class 4
    History of surgical aorto-biiliac prosthesis 1972, report can not be found
    Minor stroke 2011 before CEA of carotid artery stenosis right, art. hypertension

    ABI
    Right 0.4

    CT
    Severe calcification of the aortic bifurcation, 32 mm aneurysm left common iliac artery
    Former aortoiliac bypass can not be seen on CT

    PROCEDURAL STEPS
    1. Retrograde access both common femoral arteries
    - 7F-10 cm sheath (TERUMO)
    Left brachial access:
    - 5F diagnostic pigtail-catheter (CORDIS)
    - 0.035" soft angled short glidewire (TERUMO)
    - 0.035" SupraCore Guidewire 300 cm (ABBOTT)
    - 6F-90 cm Check-Flow Performer Sheath (COOK)

    2. Guidewire passage of the iliac occlusion right
    via brachial access:
    - 5F-125 cm Judkins Right diagnostic catheter (CORDIS)
    - 0.035" stiff angled TERUMO glidewire, 260 cm (TERUMO)
    - or 0.018" Connect 300 cm guidewire (ABBOTT)
    - Snaring of the wire into the retrograde sheath and passage of the contralateral common iliac artery occlusion via the brachial access.

    3. After Guidewire-passage PTA via the femoral access bilateral
    - Admiral 6/40 mm-balloon, 90 cm (MEDTRONIC)

    4. Stenting
    - via left groin: Sinus aortic stent 24-80 mm (OPTIMED)
    Implantation of covered stents into the aortic bifurcation:
    - 9/59 mm Lifestream covered stents (BARD)
    - 9/100 mm Fluency covered stent right external iliac artery (BARD)
    View image
  • Tuesday, January 27th: - , Global Expert Exchange

    Case 33 – Retrograde recanalization of a tibioperoneal trunk occlusion

    Center:
    Leipzig
    Case 33 – LEI 10: male, 52 years (A-P)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Critical limb ischemia left with toe-ulcerations Dig 2 and 3
    PTA and stenting left SFA and failed recanalization attempt
    left tibioperoneal trunk 1/2015
    Diabetes mellitus type 2, arterial hypertension
    CAD with PTCA 11/2013
    Former smoker, renal insufficiency with GFR 55ml/min

    ANGIOGRAPHY
    During PTA of left SFA: Occlusion of the tibioperoneal trunk the peroneal and anterior tibial artery

    PROCEDURAL STEPS
    1. Left antegrade access
    ■ 5F – 55 cm Ansel Sheath (COOK)
    Retrograde access to the posterior tibial artery:
    ■ 7 cm 21 Gauge needle (COOK)
    ■ 0.018" Connect Guidewire 300 cm (ABBOTT)
    ■ 0.018" CXC Support-Catheter 90 cm (COOK)

    2. Guidewire exchange
    ■ After retrograde guidewire-passage and snaring from antegarde exchange to 0.014" PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)

    3. PTA and stenting
    ■ MiniTrek RX 4/20 mm PTCA Balloon (ABBOTT)
    ■ Cre8 4.0/48 mm Drug-Eluting Stent (ALVIMEDICA)
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 08 – In-stent reocclusion left distal SFA / popliteal artery

    Center:
    Leipzig
    Case 08 – LEI 05: male, 72 years (R-T)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Tomohara Dohi
    CLINICAL DATA
    Severe claudication left calf, walking capacity 50 meters
    PTA of a restnosis of the SFA-ostium left with drug.-coated ballon 12/2014
    Stenting left SFA / popliteal artery 10/2013
    Thrombendartherectomy left groin /2013
    CAD and PTCA LAD 9/2013
    Arterial hypertension, diabetes mellitus, type 2, former smoker

    ABI
    Left 0.43

    ANGIOGRAPHY
    In-Stent occlusion distal SFA and P1/P2 popliteal artery left
    P3-segment significantly stenosed

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 7F 55 cm Ansel sheath (COOK)

    2. Guidewire passage
    - 0.035" QuickCross support-catheter 90 cm (SPECTRANETICS)
    - 0.035" Half stiff J-angled 300 cm (TERUMO)
    - exchange to 0.014" Floppy ES Guidewire 300 cm (ABBOTT)

    3. Filter-protection
    - WirionTM EPD-System (GARDIA MEDICAL)

    4. Laser-atherectomy
    - 7F Tandem Booster-Laser (SPECTRANETICS)

    5. PTA with drug-coated balloons
    - LegFlow OTW Drug-Coated Balloon (CARDIONOVUM)
    View image
  • Tuesday, January 27th: - , Global Expert Exchange

    Case 34 – Percutaneous deep venous arterialization (LimFlow procedure) - RECORDED CASE FROM SINGAPORE

    Center:
    Leipzig
    Case 34 – SIN 01: male 60 years
    Operators:
    • Steven Kum,
    • Andrej Schmidt
    CLINICAL DATA
    Left CLI (non healing forefoot wound)
    SFA TFT DES 8/2010
    SFA TFT Peroneal DEB 7/2011
    SFA Rotarex Peroneal POBA 4/2014
    SFA TFT Peroneal DEB 5/2014
    Failed retrograde DP 9/2014

    RISK FACTORS
    DM hypertension, CAD EF 45%, hyperlipidemia, smoker

    PROCEDURAL STEPS
    1. Antegrade 7F access
    - Retrograde posterior tibial vein (PTV) access (Ultrasound guided) micropuncture followed by COOK 5F x 45 cm Ansel sheath

    2. Antegrade LimFlow ‘Send’ Catheter 7F

    3. Retreograde LimFlow ‘Receive’ Catheter 5F

    4. Align and Crossover

    5. Predilatation crossover point

    6. Stent from TFT to PTV
    - Atrium 5 mm x 38 and Viabahn 5 mm

    7. Percutaneous Reverse Valvulotome
    View image
  • Tuesday, January 27th: - , Main Arena 1

    Case 09 – Severely calcified restenosis (partially in-stent) left SFA

    Center:
    Leipzig
    Case 09 – LEI 06: male, 72 years (L-K)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf
    Stenting of the SFA left 2009 (Samba-stent)
    Thrombenarthererctomy left groin 2010
    PTA of the right SFA / stenting 1/2015
    CAD, multiple PTCAs
    Chronic heart failure (NYHA II)
    Chronic renal insufficiency (GFR 70ml/min)
    Art. hypertension, diabetes mellitus type 2

    ABI
    Left 0.64; right 0.82 (post stenting)

    ANGIOGRAPHY
    During PTA right SFA: in-stent reocclusion and severe calcification left SFA

    PROCEDURAL STEPS
    1. Right groin and cross-over access
    - 7F 40 cm balkin Up & Over sheath (COOK)

    2. Guidewire passage
    attempt to pass the occlusion from antegrade
    - QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)

    3. In case of failure retrograde stent-puncture
    - 7 cm 18 Gauge needle and
    - QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - Snaring of the guidewire from above

    4. PTA
    - Armada 35 5.0/120 mm Ballon (ABBOTT)
    - Potentially high-pressure balloon: Conquest 6/20 mm (BARD)

    5. Stenting
    - Supera interwoven nitinol-stent (ABBOTT)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 35 – Subacute occlusion rigth SFA

    Center:
    Leipzig
    Case 35 – LEI 11: male, 68 years (H-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Tomohara Dohi
    CLINICAL DATA
    Acute onset of severe claudication right and left calf 1-2 months ago (right > left)
    Eversionatherectomy of a symptomatic internal carotid artery stenosis right 12/2014
    Arterial hypertension, diabetes mellitus type 2, former smoker

    ABI
    Right 0.55; left 0.57

    ANGIOGRAPHY
    Bilateral occlusion of the SFA, non calcification
    Thrombotic subtotal occlusion of the right carotid artery before surgery

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over access
    - 8F 40 cm Balkin Up & Over sheath (COOK)

    2. Guidewire passage
    - 0.018" CXI angled support-catheter 135 cm (COOK)
    - 0.018" V-18 COntrol Guidewire, 300 cm (BOSTON SCIENTIFIC)

    3. Thrombectomy
    - Rotarex 8F Thrombectomy Catheter (STRAUB MEDICAL)

    4. PTA and stenting on indication
    - if residual thrombus: local thrombolysis with Actilysis
    - if residual arteriosclerotic lesions: balloon-angioplasty/stenting
    - Lutonix drug coated balloon 5.0/150 mm (BARD)
    - Epic-Stent 6.0/150 mm (BOSTON SCIENTIFIC)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 36 – In-stent reocclusion left SFA

    Center:
    Leipzig
    Case 36 – LEI 12: male, 64 years (W-K)
    Operators:
    • Sven Bräunlich,
    • Yvonne Bausback
    CLINICAL DATA
    Severe claudicatio with worsening 3 months ago
    Stenting of the SFA left 12/2013
    CAD and PTCA 11/2014
    Art. hypertension, diabetes mellitus type 2, former smoker

    ABI
    Left 0.62

    ANGIOGRAPHY
    During coronary angiography: In-stent reocclusion left with stent-fractures.

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over access
    - 8F 40 cm Balkin Up & Over sheath (COOK)

    2. Guidewire passage
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - Judkins Right 5F diagnostic catheter (CORDIS)
    - Exchange to 0.018" guidewire coming with the Rotarex-catheter (STRAUB MEDICAL)

    3. Thrombectomy
    - 8F Rotarex-Thrombectomy (STRAUB MEDICAL)

    4. PTA with drug-eluting balloons
    - In-Pact Pacific 5.0/120 mm (MEDTRONIC)

    5. Stenting of areas with stent-fracture
    - Supera Interwoven Nitinol Stent 5.0/100 mm (ABBOTT)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 37 – CLI and total occlusion of all BTK arteries right

    Center:
    Leipzig
    Case 37 – LEI 13: male, 82 years (W-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Sabine Steiner
    CLINICAL DATA
    Critical ischemia with ulcerations right forefoot (Dig 3 and 4 and lateral)
    PTA of a SFA-stenosis 12/2014 with drug-eluting balloon
    CAD with CABG 2008
    Diabetes mellitus type 2, art. hypertension

    ABI
    Right 0.2

    ANGIOGRAPHY
    5 cm occlusion of the proximal peroneal artery and long tibial occlusions (ATA and PTA).

    PROCEDURAL STEPS
    1. Right antegrade access
    - 5F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage of the occlusion(s)
    - 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Amphirion Deep Balloon 2.5/120 mm - 120 cm (MEDTRONIC)
    In case of failure exchange to:
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - supported by TrailBlazer 0.018" 90 cm (COVIDIEN)

    3. PTA and drug administration
    - Amphirion Deep 2.5/120 mm Balloon (MEDTRONIC)
    - BullFrog Micro-infusion catheter for administration of Dexamethason into the arterial wall (MERCATOR MedSystems)
    View image
  • Wednesday, January 28th: - , Technical Forum

    Case 55 – SIRT – Selective internal radiotherapy

    Center:
    Leipzig
    Case 55 – LEI 21: male, 58 years old
    Operators:
    • Michael Moche,
    • Jochen Fuchs,
    • Sandra Purz,
    • Bernhardt Sattler
  • Wednesday, January 28th: - , Main Arena 1

    Case 37 – CLI and total occlusion of all BTK arteries right

    Center:
    Leipzig
    Case 37 – LEI 13: male, 82 years (W-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich,
    • Sabine Steiner
    CLINICAL DATA
    Critical ischemia with ulcerations right forefoot (Dig 3 and 4 and lateral)
    PTA of a SFA-stenosis 12/2014 with drug-eluting balloon
    CAD with CABG 2008
    Diabetes mellitus type 2, art. hypertension

    ABI
    Right 0.2

    ANGIOGRAPHY
    5 cm occlusion of the proximal peroneal artery and long tibial occlusions (ATA and PTA).

    PROCEDURAL STEPS
    1. Right antegrade access
    - 5F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage of the occlusion(s)
    - 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Amphirion Deep Balloon 2.5/120 mm - 120 cm (MEDTRONIC)
    In case of failure exchange to:
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - supported by TrailBlazer 0.018" 90 cm (COVIDIEN)

    3. PTA and drug administration
    - Amphirion Deep 2.5/120 mm Balloon (MEDTRONIC)
    - BullFrog Micro-infusion catheter for administration of Dexamethason into the arterial wall (MERCATOR MedSystems)
    View image
  • Wednesday, January 28th: - , Main Arena 2

    Case 49 – Abdominal aneurysm 5.7 cm

    Center:
    Leipzig
    Case 49 – LEI 19: male, 52 years (M-S)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Incidental finding of an abdominal aneurysm
    Since 2 years recurrent abdominal pain

    RISK FACTORS
    Art. hypertension, smoker

    CT
    57 mm abdominal aneurysm, neck-kink of 60Æ

    PROCEDURAL STEPS
    1. Proglide closure-device preloading both groins
    - 9F – 10 cm sheath both groins (TERUMO)

    2. Implantation of the main body
    - 0.035" Lunderquist 180 cm guidewire via right groin (COOK)
    - Aorfix abdominal endovascular stentgraft (LOMBARD MEDICAL)

    3. Cannulation of the contralateral limb
    - Amplatz left I diagnostic catheter 5F (CORDIS)
    - 0.035" soft angled TERUMO guidewire (TERUMO)
    - 0.035" Lunderquist 180 cm guidewire via right groin (COOK)

    4. Implanation of the contralateral limb (LOMBARD MEDICAL)
    - PTA of the graft with a Reliant-balloon (MEDTRONIC) via 12F 12 cm sheaths (COOK)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 39 – Critical limb ischemia with distal SFA occlusion left /restenosis

    Center:
    Leipzig
    Case 39 – LEI 14: female, 82 years (I-U)
    Operators:
    • Matthias Ulrich,
    • Yvonne Bausback,
    • Tomohara Dohi
    CLINICAL DATA
    Criticl limb ischemia, ulceration left lower leg and Dig 2
    CLI right leg with heel-ulceration
    PTA right SFA 1/2015
    PTA left SFA 2011 for CLI-treatment
    Atrial fibrillation
    CAS left ICA 4/2006

    ANGIOGRAPHY
    During treatment of CLI right leg: 10 cm long distal SFA-occlusion left
    Below-the-knee peroneal artery patent

    ABI
    0.34

    PROCEDURAL STEPS
    1. Right groin retrograde access and cross-over sheath placement
    - IMA 5F diagnostic catheter (CORDIS)
    - 0.035" soft angled TERUMO glidewire (TERUMO)
    - 0.035" SupraCore 190 cm (ABBOTT)
    - 6F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage and balloon-angioplasty
    - 0.018" Connect 300 cm Guidewire (ABBOTT)
    - supported by CXC 0.018" Catheter, 135 cm (COOK)
    In case of failure exchange to:
    - 0.018" Connect 250 T Guidewire, 300 cm (ABBOTT)

    3. Balloon-angioplasty and stenting
    - Pacific 5.0/80 mm Balloon, 135 cm (MEDTRONIC)
    - Tigris GORE Vascular Stent 6.0/100 mm stent (GORE)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 40 – Occlusion right common iliac artery

    Center:
    Leipzig
    Case 40 – LEI 15: female, 64 years (R-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudicatio both legs right > left, worsening 1 month ago
    CAD, intermittend atrial fibrillation
    Art. hypertension, diabetes mellitus type 2

    CT
    Occlusion right common iliac artery, partially thrombotic.

    PROCEDURAL STEPS
    1. Bilateral retrograde groin access
    - 7F 25 cm sheath (TERUMO)

    2. Passage of the occlusion from antegrade and retrograde
    Left:
    - SOS-catheter 5F (COOK)
    - 0.035" stiff straight TERUMO 260 cm (TERUMO)
    Right:
    - 0.018" Connect Flex 300 cm (ABBOTT)

    3. Guidewire exchange to
    - 0.035" SupraCore Guidewire (ABBOTT)

    4. Predilatation right
    - 5.0/40 mmm Armada 35 balloon (ABBOTT)

    5. Implantation of covered stents in kissing-technique
    - Advanta V-12 (MAQUET GETINGE GROUP)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 41 – SFA occlusion right

    Center:
    Leipzig
    Case 41 – LEI 16: male, 73 years (H-J)
    Operators:
    • Sven Bräunlich,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication right calf
    PTA and stenting left SFA 12/2014
    Art. hypertension, diabetes mellitus type 2
    Renal insufficiency (GFR 65ml/min), former smoker
    CAD with PTCA 11/2013

    ANGIOGRAPHY
    During PTA left SFA: long SFA-occlusion right.

    ABI
    Right 0.56

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross-over access
    - 6F 40 cm Balkin Up & Over sheath (COOK)

    2. Guidewire passage of the SFA-occlusion
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - 0.015" Seeker Support-Catheter, 135 cm (BARD)
    - Exchange to a 0.018" guidewire SteelCore 300 cm (ABBOTT)

    3. PTA
    - Vascutrak Balloon 5.0/250 cm (BARD)
    - Lutonix 5.0/150 mm drug-coated balloon (BARD)

    4. Stenting on indication
    - LifeStent selfexpanding Nitinol-stent (BARD)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 42 – Reocclusion of the right tibioperoneal trunk

    Center:
    Leipzig
    Case 42 – LEI 17: male, 50 years (G-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia with ulceration dig 5 right
    PAOD with stenting right SFA 11/2010 and restenosis 12/2014
    PTA with drug-eluting balloons 12/2014
    Failure to pass the TTF-occlusion from antegrade 12/2014

    ANGIOGRAPHY
    12/2014: calcified TTF-occlusion, stenosis of the proximal peroneal artery

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 5F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage
    retrograde access via the peroneal artery:
    - 7 cm 21 Gauge puncture needle (COOK)
    - 0.018" V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
    - Seeker 0.018" 90 cm support-catheter (BARD)

    3. Guidewire exchange
    After snaring of the guidewire from antegrade PTA of the lesion:
    - Exchange to a 0.014" guidewire (Floppy ES ABBOTT)
    - Vascutrak 3.5/40 mm Balloon (BARD)
    - Lutonix Drug-Coated Balloon 3.5/120 mm (BARD)
    View image
  • Wednesday, January 28th: - , Main Arena 2

    Case 51 – Abdominal aneurysm 5.5 cm with irregular neck

    Center:
    Leipzig
    Case 51 – LEI 20: male, 76 years (H-D)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan,
    • Tomohara Dohi
    CLINICAL DATA
    Progression of an abdominal aneurysm to 55mm
    CAD with PTCA 2008
    Mitral valve moderate insufficiency
    Art. hypertension, diabetes mellitus type 2

    CT
    55 mm abdominal aneurysm with irregaular neck, thrombus

    PROCEDURAL STEPS
    1. Proglide closure-device preloading both groins
    - 9F – 10 cm sheath both groins (TERUMO)

    2. Implantation of the main body
    - 0.035" Lunderquist 180cm guidewire via right groin (COOK)
    - Ovation abdominal endovascular stentgraft (TRIVASCULAR)

    3. Cannulation of the contralateral limb
    - Amplatz left I diagnostic catheter 5F (CORDIS)
    - 0.035" soft angled TERUMO guidewire (TERUMO)
    - 0.035" Lunderquist 180 cm guidewire via right groin (COOK)

    4. Implanation of the contralateral limb (TRIVASCULAR)
    - PTA of the graft with a Reliant-balloon (MEDTRONIC) via 12F 12 cm Sheaths (COOK)
    View image
  • Wednesday, January 28th: - , Main Arena 1

    Case 45 – Chronic occlusion left aneurysmatic popliteal artery

    Center:
    Leipzig
    Case 45 – LEI 18: male, 62 years
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Recurrent ulceration left foot, claudication intermittens, walking capacity 100 meters
    PTA of SFA-stenosis left 12/2014
    ABI > 1.3
    Diabetes mellitus type 2, art. hypertension
    Liver-transplantation 2009, chronic renal insufficienc (GFR 35ml /min)

    PARTIALLY CO2-ANGIOGRAPHY
    Short occlusion of the poplteal artery left (P2-segment).

    DUPLEX
    Popliteal artery diameter 1.6 cm

    PROCEDURAL STEPS
    1. Antegrade access left groin
    - 7F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage
    - 0.018" Victory 18gr 300 cm guidewire (BOSTON SCIENTIFIC)
    - Balloon for support: Pacific 5.0/40 mm (MEDTRONIC)

    3. Implantation of a stentgraft / stent
    - Viabahn 6.0/50 mm (GORE)
    - Supera 5.0/80 mm Interwoven Nitinol-stent (ABBOTT)
    View image
  • Thursday, January 29th: - , Technical Forum

    Case 80 – Distal 10 cm SFA occlusion left, retrograde recanalization through proximal anterior tibial access

    Center:
    Leipzig
    Case 80 – LEI 28: male 78 years (L-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD with rest-pain left leg, Rutherford class 4, and
    Claudicatio intermittens left calf, walking capacity 100 meters
    Failed antegrade recanalization attempt
    Diabetes mellitus type 2, former smoker

    ANGIOGRAPHY
    10 cm distal SFA-occlusion left, moderat calcification

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over access
    - 6F 40 cm Balkin Up & Over sheath (COOK)

    2. Guidewire passage from antegrade
    - 5F Multipurpose diagnostic catheter 100 cm (CORDIS)
    - 0.035" straight stiff TERUMO glidewire, 260 cm (TERUMO)
    - in case of second failure: retrograde approach via the proximal anterior tibial artery 7 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Conrol Guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" QuickCross 90 cm Supportcahteher (SPECTRANETICS)

    3. After snaring of the guidewire from antegrade PTA
    - Ultraverse 18 Balloon (BARD) and
    - Luminor Drug-coated balloon (iVASCULAR)

    4. Stenting on indication
    - Supera Interwoven Nitinol-Stent (ABBOTT)
    View image
  • Thursday, January 29th: - , Technical Forum

    Case 81 – Occlusion of the left tibioperoneal trunk, transpedal recanalization

    Center:
    Leipzig
    Case 81 – LEI 29: male, 71 years (M-C)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD with severe claudication and restpain during night left foot
    PTA / stenting of the popliteal artery left elsewhere and failure to recanalize the tibioperoneal trunk
    Art. hypertension, CAD with CABG 2008, Polymyalgia rheumatica

    ANGIO
    During first rezanalization attempt: perforation after attempt to pass the tibioperoneal trunk occlusion.

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 5F 55 cm Ansel Sheath (COOK)

    2. Retrograde guidewire passage
    - 7 cm 21 Gauge needle to puncture the posterior tibial artery
    - 0.018" V-18 control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 3F pedal sheath (COOK)
    - 0.018" CXI-support-catheter 90 cm (COOK)
    - potentially exchange to a 0.014" CTO-guidewire Winn 200 T (ABBOTT))

    3. PTA
    - Advance Micro 3.0/40 mm 90 cm Balloon (COOK) from retrograde

    4. Stenting
    - After guidewire-passage from antegrade after predilatation from retrogarde implanatation of a Xience Prime 3.5/38 mm drug-eluting stent (ABBOTT)
    View image
  • Thursday, January 29th: - , Main Arena 2

    Case 76 – Subacute type B dissection

    Center:
    Leipzig
    Case 76 – LEI 27: male, 61 years (J-G)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Acute type-B-dissection 12/2014
    Art. hypertension
    Smoker

    CT
    Enlargement of the descending thoracic aorta of 1.1 cm within 1 month.

    PROCEDURAL STEPS
    1. Percutaneous access right groin
    - Preclosing with Proglide both sides (ABBOTT)
    - 0.035" Lunderquist guidewire 260 cm (COOK)
    - Calibration-pigtail catheter left groin
    - Temporary pacemaker via right groin for rapid pacing
    - IVUS (VOLCANO)

    2. Implantation of a TAG thoracic stentgraft (GORE)
    View image
  • Thursday, January 29th: - , Technical Forum

    Case 83 – Calcified short SFA occlusion left

    Center:
    Leipzig
    Case 83 – LEI 30: male, 50 years (U-K)
    Operators:
    • Sven Bräunlich,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication left calf, walking capacity 50 meters
    Bilateral iliac artery PTA 2014
    CAD with MI and PTCA 2000
    Art. hypertension, diabetes mellitus type 2

    ABI
    Left: 0.62

    ANGIOGRAPHY
    During PTA right iliac arteries: severe calcification left SFA, short distal occlusion.

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 6F 10 cm sheath (TERUMO)

    2. Guidewire passage
    - 0.018" Victory 18g guidewire 300 cm (BOSTON SCIENTIFIC)
    - QuickCross 0.018" 90 cm support-catheter (SPECTRANETICS)

    3. PTA
    - AngioSculpt 5/80 mm (SPECTRANETICS)
    - Drug-coated balloon treatment
    - Drug-coated balloon PTA

    4. Stenting on indication
    View image
  • Thursday, January 29th: - , Technical Forum

    Case 88 – CLI with complex occlusions of all BTK arteries right

    Center:
    Leipzig
    Case 88 – LEI 32: male, 81 years (G-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia, restpain and minor ulcerations forefoot right
    Art. hypertension, CAD with PTCA 2003
    Aortic valve replacement 2013, chronic heart failure, NYHA II-III
    Atrial fibrillation, chronic renal insufficiency GFR (62 m/min)

    ANGIOGRAPHY
    During first rezanalization attempt: occlusion of the distal SFA, popliteal artery and tibioperoneal trunk

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    - 5F 55 cm Ansel Sheath (COOK)

    2. Guidewire passage
    - V-18 Control Guidewire (BOSTON SCIENTIFIC)
    - PPS Arrow Catheter (ARROW)

    3. In case of failure to pass the guidewire from antegrade
    - Retrograde approach via the dorsalis pedis artery: 7 cm 21 Gauge needle
    - 0.018 Connect Guidewire 300 cm (ABBOTT)
    - 3F pedal sheath (COOK)

    4. Guidewire passage from retrograde
    - 0.018" CXI angled support-catheter 90 cm (COOK) potentially exchange to
    - 0.014 Hydro-ST Guidewire 300 cm (COOK) and
    - Advance Micro Balloon 3.0/120 mm (COOK)
    - LegFLow Drug-Coated Balloon (CARDIONOVUM)

    5. Stenting on indication
    View image
  • Thursday, January 29th: - , Main Arena 1

    Case 69 – TAVR with cerebral protection – patient characteristics

    Center:
    Leipzig
    Case 69 – LEI 24: male, 79 years old
  • Thursday, January 29th: - , Main Arena 1

    Case 72 – Stenosis left common and profunda, occlusion of the superficial femoral artery

    Center:
    Leipzig
    Case 72 – LEI 25: male, 67 years (D-M)
    Operators:
    • Andrej Schmidt,
    • Tomohara Dohi
    CLINICAL DATA
    Critical limb ischemia with ulceration of the lower calf and forefoot
    Chronic heart failure with NYHA II-III
    Art. hypertension, diabetes mellitus type 2, former smoker

    ABI
    Left 0.45

    DUPLEX
    CFA-stenosis and SFA-occlusion

    ANGIOGRAPHY
    CFA-stenosis, PFA-stenosis and SFA-occlusion

    PROCEDURAL STEPS
    1. Right groin access and cross-over approach to left
    - 7F 40 cm Balkin Up & Over sheath (COOK)

    2. Filter-protection of the deep femoral artery
    - Spider Filter 7 mm (COVIDIEN)

    3. Atherectomy of the CFA and PFA
    - TurboHawk (LX-M) (COVIDIEN)

    4. Guidewire passage of the SFA-occlusion
    - 0.035" TrailBlazer 135 cm supportcatheter (COVIDIEN)
    - 0.035" stiff angled glidewire 260 cm (TERUMO)
    - Exchange to the Spider-Filter 7 mm (COVIDIEN)

    5. Atherectomy of the SFA
    - TurboHawk (COVIDIEN)

    6. PTA with drug-coated balloons
    - Luminor 35 (iVASCULAR)
    View image
  • Friday, January 30th: - , Technical Forum

    Case 87 – Complex occlusion left popliteal artery, retrograde recanalization

    Center:
    Leipzig
    Case 87 – LEI 31: male, 79 years (M-B)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia, ulceration left plantar forefoot
    Failed antegrade recanalization attempt 1/2015
    Chronic renal failure, GFR 54 ml/min
    Hyperlipoproteinemia, art. hypertension

    ANGIOGRAPHY
    During first rezanalization attempt: occlusion of the distal SFA, poplieal artery and tibioperoneal trunk

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 6F 40 cm Balkin Up & Over sheath (COOK)
    - retrograde access via the peroneal artery: 7 cm 21 Gauge needle
    - 0.018" V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
    - QuickCross 0.018" 90 cm (SPECTRANETICS)

    2. Passage of the occlusion from antegrade and retrograde with CART-technique
    - antegrade Pacific 4.0/80 mm Balloon (MEDTRONIC)
    - retrograde V-18 Control Guidewire (BOSTON SCIENTIFIC)

    3. PTA
    - GPS Arrow catheter
    - Dorado balloon 5/120mm (BARD)
    - Drug-coated balloon treatment: Luminor (iVASCULAR)

    4. Stenting on indication
    - Supera Interwoven Nitinol-Stent 5/150 mm (ABBOTT)
    View image
  • Friday, January 30th: - , Technical Forum

    Case 92 – Hybrid procedure for an occluded external iliac, common and superficial femoral artery occlusion

    Center:
    Leipzig
    Case 92 – LEI 33: male, 66 years (W-T)
    Operators:
    • Sven Bräunlich,
    • Holger Staab,
    • Daniela Branzan
    CLINICAL DATA
    PAOD with rest pain and severe claudicatio left
    Former smoker
    Art. hypertension

    ABI
    Left 0.2

    DUPLEX
    Severe PAOD with chronic occlusion externa iliac artery both sides, occlusion left common and superficial femoral artery, severely calcified.

    PROCEDURAL STEPS
    1. Thrombendartherectomy left common femoral artery

    2. Transbrachial guidewire passage through the left external iliac artery
    - 6F-90 cm Check-Flow Performer Sheath (COOK)
    - 5F Judkins Right diagnostic catheter 125 cm (CORDIS)
    - 0.035" stiff angled glidewire 260 cm (TERUMO)

    3. PTA of the iliac occlusion left after snaring of the guidewire into the left groin sheath
    - Admiral 6.0/80 mm-Balloon (MEDTRONIC)
    - 7.0/10 mm Complete stent (MEDTRONIC)

    4. Guidewire passage of the SFA occlusion from left antegrade through the CFA-patch and potentially retrograde via the distal SFA

    5. PTA and stenting of the SFA
    - Armada 5.0/120 mm Balloon (ABBOTT)
    - Supera 5.0/200 mm Interwoven Nitinol-stent (ABBOTT)
    View image
  • Friday, January 30th: - , Technical Forum

    Case 94 – Right subclavian artery occlusion

    Center:
    Leipzig
    Case 94 – LEI 35: male 68 years (G-S)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Subclavian steal with right arm exercise induced dizziness
    Failed recanalization attempt due to severe iliac artery kinking
    Art. hypertension, diabetes mellitus

    RISK FACTORS
    RR-difference right to left arm: > 30 %

    ANGIOGRAPHY
    During first recanalization attempt: right vertebral retrograde flow, occlusion of the right subclavian artery.

    PROCEDURAL STEPS
    1. Access via right brachial artery and right femoral artery
    - brachial: 6F 55 cm Ansel Sheath (COOK)
    - femoral: 8F Judkins Right Guiding-Catheter (CORDIS)
    - Potentially stabilization of the guiding-catheter with a Filterwire EZ in the internal carotid artery right (BOSTON SCIENTIFIC).

    2. Bidirectional attempt to pass the occlusion
    - Judkins Right 5F diagnostic catheter 100 and 125 cm(CORDIS)
    - 0.018" Connect Flex 300 cm or Connect 250 T 300 cm guidewire (ABBOTT)

    3. PTA
    - Predilatation with Sterling 5/40 mm Balloon (BOSTON SCIENTIFIC)

    4. Stenting
    - Omnilink 8/29 mm balloon-expandable stent (ABBOTT)
    View image
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