LINC 2015 live case guide

Berne

• Tuesday, January 27th: 8:10 - 8:25, Main Arena 2

  Case 11 – Iliofemoral venous intervention

  Center:

  Berne

  Case 11 – BER 01: female, 71 years (B-M)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Past Medical History:
  Iliac vein thrombosis left side in 2012 (May Thurner) treated with CDT (EKOS) and 2 overlapping stents in common and external iliac veins
  
  VTE-RISK FACTORS
  Chronic venous insufficiency (ulcer, varicose veins), smoking
  Currently no anticoagulation therapy
  
  PRESENT COMPLAINT
  Chronic venous insufficiency left leg with:
  Mild leg swelling (2 cm plus in thigh circumference) / No venous claudication
  Hyperpigmentation, varicose veins
  
  DUPLEX
  Popliteal & femoral veins: patent / Common femoral vein: patent
  External and common iliac veins: instent restenosis
  
  PROCEDURAL STEPS
  1. Local anaesthesia with standby
  
  2. Venous access with ultrasound guidance in left popliteal (10F sheath)
  
  3. Wire crossage
  - 0.035" stiff angled (TERUMO)
  
  4. Phlebography, IVUS
  
  5. Predilatation
  - Atlas Balloon 12–14 mm (BARD), Aspirex 10F (STRAUB MEDICAL) thrombectomy depending on thrombus load
  
  6. Implantation of dedicated Iliac vein stents over TERUMO stiff angled wire 0.035"
  - Sinus-Obliquus 14–16 mm (OPTIMED),
  - Sinus-XL Flex 14–16 mm (OPTIMED)
  - Vici 14–16 mm (Veniti)
  
  7. High-pressure postdilation of stents
  - Atlas Balloon 14–16 mm (BARD)

  View image
• Tuesday, January 27th: 9:30 - 9:45, Main Arena 2

  Case 13 – Iliofemoral venous intervention

  Center:

  Berne

  Case 13 – BER 02: female, 28 years (C-J)

  Operators:

  • Nils Kucher,
  • Torsten Fuß,
  • Frédéric Glause

  CLINICAL DATA
  Past medical history:
  Iliofemoral DVT left side in April 2014 treated conservatively
  VTE-Risk factors: history of distal DVT right leg 2007
  while on oral contraception and smoking
  Currently on anticoagulation therapy, compression stockings
  
  PRESENT COMPLAINT
  Chronic venous insufficiency left leg with:
  Moderate leg swelling despite compression therapy
  Severe venous claudication
  
  CT
  No clear signs of May Thurner present / external iliac vein occlusion
  Popliteal and femoral veins postthrombotic, common femoral and iliac veins occluded
  
  PROCEDURAL STEPS
  1. General anaesthesia, prone position, urinary catheter
  
  2. Venous access with ultrasound guidance in left popliteal
  - 7F destination sheath
  
  3. Wire crossage
  - TERUMO 0.035" stiff angled, 4F Berenstein catheter, torque device
  
  4. Phlebography, IVUS
  
  5. Predilation
  - Atlas Balloon 12–14 mm (BARD)
  
  6. Implantation of dedicated Iliac vein stents over TERUMO stiff angled wire 0.035"
  - Sinus-Obliquus 14–16 mm (OPTIMED),
  - Sinus-XL Flex 14–16 mm (OPTIMED)
  
  7. High-pressure post-dilation of stents
  - Atlas Balloon 14–16 mm (BARD)

  View image
• Tuesday, January 27th: 13:30 - 15:00, Main Arena 2

  Case 19 – Ilio-caval venous intervention and ovarian vein ablation

  Center:

  Berne

  Case 19 – BER 04: female 39 years, (C-M)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Past medical history:
  Bilateral iliofemoral DVT involving infrarenal VCI 2001 treated conservatively
  VTE-Risk factors: oral contraception, Faktor V Leiden
  Currently no anticoagulation therapy, compression stockings
  Endometriosis, WPW syndrome
  
  PRESENT COMPLAINT
  Chronic venous insufficiency both legs with:
  Mild leg swelling, Moderate venous claudication, cramps
  Severe pelvic congestions syndrome with abdominal and back pain, depending on menstrual cycle.
  
  DUPLEX
  Popliteal & femoral veins & external iliac veins: patent
  Iliac veins and IVC: postthrombotic high velocity flow without modulation
  MR venography: postthrombotic changes of IVC and left common iliac vein, right ovarian vein ectasia.
  
  CT
  Right ovarian vein (10 mm), postthrombotic infrarenal IVC
  
  PROCEDURAL STEPS
  1. General anaesthesia, supine position, urinary catheter
  
  2. Venous access in both common femoral (10F) and right jugular veins (6F)
  
  3. Wire crossage IVC from both femoral veins
  - TERUMO 0.035" stiff angled, 4F Berenstein catheter, torque device
  
  4. Phlebography, IVUS
  
  5. Right ovarian vein venography & embolization from jugular access
  - pushable Nester coils (COOK)
  
  6. Predilation IVC
  - Atlas Balloon 14–18 mm (BARD)
  
  7. Implantation of dedicated vein stents over TERUMO stiff angled wire 0.035" in IVC and kissing stents iliac veins
  - Sinus-XL 18–22 mm (OPTIMED) for IVC,
  - Sinus-XL Flex 14–16 mm (OPTIMED) for iliac veins
  
  8. High-pressure postdilation of stents
  - Atlas Balloon 14–18 mm (BARD)

  View image