Find all Live Cases and Live Case Centers listed below.
Conference day 1
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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)
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)
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
Case 14 – Endovascular treatment of a complex recurrent thrombosis
Center:
Galway
Case 14 – GAL 02: female, 41 years
Operators:
Gerard O'Sullivan,
Jean Marc Pernes,
Tony Lopez
CLINICAL DATA
Unusual presentation in 2008 with supra-renal IVC thrombosis and extensive right lower extremity DVT
Suprarenal IVC filter placed
Successfully treated by catheter directed thrombolysis and placement of tandem 12mm diameter, 90mm long Wallstent
Patient could not tolerate balloon dilatation beyond 10 mm
Fully anticoagulated
Lost to follow up; represented in 2013 with varicose veins RLE. CEAP 4
PROCEDURAL STEPS 1. General anaesthetic, urethral catheter, supine position
2. Mid thigh femoral venous access
- 5F sheath; ascending venography
- R IJV access; 55cm long sheath; 8F
- 5000u IV Heparin
- Upsize to 10F sheath R FV
3. Attempt to cross occluded stent in R EIV from below and if necessary above
- Stif glidewire; back end stiff glidewire; centring balloon technique CTO wire (Asahi Astata 30g with 2.5 mm balloon to back it up).
- IF we get across; attempt to clear out stent with Rotarex (STRAUB MEDICAL).
4. Exchange for a 180cm Amplatz wire
- Pre dilate lesion with a high pressure balloon (BARD Atlas).
- Stent lesion with a dedicated venous stent
Veniti Vici 16 mm diameter, 120 mm long
5. Repeat balloon dilatation to nominal diameter of stent
- Confirm full stent expansion by IVUS (VOLCANO) and cone beam CT (SIEMENS).
- Completion venography
6. Radiofrequency ablation
- IF ALL ABOVE SUCCESSFUL then; radiofrequency ablation to R GSV throughout its length (ClosureFast, COVIDIEN).
7. Remove sheaths
- Class 2 thigh high compression stockings (Jobst) for 6 weeks.
- Full anticoagulation
- Overnight thigh high sequential compression device (COVIDIEN).
- Colour Doppler US day 1; CTV at 6/52
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)
Case 24 – Right ICA postoperative re-stenosis CEA 1997
Center:
Berlin
Case 24 – BLN 03: male, 60 years old (G. F.)
Operators:
Ralf Langhoff,
Andrea Behne
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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)
Case 25 – Severe bilateral internal carotid artery stenosis
Center:
Cotignola
Case 25 – COT 03: male, 80 years old (Q. F.)
Operators:
Antonio Micari
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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)
CLINICAL DATA
PAOD Rutherford 3, claudication both legs
PTA and stenting at bi-lateral iliac arteries at 2009
Claudication appeared again early last year
Stenting for bi-lateral EIA and right SFA at 12/2014
PROCEDURAL STEPS 1. Left common femoral access and ipsi-lateral antegrade approach
- 6F Guiding sheath, Parent-Plus 23 cm (MEDIKIT)
2. Retrograde puncture of the left distal SFA
- 20G Introducer Needle (MEDIKIT)
- Cruise 0.014" 225 cm (NEOS)
- Promenent-NEO2 60 cm (TOKAI MEDICAL PRODUCTS)
3. Antegrade wiring
- 0.014" Harberd (Asahi Intec) supported by Prominent-NEO 135 cm
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)
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)
Case 26 – Re-occlusion of left distal SFA and popliteal artery (POP)
Center:
Sapporo
Case 26 – SAP 01: male, 53 years (M-T)
Operators:
Kazushi Urasawa,
T. Haraguchi
CLINICAL DATA
POAD Rutherford 3, claudication left carf at less than 100 meters
Stenting for left SFA and PTA for left POP 1/2014
Claudication appeared again at 12/2014
DUPLEX
Dyslipidemia, diabetes mellitus type 2
ABI: right 1.15, left unmeasureable
CT images of left femoral artery
PROCEDURAL STEPS 1. Left common femoral access and ipsi-lateral antegrade approach
- 6F Guiding sheath, Parent-Plus 23 cm (MEDIKIT)
2. Retrograde puncture of the left distal PTA
- 20G Introducer Needle (MEDIKIT)
- Cruise 0.014" 225 cm (NEOS)
- Promenent-NEO2 60 cm (TOKAI MEDICAL PRODUCTS)
3. Antegrade wiring
- 0.035" Redifocus small-J (TERUMO) supported by 4F angiographic catheter (CORDIS)
- 0.014" Astatto XS9-12 (Asahi Intec) supported by Prominent-NEO 135cm (TOKAI MEDICAL PRODUCTS)
6. PTA/stenting from antegrade
- Coyote 3.0 x 220 mm (BOSTON SCIENTIFIC)
- Sterling 5.0 x 220 mm (BOSTON SCIENTIFIC)
- Smart Control, if necessary (CORDIS)
CLINICAL DATA
PAOD Rutherford 2, claudication right calf at 300 meters
RISK FACTORS
Old cerebral infarction
ABI
Right 0.69, left 0.92
PROCEDURAL STEPS 1. Right common femoral access and ipsi-lateral antegrade approach
- 6F guiding sheath, Parent-Plus 23 cm (MEDIKIT)
2. Antegrade wiring
- 0.014" Halberd (ASAHI INTEC) supported by Prominent-NEO 135 cm (TOKAI MEDICAL PRODUCTS)
- 0.014" Astato XS9-12 (ASAHI INTEC)
3. Retrograde wiring
- 0.014" Cruise (Neos) supported by Prominent 135 cm (TOKAI MEDICAL PRODUCTS)
- Guidewire rendez-vous technique within SFA-CTO
4. PTA/Stenting from antegrade
- Coyote 3.0 x 220 mm (BOSTON SCIENTIFIC)
- Sterling 5.0 x 220 mm (BOSTON SCIENTIFIC)
- Smart control, if necessary (CORDIS)
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)
Case 32 – Occlusion of the right tibioperoneal trunc
Center:
Berlin
Case 32 – BLN 04: male, 60 years (W-P)
Operators:
Ralf Langhoff,
Andrea Behne
CLINICAL DATA
CLI patient , wound right dig ped I, CTO of the tibioperoneal trunc, recanalisation of the SFA in cross-over technique 12/2014 with stenting, but still not complete healing
RISK FACTORS
Abdominal aortic aneurysm 4,0 cm, CAD, CABG in 1999, art. hypertension, hyperlipidaemia, IDDM.
PROCEDURAL STEPS 1. Antegrade punctering of the right CFA, insertion of a 4F Fortress 45 cm sheath
2. Recanalisation of the tibioperoneal trunc
- 0.018" Advantage wire (TERUMO)
3. Predilatation
- Arrow GPS 3 x 40 mm balloon catheter (TELEFLEX)
4. Angiocontrol of the PTA result via balloon sideport
5. Secondary stenting
- 3.5 mm x 31 mm Cre8 BTK drug-eluting stent (ALVIMEDICA)
Case 06 – Right superficial femoral artery chronic total occlusion
Center:
Cotignola
Case 06 – COT 01: male, 63 years old (I. E.)
Operators:
Antonio Micari,
Alberto Cremonesi,
Giuseppe Vadalà
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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)
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)
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)
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)
Case 29 – Right symtomatic internal carotid artery critcal stenosis
Center:
Cotignola
Case 29 – COT 04: female, 73 years old (C. E.)
Operators:
Alberto Cremonesi,
Giuseppe Vadalà
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