LINC 2015 live case guide

Find all Live Cases and Live Case Centers listed below.

Conference day 2

  • - , Main Arena 2

    Case 47 – Infrarenal abdominal aneurysm 61 mm / Severe calcified and stenosed iliac arteries

    Center:
    Münster
    Case 47 – MUN 02: male, 82 years (F-F)
    Operators:
    • Bernd Gehringhoff,
    • Martin Austermann,
    • Arne Schwindt
    CLINICAL DATA
    CAD
    Art. Hypertension
    Nephrectomy left side

    PROCEDURAL STEPS
    1. Percutaneous approach both groins
    - Prostar XL (ABBOTT)
    - 14F sheath (COOK)

    2. Possibly predilatation of the iliacs

    3. Placement of the "ultra low profile" Incraft bifurcated endograft (14F CORDIS) below the renal arteries
    View image
  • - , Technical Forum

    Case 53 – Occlusion right EIA & CFA + occlusion left CFA

    Center:
    Dendermonde
    Case 53 – DEN 04: male, 80 years (A-V)
    Operators:
    • Koen Deloose,
    • Joren Callaert
    CLINICAL DATA
    PTCA in 2007
    COPD
    Hypercholesterolemia, ex-smoker

    PRESENT STATE
    Claudication in both legs with 100 m walking distance since 3 months.

    DUPLEX
    Weak monophasic signals in both groins with on the left side complete absence of flow.

    PROCEDURAL STEPS
    1. Left brachial access
    - 6F GlideWire 0.035" curved stiff (TERUMO)
    - Internal mammaria catheter 5F (CORDIS)
    - Destination 6F 90 cm (TERUMO)

    2. PLAN A: Anterograde recanalization
    - GlideWire 0.035"/280 cm curved stiff (TERUMO), alternative: Advantage GlideWire 0.018" (TERUMO)
    - supported by CXI 0.035"/0.018" 150 cm (COOK)

    3. PLAN B: Retrograde recanalization with SFA puncture(s)

    4. Predilatation
    - Armada 0.035" (ABBOTT VASCULAR)

    5. Stenting
    - Supera VMI (ABBOTT VASCULAR)
    View image
  • - , 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
  • - , 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
  • - , Main Arena 2

    Case 48 – Juxtarenal aortic aneurysm 73 mm

    Center:
    Münster
    Case 48 – MUN 03: male, 73 years old (W.W.)
    Operators:
    • Bernd Gehringhoff,
    • Martin Austermann
  • - , Technical Forum

    Case 54 – Hepatocellular carcinoma (HCC)

    Center:
    Heidelberg
    Case 54 – HEI 02: male, 83 years
    Operators:
    • Boris Radeleff,
    • Nikolas Kortes,
    • Natalie Tessendorf,
    • Björn Bliesener
    CLINICAL DATA
    Multifocal hepatocellular carcinoma ED: 07/14
    Child A liver cirrhosis
    After 1. DEB-TACE (3 ml 75 μm Tandem loaded with 150 mg doxorubicin
    plus 11 μml unloaded Embozene 250 μm; CELONOVA, USA) 11.12.2014
    Today: 2. DEB-TACE of the first cycle

    PROCEDURAL STEPS
    1. Transfemoral approach right groin

    2. Short 4F sheath Radifocus (TERUMO)

    3. 0.035" 180 cm J-wire

    4. 4F 110 cm 4F Sidewinder Typ I (CORDIS)

    5. 2,8F Microcatheter Progreat (TERUMO)

    6. Embolisation
    - 75μm Tandem DEB-particles (CELONOVA); loaded with 150 mg of doxorubicin
    View image
  • - , 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
  • - , Main Arena 2

    Case 48 – Juxtarenal aortic aneurysm 73 mm

    Center:
    Münster
    Case 48 – MUN 03: male, 73 years old (W.W.)
    Operators:
    • Bernd Gehringhoff,
    • Martin Austermann
  • - , 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
  • - , 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
  • - , 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
  • - , Technical Forum

    Case 56 – Persistent type II endoleak after EVAR

    Center:
    Münster
    Case 56 – MUN 04: male, 78 years old (O. H. J.)
    Operators:
    • Arne Schwindt,
    • N. Abu-Bakr
  • - , Main Arena 1

    Case 38 – In-stent reocclusion right SFA and high grade stenosis left CIA

    Center:
    Dendermonde
    Case 38 – DEN 03: male, 62 years (E-V)
    Operators:
    • Koen Deloose,
    • Joren Callaert
    CLINICAL DATA
    2008: PTA+S right CIA & EIA, left SFA
    prostatic cancer, treated with radiotherapy
    8/JAN/15: PTA+S left EIA & SFA
    hypercholesterolemia, smoking

    PRESENT STATE
    Rest pain (Rutherford 4) right angiography

    PROCEDURAL STEPS
    1. Left CFA access, 6F

    2. Crossover procedure
    - RIM Catheter (COOK) + GlideWire 0.035" (TERUMO)
    - Destination 7F 45 cm sheath (TERUMO)

    3. In-stent recanalization
    - GlideWire 0.035"/0.018" (TERUMO)
    - Berenstein 4F 100 cm (CORDIS) CXI 0.035"/0.018" catheter (COOK)

    4. Predilatation
    - Armada 0.035" (ABBOTT VASCULAR)

    5. Stenting
    - Viabahn Endoprosthesis (GORE)

    6. Left CIA stenosis stenting
    - BeGraft balloon-expandable stent-graft (BENTLEY INNOMED)
    View image
  • - , 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
  • - , Technical Forum

    Case 57 – Type II endoleak with aneurysm growth

    Center:
    Münster
    Case 57 – MUN 05: female, 79 years
    Operators:
    • Arne Schwindt,
    • Konstantinos Stavroulakis
    CLINICAL DATA
    EVAR 2009 with Talent prothesis, in followup visits perstent Type II endoleak via lumbar arteries, axial aneurysm growth of 8 mm

    RISK FACTORS
    Hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left transbrachial approach
    - 5F 90 cm shuttle sheath (COOK) to left common iliac artery

    2. Cannulation of left hypogastric
    - 0.035" Glidewire and 4F 120 cm Glidecath (TERUMO)

    3. Cannulation of left ileolumbar artery
    - 0.014" Choice PTII wire (BOSTON SCIENTIFIC)

    4. Cannulation of endoleak
    - 0.014" Echelon or 0.010 Marathon microcatheter (COVIDIEN)

    5. Embolisation of Endoleak with alcohol-copolymer
    - Onyx (COVIDIEN)
    View image
  • - , 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
  • - , Technical Forum

    Case 58 – Iliac vein compression prior EVLT

    Center:
    Teaneck
    Case 58 – TEA 03: male, 71 years old
    Operators:
    • Kevin Herman,
    • John Rundback,
    • Amish Patel
  • - , Technical Forum

    Case 59 – Chronic femoral DVT initial therapy

    Center:
    Teaneck
    Case 59 – TEA 04: male, 46 years
    Operators:
    • John Rundback,
    • Amish Patel
    CLINICAL DATA
    46-year-old gentleman with a history of chronic DVT for several years, first seen in June 2013. He has persistent progressive symptoms with left leg swelling and ankle pain, despite reliable use of graded compression stockings and other conservative measures. This is interfering with his work as an electrician. His medications are aspirin 81 mg only.

    PROCEDURAL STEPS
    1. US guided popliteal puncture
    - Sono-site ultrasound, Micropuncture set (COOK)
    - Upsize to 7F sheath (TERUMO)

    2. Lesion crossing
    - 0.035" Glidewire advantage (TERUMO)
    - Glidecatheter

    3. Balloon venoplasty
    - Charger (BOSTON SCIENTIFIC) or Admiral (MEDTRONIC)

    4. Positioning of EKOS thrombolytic infusion catheter (per chronic DVT trial)
    View image
  • - , 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
  • - , Main Arena 2

    Case 50 – Asymptomatic AAA 5.3 cm

    Center:
    Heidelberg
    Case 50 – HEI 01: male, 76 years (G-Z)
    Operators:
    • Alexander Hyhlik-Dürr,
    • Dittmar Böckler,
    • Drosos Kotelis
    CLINICAL DATA
    Asymptomatic progressive AAA 53 mm

    RISK FACTORS
    Art. hypertension, history of smoking

    PROCEDURAL STEPS
    1. Fusion imaging (2D-3D registration)
    - Artis Zeego/Leonardo (SIEMENS)

    2. Bifemoral cut-down

    3. Guidewire positioning
    - Lunderquist GW 180 cm (COOK)

    4. Implantation of a bifurcated stentgraft
    - Endurant II (MEDTRONIC)

    5. Postdilation
    - Reliant balloon (MEDTRONIC)

    6. Contrast enhanced Dyna-CT
    - Artis Zeego/Leonardo (SIEMENS)
    View image
  • - , 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
  • - , Global Expert Exchange

    Case 62 – Symptomatic severe stenosis of ostial right CCA, left ICA & SCA

    Center:
    São Paulo
    Case 62 – SAO 02: female, 69 years (E-C)
    Operators:
    • Armando Lobato,
    • Dino Felli Colli,
    • Robert Guimaraes,
    • Salomao Goldman
    CLINICAL DATA
    04/12 TIA (Dysarthria and right arm paresis)

    RISK FACTORS
    Hypertension, former smoker, hyperlipidaemia, diabetes mellitus

    PROCEDURAL STEPS
    1. Femoral access: Navigation of a diagnostic catheter into the left ECA
    - 5F JB1 diagnostic catheter, 100 cm (CORDIS)
    - 0.035" TERUMO angled guide-wire, 260 cm (TERUMO)

    2. Introduction of the cerebral protection device and endovascular clamping
    - 8F - 11 cm introducer (CORDIS)
    - 0.035" E-Wire guide-wire, 260 cm (JOTEC)
    - Endovascular Clamping Device – MoMa 8F (MEDTRONIC)

    3. Passing of the left ICA lesion and stenting
    - 0.014" Choice Pt Extra stiff guide-wire, 190 cm (BOSTON SCIENTIFIC)
    - 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
    - 40 mm Adapt RX Carotid Stent (BOSTON SCIENTIFIC)

    4. Postdilatation
    - 5.0/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)

    5. Left brachial access: Navigation of a diagnostic catheter into the left ECA
    - 7F – 45 cm introducer (CORDIS)
    - 7F VERT diagnostic catheter, 100 cm (TERUMO)
    - 0.035" Teruma angled guide-wire, 260 cm (TERUMO)

    6. Passing of the left subclavian artery lesion and stenting
    - 70/20 mm Powerflex Pro OTW PTA ballon catheter (CORDIS)
    - Stent Genesis 90 x 29 7F OTW (CORDIS)
    View image
  • - , Main Arena 2

    Case 50 – Asymptomatic AAA 5.3 cm

    Center:
    Heidelberg
    Case 50 – HEI 01: male, 76 years (G-Z)
    Operators:
    • Alexander Hyhlik-Dürr,
    • Dittmar Böckler,
    • Drosos Kotelis
    CLINICAL DATA
    Asymptomatic progressive AAA 53 mm

    RISK FACTORS
    Art. hypertension, history of smoking

    PROCEDURAL STEPS
    1. Fusion imaging (2D-3D registration)
    - Artis Zeego/Leonardo (SIEMENS)

    2. Bifemoral cut-down

    3. Guidewire positioning
    - Lunderquist GW 180 cm (COOK)

    4. Implantation of a bifurcated stentgraft
    - Endurant II (MEDTRONIC)

    5. Postdilation
    - Reliant balloon (MEDTRONIC)

    6. Contrast enhanced Dyna-CT
    - Artis Zeego/Leonardo (SIEMENS)
    View image
  • - , Main Arena 1

    Case 43 – Left renal artery stenosis

    Center:
    Teaneck
    Case 43 – TEA 01: female, 73 years
    Operators:
    • John Rundback,
    • Joseph Manno
    CLINICAL DATA
    73-year-old woman with known bilateral severe renal artery stenosis
    from a CTA on 10/16/2013 with atrophy in the left kidney.
    She has not had congestive heart failure.
    She was a former smoker; stopped approximately two years ago.
    She has a history of coronary artery disease with myocardial infarction
    and coronary stents in 2012. She does not have dyslipidemia or diabetes.

    Current blood pressure medications are clonidine 0.1 b.i.d., Toprol 12.5 daily,
    and losartan/hydrochlorothiazide 50/12.5 daily. She also takes Zocor 40,
    Plavix 75, and aspirin 81.

    VITAL SIGNS
    Blood pressure, was 178/67 mmHg in the right arm and 161/70 mm Hg in the left arm.

    LABS
    GFR 66 ml/min.1.73m2

    PROCEDURAL STEPS
    1. Right femoral puncture and insertion of 7F RDC guide sheath (CORDIS)

    2. Selective catheterization of left renal artery
    - Spartacore wire (ABBOTT)

    3. Possible Buddy Wire and pressures
    - Radi wire (VOLCANO)

    4. Renal artery stenting
    - Formula 414 stents (COOK)
    View image
  • - , Technical Forum

    Case 60 – TIPS

    Center:
    Heidelberg
    Case 60 – HEI 03: male, 52 years
    Operators:
    • Boris Radeleff,
    • Ulrike Stampfl,
    • Karl-Heinz Weiss,
    • Nikolas Kortes,
    • Natalie Tessendorf,
    • Björn Bliesener
    CLINICAL DATA
    Pat. on waiting list for LTx
    Cryptogenic liver cirrhosis, child A
    Refractory ascites
    Previous episode of hep. encephalopathy

    PROCEDURAL STEPS
    1. Transjugular venous access right side
    - 9F 20 cm sheath (Arrows)

    2. Puncture attempt: right liver vein --> right PV
    - TIPS-set (OPTIMED) 30Æ or 60Æ angled

    3. 0.035" superstiff wire (BOSTON SCIENTIFIC)

    4. Predilatation
    - 8 x 80 mm MARS® balloon (OPTIMED)

    5. 10F Sheath (Checkflow, COOK) 38-45 cm, straight / angled

    6. Stentgraft implantation
    - Viatorr®-Stentgraft (GORE)

    7. Planning
    - Puncture: right LV right PV
    - Needle type: 30Æ angled
    - Shunt: 10 mm Viatorr (GORE) 10/6/2 or 10/7/2
    View image
  • - , 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
  • - , Main Arena 1

    Case 44 – Celiac artery aneurysm

    Center:
    Teaneck
    Case 44 – TEA 02: male, 57 years
    Operators:
    • Kevin Herman,
    • John Rundback,
    • Joseph Manno
    CLINICAL DATA
    Patient is a 57-year-old gentleman with history of hypertension sleep apnea and obesity who presented to emergency room for 3 days history of sudden onset severe left abdominal pain and worse during inspiration and sometimes radiating to his left shoulder. An abdominal CT scan showed a splenic infarct 2.5 cm celiac artery aneurysm.

    RISK FACTORS
    History of a cardiomyopathy with negative cardiac catheterization, nonischemic left bundle branch block, renal insufficiency Echocardiogram showed LVEF 40% without atrial or ventricular thrombus.

    PROCEDURAL STEPS
    1. US guided radial puncture
    - Sono-site ultrasound, Micropuncture set (COOK)
    - Adminstration of NTG and Verapamil
    - Insertion of 6F Slender Sheath (TERUMO)
    - Traverse arch, wire descending thoracic aorta and exchange for 5F Shuttle Sheath (COOK)

    2. Select celiac access, subselect and coil proximal splenic artery
    - Interlock coils (BOSTON SCIENTIFIC)

    3. Possible subselect and coil embolize left gastric artery

    4. Advance 0.018" Platinum plus wire into hepatic artery

    5. Exclude celiac aneurysm with ICast stent grafts (Atrium) or Viabahn stent grafts (GORE)
    View image
  • - , Technical Forum

    Case 61 – AT/PT and lateral plantar recanalization

    Center:
    Abano Terme
    Case 61 – ABT 01: male, 60 years (Z-M)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena
    CLINICAL DATA
    DM, neurovasculopathy

    RISK FACTORS
    Right pre-tibial II-III D lesion, right foot rest pain. TcPO2: 17 mmHg
    Hypertension
    Ischemic heart disease (previous PTcA)

    PROCEDURAL STEPS
    1. Right Groin antegrade US guided approach
    - 6F 11 cm sheath (TERUMO)

    2. Antegrade wiring of AT and arch
    - 4F BER 2, 100 cm (CORDIS)
    - 0.014" Pilot 200, 300 cm (ABBOTT)

    3. Antegrade passage of the PT/lateral plantar occlusion
    - 4F BER 2 100 cm (CORDIS), V18 CW (BOSTON SCIENTIFIC)

    4. Wires rendez-vous through arch and lateral plantar artery

    5. Predilatation
    - Armada XT, 1,5 mm x 20 mm (ABBOTT)

    6. Definitive dilatation
    - Armada 14, 2,5 mm x 200 mm (ABBOTT)
    View image
  • - , 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
  • - , Main Arena 2

    Case 52 – Sac hygroma after EVAR: endograft relining

    Center:
    São Paulo
    Case 52 – SAO 01: male, 81 years (N-T)
    Operators:
    • Armando Lobato,
    • Dino Felli Colli,
    • Robert Guimaraes,
    • Marcelo Cury
    CLINICAL DATA
    Asymptomatic expanding aneurysm sac after EVAR without apparent endoleak secondary to sac hygroma

    RISK FACTORS
    Hypertension, COPD, hyperlipidaemia, former smoker

    PROCEDURAL STEPS
    1. Cut down bilateral common femoral arteries
    - DrySeal Introducer 18F (WL GORE)
    - DrySeal Introducer 20F (WL GORE)
    - 0.035" E-Wire guide-wire, 260 cm (JOTEC)

    2. Endograft relining
    - Endurant proximal cuff 28 x 45 mm (MEDTRONIC)
    - Endurant iliac limb externsion 16 x 16 x 120 mm 14F (MEDTRONIC)
    - Endurant iliac limb externsion 16 x 20 x 120 mm 16F (MEDTRONIC)

    3. Latex balloon accomodation
    - Reliant balloon (MEDTRONIC)
    View image
  • - , Main Arena 1

    Case 46 – In-stent occlusion right A. poplitea

    Center:
    Münster
    Case 46 – MUN 01: female, 55 years (N-K)
    Operators:
    • Arne Schwindt,
    • Konstantinos Stavroulakis
    CLINICAL DATA
    PAOD Rutherford 4, intermittend rest pain,claudication right calf at 20 meters
    PTA and Stent right popliteal 2009, Stent left CIA 2/2011

    RISK FACTORS
    NIDDM, hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left femoral approach
    - 5F 10 cm sheath (TERUMO)

    2. Cross-over manoeuvre
    - Insertion 6F 45 cm Destination sheath (TERUMO) via 0.035 Advantage wire (TERUMO)

    3. True lumen recanalization right A. pop.
    - Ocelot PIXL (AVINGER)

    4. Directional atherectomy popliteal artery
    - Turbohawk LSM (COVIDIEN)

    5. Postdilation
    - In.Pact paclitaxel eluting balloon (MEDTRONIC)
    View image