Find all live cases and live case centers listed below.
Berne
7 livecase(s)
Tuesday, January 26th:
-
,
Room 2 - Main Arena 2
Case 10 – BER 01:
Iliofemoral venous intervention
Center:
Berne
Case 10 – BER 01: male, 52 years (T-H)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Iliac vein thrombosis left side in 2013 treated with anticoagulation
Iliac vein thrombosis left side 06/2015
Mechanical compression of the left iliac vein (ostheosynthesis L4/5)
PRESENT STATE
Venous claudication (painfree walking distance 500 m)
Swelling (2 cm plus in thigh circumference) despite compression therapy
No skin changes
No varicose veins
DUPLEX
Postthrombotic changes in iliac and femoral veins
CT
Mechanical compression of the left iliac vein through ostheosynthetic material
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal
- 10F sheath
2. Wire crossage
- Terumo 0.035 stiff angled
3. Phlebography, IVUS
4. Predilatation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
Case 14 – BER 02:
Iliofemoral venous intervention – Part 1
Center:
Berne
Case 14 – BER 02: male, 48 years (J-Z)
Operators:
Nils Kucher,
Torsten Fuß
MEDICAL HISTORY
Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
Permanent neurocognitive deficits
Ongoing anticoagulation therapy
RISK FACTORS
Chronic venous insufficiency left leg with: venous claudication, varicose veins,
hyperpigmentation, leg swelling
Villalta-Score: 6 points
CT
May Thurner compression of the left common iliac vein
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
Case 14 – BER 02:
Iliofemoral venous intervention – Part 2
Center:
Berne
Case 14 – BER 02: male, 48 years (J-Z)
Operators:
Nils Kucher,
Torsten Fuß
MEDICAL HISTORY
Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
Permanent neurocognitive deficits
Ongoing anticoagulation therapy
RISK FACTORS
Chronic venous insufficiency left leg with: venous claudication, varicose veins,
hyperpigmentation, leg swelling
Villalta-Score: 6 points
CT
May Thurner compression of the left common iliac vein
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
CLINICAL DATA
Past medical history: No personal or familiy history of DVT
Previously healthy
Chronic venous insufficiency left leg with:
Venous claudication (walking distance 600 m)
Leg swelling (thigh 7 cm plus)
No varicose veins or skin changes
DUPLEX/CT
Stenosis of the external iliac vein left side
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated iliac vein stents
- Sinus-XL Flex 14 mm (OPTIMED), or
- Vici 14 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
MEDICAL HISTORY
Appendectomy and removal of ovarian cyst 1996
Laparoscopic adhesiolysis and tubal sterilisation 2005
Last menstrual cycle 03/2015
Recent gynecologic exam unremarkable
PRESENT STATE
Left sided abdominal dull pain, lower quadrant since 6 months
The pain is worse during defecation
No pain during or after sexual intercourse or during voiding
Pain dependence on position (no pain during bed rest, worse while standing and sitting)
Wednesday, January 27th:
-
,
Room 1 - Main Arena 1
Case 34 – BER 05:
Complex intervention of IVC and iliac veins
Center:
Berne
Case 34 – BER 05: male, 34 years (R-V)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Past medical history:
Thrombosis of IVC and bilateral Iliac veins 08/2013 treated with anticoagulation
Varicocele, hemorrhoids
Thrombophilia testing negative
Failed endovascular recanalisation attempts in 2015 in two tertiary care hospital
PRESENT STATE
Bilateral venous claudication
Lumbar pain, bilateral swelling despite compression therapy, varicose veins
Currently no anticoagulation therapy
CT: postthrombotic IVC, large hemiazygos vein,
Failed endovascular treatment
PROCEDURAL STEPS 1. Bilateral common femoral vein access, right jugular vein access with ultrasound guidance (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14–18 mm (BARD)
5. Implantation of dedicated Iliac vein stents
over TERUMO stiff angled wire 0.035":
- IVC stents: Sinus XL 22 mm (OPTIMED),
- Kissing Iliac vein stents: Sinus-XL Flex 14–16 mm (OPTIMED)
6. High-pressure post-dilation of stents
- Atlas balloon 14–18 mm (BARD)
Wednesday, January 27th:
-
,
Room 2 - Main Arena 2
Case 46 – BER 06:
Percutaneous EVAR of infrarenal AAA under local anaesthesia
Center:
Berne
Case 46 – BER 06: male, 79 years (F-L)
Operators:
Dai-Do Do,
V. Makaloski
CLINICAL DATA
Asymptomatic infrarenal AAA with progressively increasing diameter
Femorotibial bypass on the right side 2006
Lower extremity chronic venous disorders CEAP C4 on both sides
PTCA 2006
RISK FACTORS
Type 2 diabetes, arterial hypertension, hyperlipidemia,
65-pack-year cigarette smoking history
PROCEDURAL STEPS 1. Percutaneous femoral access in both groins
- Local anaesthesia, retrograde puncture of the CFA on both sides
- 0.035" Radiofocus M stiff guidewire, 180 cm (TERUMO)
- Preclosure of the access sites using ProGlide devices (ABBOTT)
2. Implantation of the INCRAFT®AAA Stent Graft System (CORDIS, CARDINAL HEALTH)
- the delivery system (14-F OD) with the main body inside up to the lower accessory right renal artery, deployment of the main body
- Implantation of the contralateral and then the ipsilateral iliac stentgraft (12-F OD)
3. Sealing ot the percutaneous access sites in both groins
- ballon dilatation of the main body and the iliac limbs: Reliant balloon (MEDTRONIC)
- control angiogram, then withdrawing the delivery system respectively the 12F sheath
- advancing and tying the knots using the knot pusher of the ProGlide system
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