LINC 2018 live case guide

Conference day 4

• 9:00 - 9:40, Room 1 - Main Arena 1

  Case 84 – Double chimney EVAR for a juxtarenal abdominal aortic aneurysm

  Center:

  Münster

  Case 84 – MUN 06: male, 71 years, (M-D)

  Operators:

  • Arne Schwindt,
  • Konstantinos Stavroulakis

  CLINICAL DATA
  - Art. hypertension
  - CAD - PTCA Riva 2001
  - Occlusion RCA
  - Occlusion right ICA and CAS left ICA some years ago
  - Bleeding from a gastric ulcer after NSAR 2016
  
  PRESENT STATE
  Progression of the aneurysm from 4.5 up to 61
  
  PROCEDURAL STEPS
  1. Cut down left axillary artery and double puncture
  2. Placement of two 7F Shuttle sheaths from above
  3. Percutanous approach both groins Prostar XL 10F (ABBOTT), placement of 14F sheaths (COOK)
  4. Cannulation of both renal arteries from above
  5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
  6. Placement of the Chimney stent-grafts in both renal arteries
  7. Closure of the accesses
  

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• 9:05 - 9:45, Room 3 - Technical Forum

  Case 87 – High grade stenosis of an arteria lusoria

  Center:

  Leipzig, Dept. of Angiology

  Case 87 – LEI 33: female, 56 years (C-L)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - Pain and paresthesia right hand during elevation followed by dizziness and headache
  - RR right: 110/ 60 mmHg ; RR left 140/80 mmHg
  
  RISK FACTORS
  Arterial hypertension, former smoker (40 py), hyperlipidema , diabetes mellitus Typ II
  
  PRESENT STATE
  - Subclavian-steal syndrome with retrograde flow in the vertebral artery
  - No dysphagia
  
  PROCEDURAL STEPS
  1. Right brachial approach
  - 5F 25 cm sheath (TERUMO)
  2. Right femoral approach
  - 7F 90 sheath, Flexor Check-Flo Introducer (COOK)
  3. Passage of the lesion
  - Snaring of the guide wire from femoral acces
  4. Predilation
  - 8 mm Admiral balloon (MEDTRONIC)
  5. Implantation of a self-expanding nitinol stent from femoral
  - Smart 10–12/60 mm stent (CORDIS)
  

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• 10:06 - 10:53, Room 3 - Technical Forum

  Case 88 – Chronic occlusion iliac arteries TASC D and long SFA occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 88 – LEI 34: female, 76 years (C-H)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 10 m left
  - ABI left 0.53
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus type 2, hyperlipidemia
  - Chronic renal failure, GFR 40 ml/min/1.73 m2
  - CAD: NSTEMI and CABG 2009
  - Cerebral ischemia 1994
  - COPD
  
  PROCEDURAL STEPS
  1. Brachial approach
  - 6F 90 cm Check-Flo Performer (COOK)
  2. Left femoral approach
  - 7 25 cm sheath (TERUMO)
  3. Guidewire passage
  - 0.035" stiff angled Glidewire, 260 cm (TERUMO)
  - Pacific 5.0/120 0mm-Ballon (MEDTRONIC)
  4. Stenting
  - LifeStream covered stent (common iliac artery) (BARD)
  - Cover Plus covered stent (external iliac artery) (BARD)
  

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• 10:15 - 10:55, Room 1 - Main Arena 1

  Case 85 – Juxtarenal aortic aneurysm

  Center:

  Leipzig, Dept. of Angiology

  Case 85 – LEI 32: female, 78 years (R-R)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  b>CLINICAL DATA
  - Incidental finding of a juxtarenal aortic aneurysm with progression to 75 mm max. diameter
  - Coiling of intercostal and lumbar arteries before FEVAR to reduce the risk of spinal ischemia and prevent type II endoleak, coiling performed during production period of the custommade device
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus Type 2
  - chronic renal impairment, GFR 60 ml/min/1.73 m2
  
  PROCEDURAL STEPS
  1. Bilateral femoral access and left axillar percutaneous access
  - Preloading of Proglide-Systems (ABBOTT) for all 3 access-sites
  2. Implantation of the CMD thoracoabdominal stentgraft (JOTEC)
  3. Implantation of E-ventus covered stents into the visveral arteries (JOTEC)
  4. Implantation of the bifurcated component with extension into the common iliac arteries
  
  

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• 11:07 - 12:30, Room 3 - Technical Forum

  Case 89 – Occlusion of the tibial trifurcation left

  Center:

  Leipzig, Dept. of Angiology

  Case 89 – LEI 35: male, 71 years (M-P)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3, claudication, walking capacity 100 m left
  - ABI left 0,68
  - Stenting SFA left (Supera) 2017, DEB angioplasty SFA right 2017
  - Angioplasty BTK arteries + stenting popliteal artery right 2014
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus Type 2
  - Chronic renal impairment, GFR 60 ml/ min/ 1.73 m2
  
  PROCEDURAL STEPS
  1. Left femoral retrograde and cross-over approach
  - 7 F 55 cm Check-Flo Performer, Raab Modification (COOK)
  2. Guidewire passage and filter positioning in the peroneal artery
  - PT2 0.014" guidewire, 300 cm (BOSTON SCIENTIFIC)
  3. Atherectomy and PTA with DCBs
  - Jetstream SC (BOSTON SCIENTIFIC)
  4. PTA with drug eluting balloons
  - Lutonix drug-coated balloon (BARD)
  

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• 11:37 - 12:17, Room 1 - Main Arena 1

  Case 86 – CMD-5-BEVAR for a thoracoabdominal aneurysm

  Center:

  Münster

  Case 86 – MUN 07: female, 65 years (H-W)

  Operators:

  • Martin Austermann,
  • Marc Bosiers,
  • S. Mühlenhöfer

  CLINICAL DATA
  - Cardiac fibrillation-anticoagulation,
  - art. hypertension,
  - ventilation disorders due to scoliosis of the spine-O2 therapy
  
  PRESENT STATE
  Growing TAAA, turned down for OR
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins
  - (Prostar XL, ABBOTT) 14 F (COOK) both groins
  2. Left axillary access 5F sheath via cut down
  3. Pull through wire between right femoral and axillary access. Pig tail catheter through the left groin for imaging. Registration of the Fusion technology
  4. Placement of the CMD-branched-endograft (COOK) with 5 branches with help of the Fusion system
  5. Placement othe the 12F Flexor sheath from above over the pull through wire
  6. Closure of the groins in order to avoid SCI
  7. Bridging of all the branches from the axillary access
  - Advanta, VBX, Viabahn
  8. Closure of the axillary access
  

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