LINC 2019 live case guide


Find all live cases and live case centers listed below.

 

 

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Conference day 3

  • - , Room 1 - Main Arena 1

    Case 55 – Live case from Abano Terme

    Center:
    Abano Terme
    Case 55 – Live case from Abano Terme
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 72 – Total occlusion of the left CIA and EIA

    Center:
    Leipzig, Dept. of Angiology
    Case 72 – LEI 25: male, 62 years (RT-V)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford class 3, severe claudication both calves, walking capacity 50 m,
    ABI left 0.3, ABI right 0.6
    COPD, biliar carcinoma 12/17

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, nicotine abuse (40PY)

    ANGIOGRAPHY
    Occlusion of left CIA and EIA and of both SFA

    PROCEDURAL STEPS
    1. Left femoral access
    - 7F 25 cm Radiofocus Introducer (TERUMO)
    - 0.035“ SupraCore guidewire 300 cm (ABBOTT)
    Left brachial approach:
    - 6F 90 cm Check-Flo Performer (COOK)
    2. Antegrade and retrograde guidewire passage
    brachial:
    - 5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
    from femoral:
    - 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
    - 0.035“ stiff angled glidewire, 260 cm (TERUMO)
    3. Predilatation and stenting of the aorto-iliac bifurcation
    - Ultraverse or Dorado balloon (BARD)
    - LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
    - Covera Plus vascular covered stent for the external iliac artery (BARD)
    View image
  • - , Room 3 - Technical Forum

    Case 73 – Directional atherectomy of DFA origin and recanalization of SFA flush occlusio

    Center:
    Bad Krozingen
    Case 73 – BK 03: male, 54 years (D-K)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    POAD Fontaine IIb / Rutherford 3 right leg, walking distance < 100 m
    Unsuccesful recanalisation attempt December 2018 in referring clinic
    ABI: 0.6/1.0

    RISK FACTORS
    Smoker, hypercholesterinemia

    ANGIOGRAM
    80% ostial DFA stenosis, flush occlusion of SFA origin, reconstitution distal SFA

    PROCEDURAL STEPS
    1. Access
    - 7F cross-over Sheath (TERUMO)
    2. Directional atherectomy of DFA origin
    - SilverHawk (MEDTRONIC)
    3. Recanalisation of SFA
    - Woodpecker (Upstream Medical)
    4. Placement of a filter protection device into the popliteal artery
    - Spider (MEDTRONIC)
    5. DA of SFA
    - SilverHawk (MEDTRONIC)
    6. DCB angioplasty
    - IN.PACT Pacific (MEDTRONIC)
    7. Stent on indication
    - BioMimics (Veryan/Otsuka)
    View image
  • - , Room 1 - Main Arena 1

    Case 66 – Live case from Münster

    Center:
    Münster
    Case 66 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 56 – Complex BTK-CTO in a CLI-patient

    Center:
    Leipzig, Dept. of Angiology
    Case 56 – LEI 19: female, 74 years (M-C)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Critical limb ischemia, minor gangrene dig 1 left,
    restpain and severe claudication left, ABI left 0.2
    Multiple interventions both legs, D4-Amputation right 11/2018

    RISK FACTORS
    Art. Hypertension, diabetes mellitus type 2 with multiple complications

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 6F 55 cm sheath (COOK)
    2. Guidewire passage antegrade into posterior tibial artery
    - 0.014“ Command (ABBOTT)
    - 0.014“ PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
    - In case of failure: retrograde approach
    3. PTA
    - Vessel preparation – scoring balloon (VascuTrak, BARD)
    - Lutonix BTK DCB (BARD)
    4. In case of dissections after DCB, provisional placement of nitinol „tacks“
    - Tack Endovascular System (Intact Vascular)
    View image
  • - , Room 1 - Main Arena 1

    Case 57 – Subacute occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 57 – LEI 20: female, 72 years (R-V)
    CLINICAL DATA
    Critical limb ischemia bilateral, ulcerations both feet (right forefoot, left lateral foot)
    ABI left 0.54, Rutherford class 5
    PTA right SFA 12/2018
    Iliac stenting 2013/2014
    CAD with PTCA 2018
    CEA right internal carotid artery 2015
    Renal transplantation 2006

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over approach
    - 8F Balkin Up&Over 40 cm sheath (COOK)
    2. Guidewire passage
    - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
    3. Rotarex-thrombectomy
    - 8F (STRAUB MEDICAL)
    4. PTA/stenting on indication
    - Pacific 5/120 mm balloon (MEDTRONIC)
    - Eluvia DES 6.0/120 mm stent (BOSTON SCIENTIFIC) or Zilver PTX (COOK)
  • - , Room 2 - Main Arena 2

    Case 67 – Live case from Paris

    Center:
    Paris
    Case 67 – Live case from Paris
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 58 – Chronic in-stent reocclusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 58 – LEI 21: male, 65 years (L-P)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    Severe claudication left calf, walking capacity 200 meters
    ABI left 0.68, Rutherford class 3
    PTA/stenting left SFA 2015 (Zilver-PTX)
    PTA right SFA, DCB-treatment 12/2018
    Dilatative cardiomyopathy, EF 35%

    RISK FACTORS
    Arterial hypertension, former smoker

    ANGIO
    Complete in-stent reocclusion left SFA

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - 8F Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    - 0.018“ Command 18, 300 cm (ABBOTT)
    - 0.018“ Quick-Cross support catheter, 135 cm (PHILIPS)
    3. Thrombectomy
    - Rotarex 8F (STRAUB MEDICAL)
    4. PTA
    - Luminor 5.0/200 mm DCB (iVASCULAR)
    - potentially with filter protection Spider-filter 6 mm (MEDTRONIC)
    View image
  • - , Room 3 - Technical Forum

    Case 74 – Live case from Abano Terme

    Center:
    Abano Terme
    Case 74 – Live case from Abano Terme
    Operators:
    • Marco Manzi,
    • Sandra Fereire Diaz
    Information will follow in due time. Thank you for your understanding.
    View image
  • - , Room 3 - Technical Forum

    Case 75 – Extremely calcified SFA CTO left, "pave and crack"-technique

    Center:
    Leipzig, Dept. of Angiology
    Case 75 – LEI 26: male, 62 years (S-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford Class 3, severe claudication left, walking capacity 50m, ABI left 0.45
    PTA both CIA 2012, multiple interventions right,
    failed recanalization attempt left SFA 12/2018
    CAD, CABG 2012, atrial fibrillation, renal impairment

    RISK FACTORS
    Arterial hypertension, hyperlipdemia, former smoker (30PY)

    ANGIOGRAPHY
    During PTA right 11/17: occlusion of the left SFA and popliteal artery

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0.035“ soft angled Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035“ SupraCore guidewire 190 cm (ABBOTT)
    - 7F 55 Check-Flo Performer Sheath, Raabe Modification (COOK)
    2. Antegrade guidewire passage
    - 0.035“ Stiff angled glidewire, 260 cm (TERUMO)
    - CXC 0.035“ support catheter, 135 cm (COOK)
    - GoBack Crossing-Catheter (UPSTREAM-PERIPHERAL)
    3. Retrograde guidewire passage
    Access via the proximal anterior tibial artery:
    - 9 cm 20 Gauge Spinal Needle (BD)
    - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 4F 10 cm Radiofocus Introducer (TERUMO)
    - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
    4. PTA and stenting
    - 6.0/20mm Admiral Xtreme balloon (MEDTRONIC)
    - 7.0/20 Conquest non-compliant high pressure balloon (BARD)

    In case of inability to open the balloons fully:
    - Implantation of a Viabahn 6.0/150 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 59 – Chronic central venous occlusion of the anonymous vein treated by covered stent

    Center:
    Münster
    Case 59 – MUN 05: female, 34 years (G-A)
    Operators:
    • Arne Schwindt,
    • S. Mühlenhöfer
    CLINICAL DATA
    Multiple skleroses since 2015, plasmapheresis via central venous catheter since 2016, central venous catheter
    removal 06/2018 due to thrombosis of right anonymous vein

    PRESENT STATE
    Chronic swelling of right arm and neck due to venous CTO of right anonymous vein

    PROCEDURAL STEPS
    1. Duplex guided puncture and access via right common femoral vein and right subclavian vein
    - Insertion of 5F 90 cm shuttle sheath femoral (COOK) and 8F 45 cm destination sheath via subclavian vein
    2. Recanalization of anonymous vein occlusion
    - Command 18 wire (ABBOTT) and 0,018“ Quickcross caheter (PHILIPS)
    3. Predilatation
    - 4 mm ULTRAVERSE balloon (BARD)
    4. Stent implantation
    - 10 mm COVERA covered stent (BARD)
    5. Postdilatation
    - 10 mm CONQUEST high pressure balloon
    6. Access managment by manual compression and pressure dressing
    View image
  • - , Room 2 - Main Arena 2

    Case 68 – Live case from Münster

    Center:
    Münster
    Case 68 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 69 – MISACE: Minimal Invasive Segmental Artery CoilEmbolisation

    Center:
    Leipzig, Dept. of Angiology
    Case 69 – LEI 24: male, 67 years, (R-H)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Thoracoabdominal aneurysm (max. diameter 61mm), progressive (41mm 2014)
    Open repair of an infrarenal aortic aneurysm 10/2014
    CAD, PTCA 2014

    RISK FACTORS
    Arterial hypertension

    CT
    Progressive aneurysm, max. diameter 61 mm

    IMPORTANT ITEMS
    Endovascular repair planned (CMD, COOK)
    Staged segmental artery coilembolisation
    for prevention of spinal-cord-ischemia planned

    PROCEDURAL STEPS
    1. Right femoral approach
    - 6F 25 cm sheath (TERUMO)
    2. Angiography
    of the segmental arteries Th 12 - Th 10 bilateral
    Selection of the arteries to be embolized during the first session
    3. Coilembolisation
    - IMA 6F guiding catheter (MEDTRONIC)
    - SIM-I 5F diagnostic catheter (CORDIS-CARDINAL HEALTH)
    - 0.014“ PT2 guidewire (BOSTON SCIENTIFIC)
    - Progreat Micro Catheter System 2.7F 130 cm (TERUMO)
    - Micro-Coils (COOK)
    View image
  • - , Room 3 - Technical Forum

    Case 77 – Percutaneous AVF in no option patients for foot veins arterialization

    Center:
    Abano Terme
    Case 77 – ABT 04: male, 81 years (L-N)
    Operators:
    • Marco Manzi,
    • Sandra Fereire Diaz
    CLINICAL DATA
    Gangrene of III and ulceration of IV toes
    Previous twice occluded fem-pop by-pass
    Failed attempts of endovascular recanalization

    PRESENT STATE
    DM, ischemic cardiac disease
    Popliteal occlusion and BTK/BTA occlusion

    PROCEDURAL STEPS
    1. Antegrade US puncture
    - 6F 11 cm sheath deployment (TERUMO)
    2. Retrograde distal leg vein (posterior tibial vein) US puncture
    - 6F 11 cm sheath deployment (TERUMO)
    3. Guidewires
    - Retrograde 0.018 vein wiring
    - Antegrade 0.014 arterial wiring
    4. AVF level identification
    5. Retrograde in-vein balloon inflation and antegrade arterial Outback deployment and balloon puncture
    6. Antegrade vein wiring and valves penetration to foot
    Venous anatomy evaluation
    7. Dilatation
    - Venous non compliant Dorado (BARD) POBA dilatation and valves rupture
    8. Stenting
    - Proximal Covered BARD Fluency SES deployment
    9. US guided closure
    - 6F Angio-Seal
    View image
  • - , Room 3 - Technical Forum

    Case 79 – Multilevel disease right, CLI, severe calcification

    Center:
    Leipzig, Dept. of Angiology
    Case 79 – LEI 28: male, 75 years (H-L)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain right, ABI 0.23; walking capacity 20 meters
    Rutherford class 4
    CAD, NYHA II
    PTA left BTK-arteries 12/2018

    RISK FACTORS
    Arterial hypertension, former smoker

    MRA
    Aneurysm of the left popliteal artery (35 mm), popliteal occlusion right

    PROCEDURAL STEPS
    1. Right antegrade access
    - 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
    2. Guidewire passage from antegrade
    - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
    - GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
    3. Atherectomy and PTA of the distal SFA-lesions
    - JetStream atherectomy device (BOSTON SCIENTIFIC)
    - RANGER DCB 6 mm (BOSTON SCIENTIFIC)
    4. Guidewire passage of the tibioperoneal-trunk occlusion
    - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
    5. In case of failure: retrograde approach via peroneal artery
    - 7cm 21 Gauge needle (COOK)
    - Pedal access-kit (COOK)
    - Connect 250T guidewire (ABBOTT)
    - CXI 0.018“ Support catheter (COOK)
    6. PTA + Stenting of the TPT
    - MiniTrek 4.0/20 mm OTW-balloon (ABBOTT)
    - Xience Prime 4.0/38 mm DES (ABBOTT)
    View image
  • - , Room 3 - Technical Forum

    Case 76 – Live case from Bad Krozingen

    Center:
    Bad Krozingen
    Case 76 – Live case from Bad Krozingen
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 78 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 78 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 60 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 60 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 70 – Live case from Münster

    Center:
    Münster
    Case 70 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 61 – CFA, SFA and popliteal artery atherectomy plus DCB angioplasty

    Center:
    Bad Krozingen
    Case 61 – BK 01: female, 71 years (O-E)
    Operators:
    • Elias Noory
    CLINICAL DATA
    PAOD Fontaine IV / Rutherford 5 both legs
    Stent angioplasty distal infrarenal aorta & DCB SFA left leg 12.12.2018
    Recanalisation & stentimplantation both CIA & EIA and SFA recanalisation left leg 2011
    ABI non-diagnostic due to mediacalcification

    RISK FACTORS
    Hypertension, hyperlipidemia

    DUPLEX
    Moderate stenosis of right CFA & SFA origin, high grade stenosis of popliteal artery

    PROCEDURAL STEPS
    1. 7F cross-over sheath
    2. Lesion crossing
    - 0.035“ Glidewire (TERUMO) guided by a 5F vertebral catheter (CORDIS)
    3. Embolic protection
    - Introduction of a Spider embolic protection system (MEDTRONIC)
    4. Atherectomy
    - Directional atherectomy (HawkOne, MEDTRONIC) of CFA, SFA origin, and popliteal artery
    5. Angioplasty
    - Drug coated balloon angioplasty (IN.PACT Pacific, MEDTRONIC or Tulip, ACOTEC)
    6. Sheath removal with closure device
    - Femoseal (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 62 – Live case from Münster

    Center:
    Münster
    Case 62 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 63 – Long SFA-occlusion left, moderate calcification

    Center:
    Leipzig, Dept. of Angiology
    Case 63 – LEI 23: male, 53 years (H-B)
    Operators:
    • Matthias Ulrich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford class 3, claudication left calf, walking capacity 150 m, ABI left 0.65
    Failed recanalization attempt (thrombectomy) 07/18 elsewere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
    2. Passage of the occlusion left SFA
    - 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    - 0.035“ CXC support catheter, 135 cm (COOK)

    In case of failure guidewire passage from antegrade:
    3. Retrograde approach via distal ATA
    - 7 cm 21 Gauge needle (COOK)
    - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 4F 10 cm Radiofocus introducer (TERUMO)
    - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
    4. PTA with DCBs
    - Passeo 18 balloon 5 x 150 mm (BIOTRONIK)
    - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
    5. Stenting on indication
    - Pulsar 18-T3 stent (BIOTRONIK)
    View image
  • - , Room 2 - Main Arena 2

    Case 71 – FEVAR for type 4 thoraco abdominal aortic aneurysm

    Center:
    Paris
    Case 71 – PAR 02: female, 72 years (V-M)
    Operators:
    • Stéphan Haulon,
    • Dominique Fabre,
    • J. Mougin,
    • L. Freycon,
    • B. Pochulu
    CLINICAL DATA
    Type 2 diabetes, HTA, obesity (BMI >30)
    Incisional hernia, splenectomy

    PROCEDURAL STEPS
    1. L: Advance 16F 30cm GORE Dryseal sheath in the LCFA over Lunderquist
    - 2 x 6F 55 cm COOK Ansel sheaths
    - 100 U/kg Heparin (Target ACT≥250)
    - L (through one of the 6F): advance long pigtail catheter
    - R: 10F sheath
    - Lunderquist (dilators up to 20)
    2. Fluoroscopy to locate fenestrations gold markers
    - R: Advanced fenestrated endograft
    - Aortic angiogram
    - Fenestrated endograft deployment
    3. R: Rosen wire advanced through preloaded catheter
    - Exchange preloaded catheter for a 6F 90 cm COOK Ansel sheath
    - Exchange Rosen for a V18 300 cm wire
    - Retrieve 6F to the level of the fenestration
    - Retrieve the 6F dilator
    - Puncture valve
    - DAV + TERUMO Roadrunner through 6F for renal artery catheterisation
    - Renal angiogram
    - Exchange TERUMO for Rosen
    - Retrieve V18 wire
    - Advance 6F into the renal artery
    - Advance BENTLEY Begraft bridging stent to parking position
    4. Same for controlateral renal artery
    5. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen
    - Advance 6F below the fenestration (SMA/CT)
    - USL + TERUMO Roadrunner through 6F sheath to catheterise target vessel (SMA/CT)
    - Vessel angiogram
    - Exchange TERUMO for Rosen wire
    - Advance 6F into target vessel
    - Advance BENTLEY Begraft bridging stent to parking position
    6. R: Release diameter-reducing ties
    - Proximal and distal attachments
    - Nose retrieval under fluoroscopy
    7. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval
    - Flare the aortic portion of stent with 9-20 mm balloon
    - Advance 6F back into the renal stent
    - Angiogram
    - same for left renal artery
    8. L: SMA/CT stent deployment (3-4cmm protruding in the aortic lumen) after 6F retrieval
    - Flare the aortic portion of stent with 10-20 mm balloon
    - Advance 6F in the SMA
    - CT stent
    - Angiogram (SMA: exchange Rosen for TERUMO wire)
    9. R : Remove nose under fluoroscopy
    - Remove fenestrated device delivery system
    L: Withdraw 6F sheath in 16F
    - insert and deploy bifurcated device and iliac limbs
    10. CODA balloon to mold overlaps and distal sealing zones
    - Pigtail catheter
    - Angiogram + non-contrast CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 64 – Live case from Bad Krozingen

    Center:
    Bad Krozingen
    Case 64 – Live case from Bad Krozingen
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 65 – Live case from Abano Terme

    Center:
    Abano Terme
    Case 65 – Live case from Abano Terme
    Information will follow in due time. Thank you for your understanding.
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