LINC 2019 live case guide

Conference day 4

• 9:00 - 13:00, Room 1 - Main Arena 1

  Case 80 – LP-18F-CMD-5-BEVAR for a thoracoabdominal aneurysm type I 79 mm max

  Center:

  Münster

  Case 80 – MUN 10: male, 68 years, (K-M)

  Operators:

  • Martin Austermann,
  • Michel Bosiers,
  • E. Beropoulis

  CLINICAL DATA
  CAD, PTCA 2006 and 2012, artrial fibrillation, art. hypertension, PAD, COPD, left hemicolectomy due to cancer 9/2018
  
  IMPORTANT ITEMS
  Stent-PTA left CIA 2001, very narrow iliac arteries
  
  PROCEDURAL STEPS
  1. Percutaneous approach both groins with 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 12 F 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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• 9:00 - 13:00, Room 1 - Main Arena 1

  Case 80b – Live case from Münster

  Center:

  Münster

  Case 80b – Live case from Münster

  Information will follow in due time. Thank you for your understanding.
• 9:00 - 13:00, Room 1 - Main Arena 1

  Case 80c – Live case from Münster

  Center:

  Münster

  Case 80c – Live case from Münster

  Information will follow in due time. Thank you for your understanding.
• 9:00 - 13:00, Room 3 - Technical Forum

  Case 81 – Occlusion of the infrarenal aorta and both iliac arteries, Leriche-syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 81 – LEI 29: male, 65 years (K-T)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication and weakness both legs and buttocks, progressive,
  Walking capacity 50 meters, Rutherford class 3
  CAD, PTCA 2010, chronic heart failure, EF 40%
  
  RISK FACTORS
  Art. hypertension, nicotine abuse
  
  CT
  Severely calcified occlusion of the infrarenal aorta and iliac arteries
  
  PROCEDURAL STEPS
  1. Transbrachial bilateral approach
  - 7F 90 cm Check-Flo-Performer sheath (COOK)
  2. Transfemoral retrograde approach
  - 8F 25 cm sheath (TERUMO)
  3. Transbrachial guidewire passage
  - 0.035“ Stiff angled glidewire, 260 cm (TERUMO)
  - 6F 100 cm Multipurpose guiding catheter (MEDTRONIC)
  - 5F 125 cm Judkins Right diagnostic catheter (CORDIS-CARDINAL HEALTH)
  4. Snaring of the gudewire-tip from antegrade into the retrograde femoral sheaths
  - 6F Judkins Right guiding catheter
  5. Renal protection
  - Implantation of 2 covered stents (LifeStream 7/26 mm, BARD)
  6. PTA of the infrarenal occlusion from retrogade
  - 6.0/120 mm Admiral balloons (MEDTRONIC)
  7. Implantation of covered stents
  - BeGraft covered stent (BENTLEY)

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• 9:00 - 13:00, Room 3 - Technical Forum

  Case 82 – Symptomatic occlusion of the left subclavian artery

  Center:

  Leipzig, Dept. of Angiology

  Case 82 – LEI 30: male, 72 years (M-S)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Dizziness, syncope 12/2018
  Recurrent minor strokes 2017,
  Attempt to recanalize the subclavian artery via a femoral approach 12/2018
  CAD, PTCA 2012
  PAOD, stenting iliac arteries right
  Nicotine abuse
  
  DUPLEX
  Occlusion right vertebral artery, high-grade stenosis right internal carotid artery,
  Occlusion left subclavian artery
  
  PROCEDURAL STEPS
  1. Left transbrachial approach
  - 6F 55 cm Flexor Check-Flo Introducer Raabe-configuration (COOK)
  2. Transfemoral retrograde approach
  - 8F 25 cm sheath (TERUMO)
  - 8F Judkins-Right guiding catheter (MEDTRONIC)
  3. Transbrachial and transfemoral guidewire-passage
  - 0.018“ Connect Flex guidewire (ABBOTT)
  4. Snaring of the gudewire-tip from antegrade or retrograde and pull-through-wire
  5. PTA and stenting
  - Pacific 5.0/40 mm balloon (MEDTRONIC)
  - BeGraft covered peripheral stent (BENTLEY)

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• 9:00 - 13:00, Room 3 - Technical Forum

  Case 83 – Reocclusion right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 83 – LEI 31: male, 56 years (G-M)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, ABI 0.67; walking-capacity 150 meters
  Rutherford class 3
  PTA/Stenting ot the infrarenal aorta and iliac arteries 2015
  PTA stenting both SFA 2016
  PTA of a reocclusion left SFA 12/2018
  
  RISK FACTORS
  Art. Hypertension, heavy smoker
  
  PRESENT STATE
  Reocclusion right SFA since 2 months, slow onset of symptoms
  
  PROCEDURAL STEPS
  1. Left retrograde and cross-over approach
  - 7F 40 cm Up&Over sheath (COOK)
  2. Guidewire passage from antegrade
  - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
  - GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
  3. Potentially retrograde stent puncture
  4. Guidewire passage of the tibioperoneal trunk occlusion
  - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
  5. Pre-treatment
  - Rotarex 6F Thrombectomy (STRAUB MEDICAL)
  6. PTA + Stenting
  - RANGER DCB within the stents (BOSTON SCIENTIFIC)
  - Evaluation of the stentfracture and potentially relinining with Supera stents (ABBOTT)
  - Eluvia DES for the proximal SFA (BOSTON SCIENTIFIC)

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