Conference day 4

• 9:00 - 13:00, Room 1 - Main Arena 1

  Case 71 – Proximal and distal extension of a 4-branched thoracoabdominal endograft by TEVAR and IBD on the right side

  Center:

  Münster

  Case 71 – MUN 08: male, 66 years, (V-W)

  Operators:

  • Martin Austermann,
  • E. Beropoulis,
  • Y. Khatadba

  CLINICAL DATA
  CAD-stent-PTCA 1/12, arterial hypertension
  
  CLINICAL HISTORY
  2003: Open repair of a AAA by replacement with a monoiliac graft
  Preexisting occlusion of the left iliac artery
  2014: BEVAR for a proximal anastomitic aneurysm and a TAAA type 4 in combination with a cross-over bypass
  
  PRESENT STATE
  New aneurysm of the thoracic aorta above the graft and growing Iliac aneurysm below the graft
  Stenosis of the proximal SFA
  
  PROCEDURAL STEPS
  1. Left axillary access 5 F sheath via cut down
  2. Cut down right groin below the cross over bypass
  Placement of a 14F sheath (COOK)
  Cannulation of the aorta up to the aortic valve and change for a Lunderquist wire (COOK)
  3. Implantation of the thoracic endograft TGM 37 37 15 E (GORE)
  4. Implantation of the IBD ZBIS 12 62 41 (COOK)
  5. Closure of the groins in order to avoid SCI
  6. Placement of the the 12F Flexor sheath from above
  7. Bridging of the hypogastric branch (Advanta GETINGE, VBX or Viabahn GORE)
  8. Endovascular treatment of the SFA stenosis through the bypass
  9. Closure of the axillary access

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• 9:00 - 13:00, Room 1 - Main Arena 1

  Case 72 – Subacute type-B-dissection, STABILISE-therapy

  Center:

  Leipzig, Dept. of Angiology

  Case 72 – LEI 28: male, 57 years (A-G)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  Subacute type-B-dissection, progressive dilatation of the descending thoracic aorta
  EVAR 2019 elsewhere
  Coilembolisation of segmental arteries to reduce the risk of spinal ischemia during Stabilise therapy
  Implantation of a thoracic dissection stentgraft 1/2020
  
  PROCEDURAL STEPS
  1. Access right groin
  – 16F sheath (COOK) right groin after preloading of Proglide systems (ABBOTT)
  2. Confirmation of guidewire position in the true lumen by IVUS
  – Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
  3. Stent implantation
  – Dissection Endovascular stent (COOK)
  4. Postdilatation of the dissection stent
  – Reliant balloon (MEDTRONIC)
  

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

  Case 74 – Calcified occlusion of the right distal SFA and right popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 74 – LEI 30: female, 72 years (D-M)

  Operators:

  • Matthias Ulrich,
  • Sven Bräunlich

  CLINICAL DATA
  PAOD Rutherford 4, restpain and severe claudication right calf, walking capacity 10 m, ABI right 0.2, failed recanalization attempt 09/19 elsewhere
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, diabetes mellitus type 2
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  – Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  – 0.035'' SupraCore guidewire 30 cm (ABBOTT)
  – 7F-40 cm Balkin Up&Over sheath (COOK)
  2. Second attempt of guidewire passage from antegrade
  – 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
  – GoBack crossing catheter (UPSTREAM PERIPHERAL) or retrograde approach via anterior tibial artery in case of failure to pass
  3. Vessel preparation
  – UltraScore 5.0/300 mm scoring balloon (BARD/ BD)
  – 4.0 - 6.0 mm Armada 35 balloon (ABBOTT)
  – Conquest high pressure balloon on indication (BARD/ BD)
  4. Stenting
  – Supera Interwoven Nitinol stent (ABBOTT)
  

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

  Case 75 – Occlusion left popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 75 – LEI 31: male, 68 years (R-H)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford 4, severe claudication left and rest-pain, walking capacity 20 m, ABI left 0.43
  Failed recanalization attempt left, elsewhere
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, nicotine abuse
  
  PROCEDURAL STEPS
  1. Right groin and cross-over approach
  – Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  – 0.035'' SupraCore guidewire 30 cm (ABBOTT)
  – 7F-40 cm Balkin Up&Over sheath (COOK)
  2. Second attempt of guidewire passage of the occlusion from antegrade
  – Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
  3. In case of failure to pass with a GW from antegrade
  – GoBack crossing catheter (UPSTREAM PERIPHERAL)
  or retrograde approach via peroneal artery:
  – 21 Gauge 9 cm needle (B. Braun)
  – 0.018Ó V-18 Control GW, 300 cm (BOSTON SCIENTIFIC)
  – 0.018Ó CXC support catheter, 90 cm (COOK)
  4. Laser atherectomy
  – 7F Turbo Power Laser with Turbo Elite 2.3 mm cathether (PHILIPS)
  5. PTA with DCBs
  – 5.0/80 mm and 6.0/80 mm iLuminor DCB (iVASCULAR)
  6. Stenting
  – Supera Interwoven Nitinol stent in case of severe recoil (ABBOTT)
  

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