During the Leipzig Interventional Course 2022 more than 40 interventional and surgical live cases are scheduled to be performed and transmitted to the auditorium.
LINC 2022 live case guide
Find all live cases and live case centers listed below.
CLINICAL DATA
– Severe claudication bilateral, maximal walking-capactiy 150 meters,
– Pain left > right buttock, thigh and calf
– Unsuccessful recanalization-attempt elsewhere 5/2022
– Guidewire-passage from antegrade (transbrachial) and retrograde impossible
RISK FACTORS
– ABI right 0.76; left 0.60
– Hypertension
– Smoker
PROCEDURAL STEPS 1. Transbrachial and left femoral access
– 7F 90cm Check-Flo Performer Sheath (COOK)
– 7F 25cm Radiofocus Introducer II (TERUMO)
– SupraCore 300cm 0.035" Guidewire (ABBOTT)
2. Passage of the CTO left common iliac artery:
Via brachial access:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
– 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)
3. Passage into the CTO left CIA from left retrograde for reversed CART-technique:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)
4. Balloon-angioplasty and stenting in kissing-technique:
– Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
– Advanta V12 Balloonexpandable Covered Stent (GETINGE)
– 8.0/37mm right CIA; 8.0/57mm left CIA
CLINICAL DATA
– Long-standing type 2 diabetes (on target), hypertension, hypercholesterolemia
– 2021 CAD with 3-vessel disease treated by multiple DES. EF 55%
– 2022 Bilateral carotid artery disease (right 85%, left 65%). Asymptomatic.
– Moderate renal failure (GFR 40ml/min/m2)
RISK FACTORS
– Doppler US: RICA PSV 3.29 m/sec
– CT-angiography: Type 1 aortic arch. Critical RICA stenosis with >180° calcium distribution followed by long soft plaque; Normal brain CT scan
PROCEDURAL STEPS 1. Right radial approach
– TERUMO slender sheath "6 in 5"
2. Right carotid axes engagement with coaxial system
– 6F MP guide over 5F 125cm-long Simmons-2 catheter
3. Baseline RICA and intracranial views angiography
4. Distal filter positioning
– Spider FX 5.0mm, MEDTRONIC or Filterwire EZ, BOSTON SCIENTIFIC
5. IVUS assessment
– Opticross, BOSTON SCIENTIFIC
6. Intra vascular lithotripsy with 4.0x12mm balloon
– SHOCKWAVE
7. IVUS assesmnet of the initial result
– Opticross, BOSTON SCIENTIFIC
8. Stenting with Roadsaver 8x30
– TERUMO
9. Stent post-dilation
– Sterling 5.0mm x 20mm, BOSTON SCIENTIFIC
10. Final IVUS assessment
– Opticross, BOSTON SCIENTIFIC
CLINICAL DATA
– Severe claudication bilateral, maximal walking-capactiy 150 meters,
– Pain left > right buttock, thigh and calf
– Unsuccessful recanalization-attempt elsewhere 5/2022
– Guidewire-passage from antegrade (transbrachial) and retrograde impossible
RISK FACTORS
– ABI right 0.76; left 0.60
– Hypertension
– Smoker
PROCEDURAL STEPS 1. Transbrachial and left femoral access
– 7F 90cm Check-Flo Performer Sheath (COOK)
– 7F 25cm Radiofocus Introducer II (TERUMO)
– SupraCore 300cm 0.035" Guidewire (ABBOTT)
2. Passage of the CTO left common iliac artery:
Via brachial access:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
– 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)
3. Passage into the CTO left CIA from left retrograde for reversed CART-technique:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)
4. Balloon-angioplasty and stenting in kissing-technique:
– Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
– Advanta V12 Balloonexpandable Covered Stent (GETINGE)
– 8.0/37mm right CIA; 8.0/57mm left CIA
Transradial carotid artery stenting for right side recurrent stenosis of internal carotid artery after surgical TEA
Center:
Münster
Case 06 – Münster 02: Female, 71 years (A-K)
Operators:
Yousef Shehada
CLINICAL DATA
– Eversion-endarterectomy of right carotid 2004
– in yearly duplex FU high grade recurrent stenosis of right ICA, vmax 300cm/sec., asymptomatic
RISK FACTORS
– CVRF: Hypertension, hyperlipidemia
PROCEDURAL STEPS 1. Radial puncture right side with micropuncture set (COOK)
2. Change to 5F 90cm destination sheath (TERUMO)
3. Canulation of right CCA with 0,35 wire (Advantage, TERUMO) and Berenstein catheter (CORDIS)
4. Canulation of ICA-stenosis with 0,014 Epifilter wire (BOSTON SCIENTIFIC)
5. Implantation of dual layer micromesh-stent (Roadsaver, TERUMO)
6. Post dilatation with rx-balloon 5/6x30mm (Sterling, BOSTON SCIENTIFIC)
7. Withdrawal of catheters ad puncture site management with radial compression device (TR-band, TERUMO)
Directional atherectomy followed by drug-coated balloon angioplasty of deep femoral artery in the presence of a chronic SFA occlusion
Center:
Bad Krozingen
Case 02 – Bad Krozingen 01: Male, 70 years (K-G)
Operators:
Börries Jacques
CLINICAL DATA
– Claudication Rutherford 3 left leg
– October 2021 DCB angioplasty of DFA main trunk due to PAOD Rutherford 5, wounds healed in the meantime
– September 2021 stent-recanalisation of chronic CTO of SFA right leg
RISK FACTORS
– CVRF: Nicotine abuse, arterial hypertension, hypercholesterolemia
– Coronary artery disease, cardiomyopathy with mid-grade impaired cardiac function
PROCEDURAL STEPS 1. Retrograde right transfemoral access 7F
2. Placement of a Spider filter (MEDTRONIC) into the DFA
CLINICAL DATA
– Comorbidities: Nephrotic syndrome till 17 (autoimmune cause),
Coagulation defects: Leiden V hetero, therapy: acenocumarol
RISK FACTORS
– Acute DVT in 1998 (left leg) and 1999 (right leg). Bilateral Post-Thrombotic Syndrome
– Villalta score: 13 left leg, 14 right leg. Venous claudication. CEAP C4b bilateral.
– US examination: non-phasic flow common femoral vein bilateral, good access at femoral vein, good inflow. Wireless Air-Pletismography: outflow obstruction.
– Venography: cava occlusion, bilateral iliac stenosis
PROCEDURAL STEPS
1. Bilateral ultrasound guided access at mid-thigh under general anesthesia, venography from both access.
2. Systemic heparinization, Recanalization of the inferior cava and ilio-femoral district with 0.035 Terumo Advantage wire J curve and Cook TriForce Peripheral Crossing Set
3. IVUS evaluation of the inferior cava and ilio-femoral district (Opticross 35 Peripheral Imaging Catheter – BOSTON SCIENTIFIC)
4. Multiple dilatation with Atlas Gold PTA Dilatation Catheter (from 12x40 to 20x40 mm) (BD)
5. IVUS evaluation of proximal and distal inferior cava landing zones and stent sizing according to vessel area (Opticross 35 Peripheral Imaging Catheter – BOSTON SCIENTIFIC)
6. Inferior cava stenting (Wallstent Endoprosthesis – BOSTON SCIENTIFIC) and postdilatation with Atlas Gold PTA Dilatation Catheter (BD)
7. IVUS evaluation of proximal and distal ilio-femoral landing zones, evaluation of the profunda vein system and possible extension under the inguinal ligament
8. Stenting of the iliac bifurcation with Kissing thechnique (Wallstent Endoprosthesis – BOSTON SCIENTIFIC) and postdilatation with Atlas Gold PTA Dilatation Catheter (BD)
9. According to IVUS evaluation possible stenting of the external iliac vein and common femoral vein (distal landing zone above profunda vein system) with Wallstent (BOSTON SCIENTIFIC) and postdilatation with Atlas Gold (BD)
10. Final IVUS evaluation and Venography from both access
CLINICAL DATA
– Severe claudication left leg, walking capacity 100 meters
– ABI left 0.56; Rutherford class 3
– PTA left and right iliac arteries 1 and 2/2022
– CAD, PTCA 2008 and 2016
– COPD
– Hypertension
– Former smoker
RISK FACTORS
– Angiography during angioplasty of the right iliac arteries
Low profile devices for SFA total occlusion treatment
Center:
Leipzig, Universitätsklinikum, Abt. Angiologie
Case 10 – LEI 03: Female, 65 years (H-S)
Operators:
Axel Fischer
CLINICAL DATA
– Severe claudication left leg, walking capacity 100 meters
– ABI left 0.60, Rutherford class 3
– Angioplasty of iliac stenosis right and left 4/2022 with only little relief of symptoms
– Diabetes mellitus type 2
– Hypertension
RISK FACTORS
– Angiography left leg during PTA of iliac arteries showing small diameter infrainguinal arteries
PROCEDURAL STEPS 1. Cross-over approach from right to left
– 5Fr Fortress Sheath (BIOTRONIK)
CLINICAL DATA
– NTLC Child B, prior resection intrahepatic bile duct adenoma S VIII,
prior stereotactic radiation therapy of HCC S VIII (60Gy), new HCC segment VII, TACE failure, ITB waived radiosegmentectomy
RISK FACTORS
– Prior TACE non responder, surgery due to cirrhosis contraindicated,
prior evaluation showed perfect tumor-to-liver ration in uptake, no relevant extrahepatic deposition or lung shunt, no extrahepatic disease, bridging to transplant
IVUS controled atherectomy of popliteal artery in patient with CLI
Center:
Münster
Case 11 – Münster 03: Male, 84 years (H-R)
Operators:
Yousef Shehada
CLINICAL DATA
– Patient with gangrene of first digit right foot, Rutherford VI, ABI 0,3
RISK FACTORS
– CVRF: Hypertension, IDDM
– CTA: Subtotal stenosis of right popliteal artery,
– occlusion of posterior tibial artery and stenosis of anteror tibial artery
PROCEDURAL STEPS 1. Antegrade access right common femoral artery and intrduction 7F 10cm sheath (TERUMO)
2. Canulation of popliteal artery stenosis with 0,018 wire (V12 BOSTON SCIENTIFIC) and 0,018 support catheter (Quickcross/PHILIPS), change to 0,014 300cm Phoenix wire (PHILIPS)
3. Analysis of lesion with IVUS catheter (Visions PV .018, PHILIPS)
4. Atherectomy of lesion with Phoenix 2.2 deflected cathete (PHILIPS)
5. DCB-PTA of popliteal artery with Stellarex Ballon (PHILIPS)
6. Control of lesion with IVUS catheter (Visions PV .018, PHILIPS)
7. Adjunctive stenting if needed with either InTact Tack (PHILIPS) or Supera stent (ABBOTT)
8. Treatment of BTK-vessels with Phoenix 1,5 (PHILIPS) and DCB (Stellarex, PHILIPS)
Recurrent varicosis right leg and vulva varicosis due to pelvic congestion syndrome right ovarian vein
Center:
Zurich
Case 17 – Zurich 01: Female, 33 years (M-D)
Operators:
Nils Kucher,
Erik Holy
CLINICAL DATA
– Chronic venous insufficiency with recurrent symptomatic leg and vulva varicosis
– History of embolization therapy of ovarian veins and right internal iliac vein
– History of crossectomy and stripping of right great saphenous vein
– History of foam sclerotherapy varicosities right leg
RISK FACTORS
– Duplex: nutcracker anatomy (image 2), no May Thurner anatomy,
– right ovarian vein dilated with reflux
– MRV: nutcracker, no May Thurner, both ovarian veins dilated and recanalized (image 1)
– PCS Score (Kucher): 5 point
PROCEDURAL STEPS 1. Access right IJ ultrasound guided 5F
2. Use 5F vertebral catheter or multipurpose catheter for selective venography of left renal vein and ovarian veins
3. Valsalva venograms to both ovarian veins
4. Catheter-directed sclerotheraphy to parauterine veins during Valsalva (Aethoxysclerol 3%)
5. Coil embolization right ovarian vein and possibly left ovarian vein if reflux is present (Interlock, BOSTON SCIENTIFIC) in Sandwich-technique
Pelvic congestion syndrome with nutcracker anatomy and left ovarian vein reflux in a nulliparous adolescent
Center:
Zurich
Case 18 – Zurich 02: Female, 17 years (A-Y-E)
Operators:
Nils Kucher,
Erik Holy
CLINICAL DATA
– Lower abdominal pain, aggravated by menstruation and upright position
– Suspected endometriosis not confirmed, hormon treatment without improvement
– No hematuria, no flank pain, no venous claudication
– Pollakisuria
– PCS score (Kucher): 5 points
RISK FACTORS
– Duplex: mild May Thurner anatomy, no reflux to left internal iliac vein,
nutcracker anatomy with dilated left ovarian vein with reflux (image 1)
– MRV: nutcracker anatomy with dilated left ovarian vein (8mm)
PROCEDURAL STEPS 1. Venous access to right IJ ultrasound guided 6F
2. Selective venography with and without Valsalva of left renal vein
3. If no left renal flow into IVC is visible, may consider transient balloon occlusion of left ovarian vein with simultaneous selective venography of left renal vein (requires second venous access)
4. Foam sclerotheraphy (aethoxysclerol 3%) to parauterine veins
5. Coil embolization left renal vein (Interlock BOSTON SCIENTIFIC) in Sandwich technique
Chronic, Calcified Occlusion right Common Iliac Artery
Center:
Leipzig, Universitätsklinikum, Abt. Angiologie
Case 12 – LEI 04: Male, 52 years (M-E)
Operators:
Sandra Düsing
CLINICAL DATA
– Severe claudcation right leg (buttock, thigh and calf)
– Walking capacity 100 meters
– PTA / stenting of a left external iliac occlusion 12/2021 elsewhere
RISK FACTORS
– Current smoker
– Hypertension
– ABI right 0.58; left 0.81
PROCEDURAL STEPS 1. Transbrachial and right femoral access
– 7F 90cm Check-Flo Performer Sheath (COOK)
– 7F 25cm Radiofocus Introducer II (TERUMO)
– SupraCore 300cm 0.035" Guidewire (ABBOTT)
2. Passage of the CTO right common iliac artery
Via brachial access:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
– 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)
3. Passage into the CTO left CIA from right retrograde for reversed CART-technique
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)
4. Balloon-angioplasty and stenting in kissing-technique
– Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
– Viabahn VBX Balloonexpandable Endoprosthesis (GORE)
– 8.0/59mm right CIA; 8.0/39mm left CIA
Chronic, Calcified Occlusion right Common Iliac Artery
Center:
Leipzig, Universitätsklinikum, Abt. Angiologie
Case 12 – LEI 04: Male, 52 years (M-E)
Operators:
Sandra Düsing
CLINICAL DATA
– Severe claudcation right leg (buttock, thigh and calf)
– Walking capacity 100 meters
– PTA / stenting of a left external iliac occlusion 12/2021 elsewhere
RISK FACTORS
– Current smoker
– Hypertension
– ABI right 0.58; left 0.81
PROCEDURAL STEPS 1. Transbrachial and right femoral access
– 7F 90cm Check-Flo Performer Sheath (COOK)
– 7F 25cm Radiofocus Introducer II (TERUMO)
– SupraCore 300cm 0.035" Guidewire (ABBOTT)
2. Passage of the CTO right common iliac artery
Via brachial access:
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
– 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)
3. Passage into the CTO left CIA from right retrograde for reversed CART-technique
– Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
– 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)
4. Balloon-angioplasty and stenting in kissing-technique
– Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
– Viabahn VBX Balloonexpandable Endoprosthesis (GORE)
– 8.0/59mm right CIA; 8.0/39mm left CIA
Persistent severe nutcracker syndrome post surgical transposition of the left renal vein and ligation of left ovarian vein
Center:
Zurich
Case 19 – Zurich 03: Female, 21 years (A-B)
Operators:
Nils Kucher,
Erik Holy
CLINICAL DATA
– Left flank pain accompanied with hematuria
– History of non-thrombotic May Thurner Syndrome treated with Beyond stent with improvement of lower abdominal pain and leg claudication 10/2021
– History of transposition of the left renal vein and ovarian vein ligation 12/2021
– History of ballon angioplasty of left renal vein with no imrpovement of nutcracker syndrome 05/2022
RISK FACTORS
– Duplex: severe nutcracker with no flow in left renal vein (image 1)
– MRV: severe nutcracker with recanalized left ovarian vein (image 2)
– Venography: severe nutcracker with recanalized left ovarian vein (image 3)
Directional Atherectomy and Antirestenosis Treatment (DAART) of a SFA-CTO
Center:
Leipzig, Universitätsklinikum, Abt. Angiologie
Case 13 – LEI 05: Male, 58 years (J-F)
Operators:
Axel Fischer
CLINICAL DATA
– Severe claudication bilateral, walking capacity 150 meters
– ABI right 0.62; left 0.6
– SFA total occlusions both side, PTA right iliac 4/2022
– Hypertension, Current smoker
Pelvic congestion snydrome due to non-thrombotic May Thurner anatomy
Center:
Zurich
Case 20 – Zurich 04: Female, 18 years (A-K-P)
Operators:
Nils Kucher,
Erik Holy
CLINICAL DATA
– Lower abdominal pain with aggravation during exercise and upright position
– Pain radiation to left groin and venous claudication during exercise left leg
– Pollakisuria
RISK FACTORS
– Known endometriosis post laparoscopic removal 6/2020 with no improvement of symptoms
– Treadmill test with 12% inclination, 3,2 km/h: lower abdominal pain after 70 meter, pain left groin and left leg after 150 meter. Venous claudication persists after termination of exercise.
– Duplex: No nutcracker but May Thurner anatomy (image 1), spontaneous permanent retrograde flow in left internal iliac vein
– MRV: May Thurner anatomy
PROCEDURAL STEPS 1. Venous access ultrasound guided 10 F left CFV
2. Venography left common iliac vein
3. IVUS May Thurner
4. Sinus obliquus stent into May Thurner lesion (OPTIMED)
Transradial approach for iliac stenting in PAD patient
Center:
Münster
Case 14 – Münster 04: Male, 60 years (B-D)
Operators:
Yousef Shehada
CLINICAL DATA
– Rutherford III WD 100mABI bilateral 0,6 CTA: High grade bilateral common iliac artery stenosis, right side external iliac artery stenosis
– CVRF: Hypertension, Nicotine use
PROCEDURAL STEPS 1. Radial puncture left side with micropuncture set (COOK)
3. Canulation of right iliac lesions with 0,035 wire (Advantage TERUMO)
4. Treatmet of external iliac artery with 8x60mm SES and common iliac artery with 8x38mm cobalt chromium stent, 170cm delivery system (Dynetic BIOTRONIK)
5. Treatment of left common iliac with 10x38 cobalt chromium stent,
170cm delivery system (Dynetic BIOTRONIK); Puncture site management with radial compression device (TR-band TERUMO)
6. Withdrawal of catheters ad puncture site management with radial compression device (TR-band, TERUMO)
CLINICAL DATA
– Ulceration right lateral forefoot, severe claudication right calf
– Walking-capacity 50 meters
– Complex recanalization of an extremely calcified long femoropopliteal occlusion 5/2022
– Planned BTK-recanalization right
– Stenting right SFA 2017 elsewhere, reoccluded
– CAD, CABG 2017
RISK FACTORS
– Angiography before and after femoropopliteal recanalization 5/2022
– ABI right 0.2
Trans-jugulary-intrahepatic portosystemic stent shunt (TIPSS) in refractory ascites and Child C cirrhosis
Center:
Jena
Case 21 – Jena 02: Female, 52 years (S-A)
Operators:
Florian Bürckenmeyer
CLINICAL DATA
– Child C cirrhosis with ascites, otherwise refractory to therapy
RISK FACTORS
– CT confirmed cirrhosis and patency of the right hepatic vein, rule out of HCC in estimated puncture tract, no PVT, no large cysts
PROCEDURAL STEPS 1. Ultra-sound guided puncture of right jugulary vein
2. Insertion of Flexor Check Flo II Introducer Set 10F (COOK)
3. Cannulation of right hepatic vein using Turcon NB Advance Catheter (COOK) TIPS-Configuration and road-runner guide wire 0.018" (COOK)
4. Advancing introducer-sheath into right hepatic vein using Amplatzer super stiff wire (BOSTON SCIENTIFIC)
5. Ultrasound-guided puncture of intrahepatic right portal vein using Transjugulary liver access and biopsy Needle Set (COOK)
6. Advancing diagnostic catheter into portal vein using PIG-Vessel sizing catheter-20B UHF (MERIT MEDICAL) to define lenght of TIPSS-Stentgraft
7. Measurement of pressure in inferior caval vein, right hepatic vein and portal vein
8. Dilatation of liver-tract using Passeo 35-XEO 8mm (BIOTRONIK) and advancement of the transjugulary sheath into the portal vein
9. Implantation of Viatorr 8-10 mm controlled expandable stentgraft (GORE) and repeating of pressure measurement, target pressure of <10mm Hg for HVPG
Conference day 3
-
,
Main Arena 1
Chronic occlusion of the right PA and stenosis of the left PA
Center:
Chengdu
Case 22 – Chengdu, China 01: Female, late 50s (D-L)
Operators:
Jichun Zhao,
Fei Xiong,
Bin Huang,
Hankui Hu
CLINICAL DATA
– Intermittent claudication of both lower limbs for 12 years, rest pain for 3 months, ulcer in left hallux, wound after right BK amputation is unable to heal 3 months, ulcer in left hallux, wound after right BK amputation is unable to heal
RISK FACTORS
– Hypertension.
– Present state: Ulcer in left hallux, non-healing wound in right keen
– CTA: Occlusion of right PA, and stenosis of left PA with serious calcification
PROCEDURAL STEPS 1. Both femoral access (5F)
2. Lesion crossing: 0.018“ V18, (BOSTON SCIENTIFIC),0.014“ GAIA (ASAHI). 0.018 “
Seeker support catheter (BD) if needed
IBD for common iliac aneurysm with internal artery stenosis and buttock claudication
Center:
Münster
Case 28 – Münster 05: Male, 71 years (R-L)
Operators:
Marco Virgilio Usai,
Efthymios Beropoulis
CLINICAL DATA
Healthy patient with casually diagnosed iliac aneurysm on the right side
because of buttock claudication when going upstairs after few meters
RISK FACTORS
Arterial hypertension, otherwise healthy. On CT 3,5 cm Iliac aneurysm on the right side with high grade stenosis of the internal iliac
2. Introducing 14 F Sheath (COOK) on the right side and a 12 F flexor (COOK) Sheath on the left. Change on the rigth side to a Lunderquist wire.
3. Retrograde Angiography in 35' LAO to localise the internal ilic artery.
4. Introducing the IBD device, over the right side Creation of a through and through wire with the Help of Indy Snare (COOK) and a TERUMO 35 260 cm stiff wire.
5. Releasing the graft until the sidebranch is free. Push in cross over of the 12 F sheat.
6. Cannulation of the internal artery after angiographic control with Bern (MERIT) and a 35 TERUMO stiff.
7. Predilatation of the internal artery to reduce the stenosis. Change to a Rosenwire (COOK)
8. Implantation og a 8x59 VBX (GORE). Withdrawal of the Through and Through Wire and completion fo the IBD deployment.
9. Deployment of the Aortic main Graft (COOK), cannulation of the controlateral leg and deployment of the iliac extension (COOK), then deployment of the ipsilateral with Cool Iliac.
CLINICAL DATA
– Ulcerations right forefoot and heel, severe claudication,
– maxmial walking capacity 100 meters, ABI right 0,41, Rutherford class 6
– CLI with endovascular treatment left leg 5/2022
– Chronic renal insufficiency, GFR 57mm/min
– Diabetes mellitus type 2, Hypertension, Former smoker
RISK FACTORS
– Angiography during PTA left leg showing diffuse disease of the right femoropopliteal tract, Severe calcifications
PROCEDURAL STEPS 1. 7Fr Cross-over approach from left to right
– 7Fr 40cm Balkin Up&Over Sheath (COOK)
CLINICAL DATA
– TAAA (max. diameter 7cm)
Past medical history:
– Frozen Elephant-Trunk 2021
– ascendens replacement 2019
RISK FACTORS
– Small access and target vessels, kinked anatomy
– Pseudo-occluded celiac trunk, hepartic artery from SMA
– History of right axillary artery occlusion with stenting
– Liquordrainage
CLINICAL DATA
– TAAA (max. diameter 7cm)
Past medical history:
– Frozen Elephant-Trunk 2021
– ascendens replacement 2019
RISK FACTORS
– Small access and target vessels, kinked anatomy
– Pseudo-occluded celiac trunk, hepartic artery from SMA
– History of right axillary artery occlusion with stenting
– Liquordrainage
Endovascular Treatment of chronic superficial femory artery stent occlusion
Center:
Zurich
Case 25 – Zurich 05: Male, 72 years (K-G)
Operators:
Nils Kucher,
Erik Holy
CLINICAL DATA
– Symptomatic PAD of the left lower leg since 01/2022, currently worsening and Fontaine stage IIb (100 m)
RISK FACTORS
– CVRF: former smoker, Dyslipidemia
– Left SFA: PTA/Stenting chronic occlusion 2018, PTA in 2019 Stent restenosis,
– PTA/DEB/Stenting 2021 In-Stent occlusion (currently on DAPT)
– TEA and resection of a right CFA anuerysm 2018
– Duplex 05/2022 (Figure 1 and 2): occluded Stent, reconstitution of distal popliteal artery via collateral vessels
PROCEDURAL STEPS 1. Antegrade access left CFA (6 F)
2. Diagnostic angiography
3. Catheter supported recanalisation of SFA occlusion
CLINICAL DATA
– Symptomatic thoracoabdominal aneurysm, Crawford III,
– Recurrent abdominal pain
– Maximal diameter of the aneurysm 68 mm
– Preemptive embolization of the inferior mesenteric artery
– Renal insufficiency GFR 65ml/min
– CAD
Complex calcified aortic disease in a patient with severe claudication and CLI
Center:
Kingsport
Case 26 – Kingsport, USA 01: Female, 51 years (JDD)
CLINICAL DATA
– Severe bilateral hip and buttock claudiaction @ 50'; embolic events with amputation of toes bilaterally
RISK FACTORS
*CAD with prior MI and DES's; *NIDDM; *Hypertension; *ongoing tobacco use; *dyslipidemia; ABI's: R 0.66>0.24 with exercise; L 0.64>0.25 with exercise; *CTA: 90% severely calcified distal aorta, 50–75% calcified common iliac arteries, no significant infra-inguinal disease
CLINICAL DATA
– Critical Limb Ischemia right, ulcerations rigth forefoot,
– ABI right 0.32, Rutherford class V
– CAD, CABG 2018
– Diabetes mellitus type 2
– Chronic renal insufficiency, GFR 49ml/min
– PTA / stenting BTK right 2/2020 (ATA and peroneal artery)
– Angiography and unsuccessful recanalization attempt elsewhere
Long total occulusion of ATA with severe calcification
Center:
Amagasaki
Case 32 – Amagasaki 01: Male, 57 years (S-K)
Operators:
Osamu Iida,
Yosuke Hata,
Taku Toyoshima,
Naoko Higashino
CLINICAL DATA
– Nov/2021: drug coated balloon for left popliteal stenosis
– April/2021: drug coated balloon for right SFA stenosis, plain angioplasty for tibial-peroneal trunk
– Previous amputation for right toe thumb
RISK FACTORS
– Hypertension, Type II diabetes, Dislipidemia, Hemodialysis, Coronary artery disease
– Skin perfusion pressure: dorsal 24mmHg, plantar 22mmHg
– WIFI classification: W 1, I 3, fl 0
PROCEDURAL STEPS 1. Ipsilateral antegrade approach from rt CFA with 5Fr sheath
2. Retrograde approach from dorsal pedis artery with micro catheter
if antegrade approach is failed
3. Wire: 0.014 inch Regalia, Gladius (ASAHI INTECC), 0.035 inch GLIDEWIRE. Baby-J™ Hydrophilic Coated Guidewire (TERUMO)
4. Support catheter: CXI 4Fr (COOK), Armet (ASAHI INTECC)
5. Support catheter: CXI 4Fr (COOK), Armet (ASAHI INTECC)
CLINICAL DATA
– Multiple small ulcerations left lower leg, restpain left foot, walking capacity 20 meters,
– ABI left 0.2; Rutherford VI
– CAD, PTCA 2021
RISK FACTORS
– Angiography elsewhere showing a long popliteal occlusion left
– Diabetes mellitus type 2
– Hypertension
– Former smoker
CLINICAL DATA
– Incidental finding of an infrarenal aortic aneurysm with extension to the left common iliac artery, maximal diameter 42mm
– Resuscitation during general anaesthesia for surgery of prostatic cancer 2015
– Coilembolization of aortic sidebranches to prevent type II endoleaks 4/2022
TEVAR extension and 5-branched EVAR with fenestration of the dissection membrane
Center:
Hamburg
Case 41 – Hamburg 03: Female, 68 years (G-M)
Operators:
Fiona Rohlffs,
Gesche Homfeld
CLINICAL DATA
– Chronic Type B Aortic dissection with Type Ia endoleak and progression of false lumen aneurysm
Past medical history:
– Carotid-subclavian-bypass and TEVAR religning in 2022
– first TEVAR 2020
RISK FACTORS
– FBN2-mutation
– Two right renal arteries from false lumen, lower renal artery with dissection
Pedal recanalization for limb threatenting ischemia
Center:
Leipzig, Universitätsklinikum, Abt. Angiologie
Case 36 – LEI 12: Male, 71 years (J-S)
Operators:
Sandra Düsing
CLINICAL DATA
– Ulceration right forefoot, acute worsening 6 weeks ago,
– Recanalization of an acute occlusion of the popliteal artery right 4/2022
– Unsuccessful guidewire-passage into pedal arteries (posterior tibial artery)
RISK FACTORS
– Angiography 6 weeks before showing the popliteal artery occlusion, recanalization and remaining distal tibial artery occlusions, and angiography after additional thrombolysis showing chronic distal tibial and pedal occlusions
– ABI right 0
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