LINC 2022 live case guide
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.
Conference day 4
-
- , Main Arena 1
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 DATAView image
– 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)
6. Imaging modality: intravascular ultrasound (TERUMO)
7. Treatment: Plain balloon angioplasty (IVUS-guided decision) -
- , Main Arena 1
BTK: Long PT occlusion
- Center:
- Abano Terme
Case 33 – Abano Terme 01: Male, 81 years (G-F)- Operators:
-
- Salvatore Esposito,
- Cesare Brigato
CLINICAL DATAView image
– Type 2 DM, ischemic cardiopathy, neurovasculopathy, dyslipedemia, obesity
– wet gangrene right III° toe
– TcPO2 = 20 mmHg
PROCEDURAL STEPS
1. US guided antegrade 6F sheath
2. CO2 angio and 2D perfusion of the foot
3. Antegrade CTO crossing 0,18/0,14 wires
4. Retrograde with/without puncture (transloop) whenever failure
5. POBA, DEB and dedicated stents
Devices:
– Ranger (BOSTON SCIENTIFIC) or
– Lutonix DCB (BD) -
- , Main Arena 2
TEVAR (CMD TEVAR, low-radial force distally)
- Center:
- Hamburg
Case 37 – Hamburg 02: Male, 36 years (J-M)- Operators:
-
- Fiona Rohlffs,
- Gesche Homfeld
CLINICAL DATAView image
– Type A aortic dissection with David Procedur and Frozen Elephant Trunk 2021
RISK FACTORS
– TGFB3 gene variation
PROCEDURAL STEPS
1. Percutaneous femoral access (Manta, TELEFLEX)
2. Confirmation of true lumen access (angiogramm)
3. Lunderquistwire (extra stiff wire, COOK) to ascending aorta from right side, angiocatheter from left side
4. Deployment of CMD-TEVAR (COOK)
5. Completion angiogramm -
- , Main Arena 1
Complex popliteal CTO, CLI
- Center:
- Leipzig, Universitätsklinikum, Abt. Angiologie
Case 34 – LEI 11: Male, 63 years (N-V)- Operators:
-
- Axel Fischer
CLINICAL DATAView image
– 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
PROCEDURAL STEPS
1. Left antegrade access
– 6Fr 55cm sheath (COOK)
2. Retrograde posterior tibial, peroneal or anterior tibial access
– Micropuncture Pedal Access Kit (COOK)
3. Antegrade and retrograde intraluminal wiring
– Hydro ST 0.014"" Guidewire 300cm (COOK)
– Approach CTO 0.014"" Guidewire 300cm (COOK)
– CXI Support-Catheter 0.018"" 90cm angled (COOK)
4. Balloon-angioplasty
– Advance Serenity 14 (COOK)
– Micro 14 Angioplasty Balloon (in case of retrograde ballooning) (COOK) -
- , Main Arena 2
Frozen elefant trunk with new hybrid prosthesis
- Center:
- Leipzig, Heart Center
Case 38 – Leipzig – Heart Center Leipzig 01: Female, 73 years (B-M)- Operators:
-
- Martin Misfeld,
- Christian Etz
CLINICAL DATA
– Aortic arch aneurysm
RISK FACTORS
– Advanced age
– E-vita Open Neo Hybrid Prothesis (ARTIVION)
PROCEDURAL STEPS
1. Cardio-pulmonary-bypass 8CPB
2. Procedure performed in hypothermia
3. Selective cerebral perfusion
4. E-vita Open Neo Hybrid prothesis (ARTIVION) implantation in zone 2
5. Extra-anatomical bypass to left subclavian artery
6. Rewarming and weaning from CBP -
- , Main Arena 2
BEVAR for Arch penetrating ulcer
- Center:
- Paris
Case 39 – Paris 02: Male, 73 years- Operators:
-
- Stéphan Haulon,
- Thomas Le Houérou,
- Antoine Gaudin,
- Côme Bosse,
- Sean Crawford,
- Dominique Fabre
CLINICAL DATAView image
– Severe COPD, ASA 3
PROCEDURAL STEPS
1. Percutaneous right axillary and femoral access
2. RV access from right femoral vein
3. LV access from right femoral artery
4. Deployement of the branched endograft under rapid pacing
5. Deployement of inominate artery bridging limb from right axillary access
6. Access and deployement of LCC and LSA bridging stents from the groin
7. Completion angiogram and CBCT
Devices:
– COOK CMD endograft
– Begraft + bridging stents (BENTLEY)
– Viabahn bridging stents (GORE) -
- , Main Arena 2
Infarenal aortoiliac aneurysm, EVAR with IBD
- Center:
- Leipzig, Universitätsklinikum, Abt. Angiologie
Case 40 – LEI 13: Male, 72 years (T-F)- Operators:
-
- Axel Fischer
CLINICAL DATAView image
– 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
RISK FACTORS
– CAD, PTCA 2016
– Prostatic cancer 2015
– Hypertension
PROCEDURAL STEPS
1. Treatment under local anaesthesia
– Bilateral femoral access with preloading of 2 ProStyle-systems per groin (ABBOTT)
2. Placement of super-stiff guidewires bilateral and sheaths
– Lunderquist 0.038"" 260cm Guidewire (COOK)
– 12 Fr-45cm sheath left groin (GORE)
– 22Fr-33cm sheath right groin (GORE)
3. Snaring of a 0.018"" support-guidewire accross the aorto-iliac bifurcation
– 0.018"" V-18 Control Guidewire 300cm (BOSTON SCIENTIFIC)
– 10mm Amplatz Goose Neck Snare Kit (MEDTRONIC)
4. Insertion of the sidebranch device right iliac axis
– IBD 23mm-14.5mm (GORE)
5. Cross-over insertion of the sidebranch graft
– internal iliac ectension 16-14.5-70mm (GORE)
6. Implantation of the infrarenal bifurcated stentgraft
– C3 28-14.5-140mm (GORE)
7. Bridging to the IBD left and extension to the right common iliac artery
– 16-27-100mm (GORE) right
– 16-23-120mm (GORE) left -
- , Main Arena 1
BTK/BTA: Long PT/plantar occlusion
- Center:
- Abano Terme
Case 35 – Abano Terme 02: Male, 61 years (G-F)- Operators:
-
- Salvatore Esposito,
- Cesare Brigato
CLINICAL DATAView image
– Type 2 DM; ischemic cardiopathy; heart failure; dyslipedemia; obesity; previous controlateral chopart amputation; Fontaine IV; Rutherford 5
– Deep heel ulcer, moderate ischemia, mild infection
– WIFI: W3 I2 Fi1
PROCEDURAL STEPS
1. US guided antegrade 6F sheath
2. CO2 angio and 2D perfusion of the foot
3. Recanalization anterior and posterior tibial arteries CTO 0,018 /0,014 wires
4. Predilatation if needed and POBA; DEB and dedicated stents discussion
5. US guided Closure device deployment
Devices:
– Ranger (BOSTON SCIENTIFIC) or
– Lutonix DCB (BD) -
- , Main Arena 1
BTK/BTA: Long PT/plantar occlusion
- Center:
- Abano Terme
Case 35 – Abano Terme 02: Male, 61 years (G-F)- Operators:
-
- Salvatore Esposito,
- Cesare Brigato
CLINICAL DATAView image
– Type 2 DM; ischemic cardiopathy; heart failure; dyslipedemia; obesity; previous controlateral chopart amputation; Fontaine IV; Rutherford 5
– Deep heel ulcer, moderate ischemia, mild infection
– WIFI: W3 I2 Fi1
PROCEDURAL STEPS
1. US guided antegrade 6F sheath
2. CO2 angio and 2D perfusion of the foot
3. Recanalization anterior and posterior tibial arteries CTO 0,018 /0,014 wires
4. Predilatation if needed and POBA; DEB and dedicated stents discussion
5. US guided Closure device deployment
Devices:
– Ranger (BOSTON SCIENTIFIC) or
– Lutonix DCB (BD) -
- , Main Arena 2
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 DATAView image
– 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
PROCEDURAL STEPS
1. Percutaneous femoral access (Prostar, ABBOTT)
2. Lunderquistwire (extra stiff wire, COOK) to ascending aorta from right side, Angiocatheter from left side
3. Deployment of low profile TEVAR and 5-branched graft (CMD, COOK), 5th branch retrograde orientation
4. Transfemoral retrograde access to antegrade branches with steerable sheeth (Fustar sheeth 10F/70cm, LaMed) and placement of bridging stents (Viabahn/VBX, GORE; Advanta V12, GETINGE; VisiPro stent, MEDTRONIC; Fluency, BD)
5. Catheterisation and stenting of retrograde branch into false lumen with fenestration of the dissection membrane using Basilika-Technique
6. Potentially staged procedure, completion angiogramm according to approach -
- , Main Arena 1
Pedal recanalization for limb threatenting ischemia
- Center:
- Leipzig, Universitätsklinikum, Abt. Angiologie
Case 36 – LEI 12: Male, 71 years (J-S)- Operators:
-
- Sandra Düsing
CLINICAL DATAView image
– 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
PROCEDURAL STEPS
1. Antegrade access right groin
– 6Fr 50cm sheath (COOK)
2. Guidewire-passage of the posterior tibial artery occlusion
– 0.014"" Command ES 300cm (ABBOTT)
– 0.014"" Winn 200T 300cm (ABBOTT)
– Command 18, 300cm (ABBOTT)
3. Atherectomy / thrombectomy (peroneal artery and posterior artery occlusion)
– Excimer-laser 1.4mm (PHILIPS)
4. Balloon-Angioplasty /DCB-PTA
– Armada 14 2.5/120mm (ABBOTT)
– Litos Drug-Coated Balloon 3.0/120mm (ACOTEC)