LINC 2018 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 1

  • - , Room 1 - Main Arena 1

    Case 01 – Severely calcified CTO of the SFA left

    Center:
    Leipzig, Dept. of Angiology
    Case 01 – LEI 01: male, 56 years (G-Q)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Severe claudication left calf, walking capacity 50 meters
    - ABI left 0.62
    - Thrombendatherectomy right groin 7/2016
    - Minor stroke 2014

    RISK FACTORS
    - Art. hypertension, diabetes mellitus type 2, nicotine abuse

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - 0.035" SupraCore guidewire 190 cm (ABBOTT)
    - 7F–40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage and PTA
    - Command 18 and Armada 18 balloon (ABBOTT) or
    - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO) and 4.0/120 mm Armada 35 balloon (ABBOTT)
    - 6.0/40 mm Armada 35 balloon (ABBOTT)
    - Conquest high pressure balloon on indicaiton (BARD)
    3. Stenting
    - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 10 – Pelvic lymphocele causing post-thrombotic syndrom left leg

    Center:
    Zürich
    Case 10 – ZUE 01: male, 59 years (W-J)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    - Swelling left leg
    - Residual small pelvine lymphocele post sclerotherapy

    RISK FACTORS
    Compression left external iliac vein, inactive prostate carcinoma

    CT-SCAN
    Lymphocele (post sclerotherapy)

    PROCEDURAL STEPS
    1. Retrograde left common femoral vein access
    - 10F sheath
    2. Retrograde recanalization left iliac vein obstruction
    3. IVUS
    4. Vessel preparation
    5. Stenting
    - New generation woven nitinol stent (Blue Flex stent) 10F (14/100 and 14/150)
    6. Post dilatation
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  • - , Room 1 - Main Arena 1

    Case 02 – Re-occlusion left popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 02 – LEI 02: male, 78 years (G-A)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - Restpain left foot, Rutherford class 4, ABI left 0.40
    - PTA/ stenting left SFA 11/2016 and PTA left popliteal artery
    - PTA/ stent right SFA 11/2015

    RISK FACTORS
    - Chronic renal failure, GFR 65 ml/min
    - Nephrectomy left due to renal cell carcinoma 1994
    - Art. hypertension, former smoker

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 0.035" SupraCore guidewire 190 cm (ABBOTT)
    - 6F–55 cm sheath (COOK)
    2. Guidewire passage
    - Command 18, 300 cm guidewire (ABBOTT)
    - Armada 18 4.0/80 mm balloon (ABBOTT)
    In case of failure to pass the CT from antegrade:
    3. Retrograde approach via proximal anterior tibial artery
    - 7 cm 21 Gauge needle (COOK)
    - Command 18, 300 cm guidewire (ABBOTT)
    - 0.018" 3.0/40 mm Armada 18 balloon (ABBOTT)
    4. P TA and stenting
    - Armada 18 5.0/50 mm balloon (ABBOTT)
    - Supera Interwoven Nitinol Stent 5.0/80 mm (ABBOTT)
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  • - , Room 2 - Main Arena 2

    Case 11 – Left lower limb DVT

    Center:
    Galway
    Case 11 – GAL 01: female, 57 years (A-J)
    Operators:
    • M. Al Hajiry,
    • Gerard O'Sullivan
    CLINICAL DATA
    - 8 day history of low back and pelvic pain; 4 days history of leg pain
    - Swollen, purple, tense; normal pulses

    PRESENT STATE
    - No prior history, no medications, no cancer
    - Recently laid up with severe flu
    - US diagnosed left Ilio-femoral deep vein thrombosis; confirmed on CT

    PROCEDURAL STEPS
    1. Prone position; US guidance
    - 11F sheath; 5000u IV Heparin
    2. Initial venograms; cross lesion with hydrophiic wire (MERIT MEDICAL); confirm position in IVC
    3. Penumbra Indigo 8F Cat system 80 cm long
    4. May or may not use Alteplase 5–20 mg
    5. Repeat venography
    6. Aspiration
    - 7F Detachable Hub sheath (TERUMO) or 8F 45 cm Hockey Stick (CORDIS)
    7. IVUS
    - VOLCANO/ PHILIPS
    8. Balloon
    - Atlas 14–16 mm at high pressure (>20 atm) (BARD)
    9. Venous Stent
    - Zilver Vena 14/140 mm inferiorly (COOK); 16mm x 100 or 140mm superiorly; repeat balloon dilatation to nominal diameter stent
    10. IVUS to confirm full stent expansion; minimal venography to finish; CDUS Day 1; pneumatic compression boots; Class 2 thigh high stockings x 6 weeks
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  • - , Room 3 - Technical Forum

    Case 21 – Progressive bilateral carotid artery stenosis ~80% (surveillance since 2012)

    Center:
    Berlin
    Case 21 – BLN 01: male, 79 years (R-L)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    - CRF: art. hypertension, hyperlipidemia
    - PAOD with bilateral iliac stenting in 2013
    - CHD with CABG and ischemic cardiomyopathy
    - Stenting of right carotid artery 12/2107

    IMPORTANT ITEMS
    - Known carotid artery disease since 2012
    - Yearly DUS surveillance and since Dec. 2017 treatment was initiated by vascular surgeon
    - Vascular surgeon referred the patient for bilateral CAS

    DUPLEX
    PSV right 377 cm/s, left 420 cm/s

    PROCEDURAL STEPS
    1. Transfemoral access
    - 8F short sheath (TERUMO)
    2. Intubation of LCC
    - Berenstein 4F catheter (4F, TEMPO AQUA, CARDINAL HEALTH)
    3. Placement of guiding sheath
    - 8F CBL or Simmons 8F guiding sheath (VISTA BRITE TIP IG, CARDINAL HEALTH)
    4. Wiring with Filter Wire
    - EZ Distal EPD (BOSTON SCIENTIFIC)
    5. Predilation of left ICA
    - 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
    6. Stenting
    - 9 x 30 mm Carotid Wallstent (BOSTON SCIENTIFIC)
    7. Postdilation
    - Paladin 5 x 20 mm balloon with integrated filter protection (CONTEGO MEDICAL)
    8. Removal of guiding catheter and sheath
    9. Vessel closure
    - Angioseal 8F (TERUMO)
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  • - , Room 2 - Main Arena 2

    Case 12 – Right common iliac occlusion in a patient with severe aortic carrefour disease

    Center:
    Cotignola
    Case 12 – COT 02: male, 70 years (P-P)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    - Known vascular history with previous LICA PTA in 2015
    - No history of chest pain, referred progressively deteriorating symptoms of claudication from October '17, now severely impairing his quality of life

    RISK FACTORS
    - Hypertension, previous history of smoking, hypercholesterolemia
    - Severe claudication (20 mt), erectile dysfunction
    - pronounced flow demodulation in both common femoral arteries

    PROCEDURAL STEPS
    1. Radial access for angiographic evaluation
    2 . Bilateral femoral access
    3. Right common iliac artery lesion crossing
    - 0.018'' 300 cm wire or Terumo soft 0,035'' hydrophilic wire
    4. Kissing stenting with balloon-expandable stents
    - Assurant-Cobalt stents (MEDTRONIC)
    5. Postdilation as required
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  • - , Room 2 - Main Arena 2

    Case 13 – TASC D iliac occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 13 – LEI 06: male, 59 years (A-W)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Severe claudication left, walking-capacity 120 meters
    - Rutherford class 3, ABI left 0.53

    RISK FACTORS
    Minor stroke 2009, art. hypertension, former smoker, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Left femoral access
    - 7F 25 cm Radiofocus Introducer (TERUMO)
    - 0.035" SupraCore guidewire 300 cm (ABBOTT)
    Left brachial approach:
    - 7F 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 7/58 bilateral common iliac arteries in kissing-technique (BARD)
    - Covera Plus vascular covered stent for the external iliac artery (BARD)

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  • - , Room 2 - Main Arena 2

    Case 14 – Postpartal ilio-femoral vein thrombosis left

    Center:
    Zürich
    Case 14 – ZUE 02: female, 27 years, (K-S)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    Post-thrombotic syndrome with leg swelling and claudicatio venosa

    RISK FACTORS
    Delivery, postpartum status, May-Thurner anatomy

    DUPLEX
    Occlusion left external iliac and common femoral veins; maintained venous inflow by V. femoralis & V. profunda femoris

    PROCEDURAL STEPS
    1. Ultrasound-assisted retrograde left common femoral vein access
    - 10F sheath
    2. Passage left iliac vein occlusion
    3. IVUS
    4. Vessel preparation
    5. Stenting
    - VIC: Sinus Obliquus (14/150) (OPTI MED)
    - VIC: Sinus XL Flex (14/100) (OPTI MED)
    - VFC: Sinus XL Flex (14/80) (OPTI MED)
    6. Post-dilatation
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  • - , Room 1 - Main Arena 1

    Case 03 – Chronic total occlusion right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 03 – LEI 03: male, 62 years (F-L)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    - Severe claudication right calf, walking capacity 10 meters
    - ABI right 0.35
    - Rutherford class 3

    RISK FACTORS
    - Congesitve heart failure, EF 40%
    - Chronic renal failure, GFR 50 ml/min
    - Art. hypertension, diabetes mellitus type 2, former smoker

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - 0.035" SupraCore guidewire 190 cm (ABBOTT)
    - 6F–40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
    - CXI support catheter, 0.035" 135 cm (COOK)
    In case of failure to pass the CT from antegrade:
    3. Retrograde approach via distal SFA
    - 9 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" CXI support catheter 90cm (COOK)
    4. Angioplasty
    - Advance balloon 5.0/100 mm (COOK)
    - Advance Enforcer 6.0/40 mm in case of focal residual stenosis (COOK)
    5. Stenting
    - Zilver PTX stent 6.0/140 mm (COOK)
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  • - , Room 3 - Technical Forum

    Case 22 – Symptomatic left internal carotid disease in a 79-year old woman

    Center:
    Cotignola
    Case 22 – COT 03: female, 79 years (D-P)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    CLINICAL DATA
    - In November '17 major stroke with right-sided hemiparesis
    - Progressive full recovery in the subsequent 30 days

    RISK FACTORS
    - Hypertension, hypercholesterolemia
    - Asymptomatic (recent stroke)

    DUPLEX
    Left internal carotid tight disease with soft/ mixed plaque determining significant flow acceleration

    PROCEDURAL STEPS
    1. Femoral access
    2. Proximal protection
    - MOMA 9F (MEDTRONIC)
    3. Lesion crossing with 0.014'' wire
    4. Direct stenting
    - 'Double mesh' stent C-Guard (INSPIRE MD)
    5. Postdilation
    - 5.0 mm Maverick XL balloon (BOSTON SCIENTIFIC)
    6. Debris aspiration (if any)
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  • - , Room 1 - Main Arena 1

    Case 04 – Drug eluting stents in SFA lesions

    Center:
    Jena
    Case 04 – JEN 01: male , 46 years (F-T)
    Operators:
    • René Aschenbach,
    • Marcus Thieme
    CLINICAL DATA
    - PAOD Rutherford 3, walking distance 200 meters

    RISK FACTORS
    - Arterial hypertension, current smoker, thromendatherectomy right CFA 12/2017

    DUPLEX
    Long occlussion of left SFA

    PROCEDURAL STEPS
    1. Cross-over access with 6F sheath
    - CXI Support-Catheter Straight, Angled & Angled 2 (COOK)
    2. Guidewire passage to popliteal artery
    - CTO-Approach guidewire 12gr (COOK)
    3. Predilatation
    - 18 LP Advance Balloon (COOK)
    - 35 LP Advance Balloon (COOK)
    4. Drug-eluting stent implantation
    - Zilver-PTX (COOK-MEDICAL)
    5. Postdilatation
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  • - , Room 2 - Main Arena 2

    Case 14 – Postpartal ilio-femoral vein thrombosis left

    Center:
    Zürich
    Case 14 – ZUE 02: female, 27 years, (K-S)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA CLINICAL DATA
    Post-thrombotic syndrome with leg swelling and claudicatio venosa

    RISK FACTORS
    Delivery, postpartum status, May-Thurner anatomy

    DUPLEX
    Occlusion left external iliac and common femoral veins; maintained venous inflow by V. femoralis & V. profunda femoris

    PROCEDURAL STEPS
    1. Ultrasound-assisted retrograde left common femoral vein access
    - 10F sheath
    2. Passage left iliac vein occlusion
    3. IVUS
    4. Vessel preparation
    5. Stenting
    - VIC: Sinus Obliquus (14/150) (OPTI MED)
    - VIC: Sinus XL Flex (14/100) (OPTI MED)
    - VFC: Sinus XL Flex (14/80) (OPTI MED)
    6. Post-dilatation
    View image
  • - , Room 2 - Main Arena 2

    Case 15 – Dealing with a chronic post thrombotic iliac obstruction

    Center:
    Galway
    Case 15 – GAL 02: female, 57 years (S-C)
    Operators:
    • M. Al Hajiry,
    • Gerard O'Sullivan
    CLINICAL DATA
    - Swollen left leg 10 months after an IF DVT
    - Initially presented April 2017 with acute L IFDVT
    - Delayed diagnosis
    - Attempted lysis treatment complicated by genuine anaphylactic reaction to iodinated contrast
    - Abandoned
    - CTV showed IVC to ankle DVT
    - Transferred to Galway; 3 days CDT improved situation, did not stent
    - Anticoagulated for 7 months; leg has improved; still some venous claudication
    - MRV to follow: MRV shows chronic iliac occlusion IVC to L CFV
    - We think CFV is good enough for inflow

    PROCEDURAL STEPS
    1. Access R IVJ; L FV or PFV General anaesthetic; supine, urethral catheter
    - 10F 35cm sheath
    - 8F Hockey stick
    - 5f CXI catheter (COOK)
    - Road runner wire (COOK) or Glide wire (MERIT MEDICAL)
    2. Ideally cross from above and below; confirm position – multiple obliques
    3. Predilatation @ 20atm
    - 16 mm Bard Atlas CIV EIV
    - 14 mm CFV 12 mm PFV
    - or FV cephalad end
    4. Stent choice
    there is no right or wrong; no stent has a proven advantage over another – so: deploying from inferior to superior
    - 14 mm Wallstent/ Veniti Vici/ Bard Venovo/Cook Zilver Vena/ OPTI MED Sinus Venous/ MEDTRONIC Abre; then 16 mm to CIV
    5. Identifying the dominant inflow by IVUS is probably the key step to this case
    6. Post stent dilatation; same size balloons to high pressure
    7. Confirm full stent expansion with IVUS
    8. Venography to finish
    9. Pneumatic compression boots
    (Tyco/COVIDIEN); Class 2 stockings; CDUS day 1; full anticoagulation before, during and after

    View image
  • - , Room 2 - Main Arena 2

    Case 16 – Recanalization chronic iliac vein occlusion left

    Center:
    Zürich
    Case 16 – ZUE 03: female, 69 years (R-L)
    Operators:
    • Nils Kucher,
    • Ulrich Frank
    CLINICAL DATA
    Post-partal iliac vein thrombosis (1969) with post-thrombotic syndrome

    RISK FACTORS
    APC-resistance, atypical left iliac vein compression

    CT-SCAN
    Spontaneous palma, no May-Thurner anatomy but atypical iliac vein compression

    PROCEDURAL STEPS
    1. Ultrasound-assisted retrograde left femoral vein access
    - 10F sheath
    2. Passage left iliac vein occlusion
    3. IVUS
    4. Vessel preparation
    5. Stenting
    - VIC: Sinus Obliquus (14/150) (OPTI MED)
    - VIE: Sinus XL Flex (14/100) (OPTI MED)
    - VFC: Sinus XL Flex (14/80) (OPTI MED)
    6. Postdilatation
    View image
  • - , Room 3 - Technical Forum

    Case 23 – Chronic total occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 23 – LEI 07: male, 72 years (U-R)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - Severe claudication left calf, walking capacity 150 meters
    - ABI left 0.67, Rutherford class 3
    - Failed recanalization-attempt left SFA 11/2017

    RISK FACTORS
    Art. hypertension, former smoker, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 0.035" SupraCore guidewire 190 cm (ABBOTT)
    - 6F–40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO) and
    - QuickCross support catheter, 0.035" 135 cm (SPECTRANETICS - PHILIPS)
    3. PTA and stenting on indication
    - SeQuent Please DCB 5.0/150 mm (B.BRAUN)
    - VascuFlex Multi-LOC (B.BRAUN)
    View image
  • - , Room 2 - Main Arena 2

    Case 17 – IVC sewn graft – occluded – what to do?

    Center:
    Galway
    Case 17 – GAL 03: male, 47 years (M-M)
    Operators:
    • M. Al Hajiry,
    • Gerard O'Sullivan
    CLINICAL DATA
    - Leiomyosarcoma IVC resection 1996;
    - IVC sewn graft;
    - patient for years and discharged to GP;
    - recent severe RTA;
    - no head injury;
    - mildly swollen legs but now more severe

    CT
    CT abdomen with IV contrast as shown

    PROCEDURAL STEPS
    1. Access
    - 10F 35 cm sheaths above and below- RIJV + L CFV + R CFV
    2. Support catheters
    3. Hydrophilic catheters and wires
    4. If successful in crossing, then CBCT (SIEMENS) to confirm all intra-luminal
    5. Exchange to 260 Lunderquist wires (COOK)
    6. Capturex from above to trap any debris
    - Consider use of Aspirex (STRAUB) – I don't know how acute this is really
    7. Attempt balloon dilatation
    - Kissing 14 mm balloons (BARD ATLAS) entire length of occlusion
    8. Kissing stents with high resistance to compression
    - Veniti Vici 14/120 mm and or Sinus XL 24/80 to top end; distal extension to mid CIV or EIV bilaterally
    9. Post stent implantation to same high pressure (>20 atm)
    10. IVUS , venography and CBCT to finish
    - Normally I wouldn't use this much radiation but this is a bit unusual!!!

    View image
  • - , Room 1 - Main Arena 1

    Case 05 – Right superficial femoral diffuse severe disease

    Center:
    New York
    Case 05 – NY 01: female, 66 years (E-M)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • S. Singla,
    • Rheoneil Lascano
    CLINICAL DATA
    - Patient presents with 2 block life-style limiting lower extremity claudication
    - over last 6 months. Progressively worsening. Rutherford Category 3.
    - No history of ulcer. Failed maximal medical therapy.
    - ABI: right 0.71, left 0.92

    RISK FACTORS
    - Hypertension, ex smoker, dyslipidemia
    - CAD s/p CABG
    - PVD - s/p left fempop bypass

    PROCEDURAL STEPS
    1. Left groin access with retrograde cross over approach
    - UF 4F diagnostic catheter (ANGIO DYNAMICS)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
    - 7F–45 cm Pinnacle sheath (TERUMO)
    2. Passage through the right SFA stenosis
    - 0.035" Tempo Aqua Vert support catheter, 125 cm (CORDIS)
    - 0.014" Fielder guidewire, 300 cm (ABBOTT VASCULAR)
    - Exchange to 0.014" Spartacore guidewire, 300 cm (ABBOTT VASCULAR)
    3. Filter placement
    - Exchange to a Barewire through the support catheter (ABBOTT VASCULAR)
    - Emboshield Nav 6 filter placement (ABBOTT VASCULAR)
    4. Plaque modification
    - Chocolate balloon 5 x 120 mm (MEDTRONIC)
    5. PTA with drug-coated balloon
    - In.Pact Admiral 6.0 x 150 mm DCB (MEDTRONIC)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 29 – Occlusion of tibioperoneal trunk left

    Center:
    Berlin
    Case 29 – BLN 03: female, 79 years (K-S)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    - PTA of left SFA & recanalisation of tibioperoneal trunk and ATA 2013
    - Stenting of left SFA 2016 (re-occlusion)
    - Stenting, scoring PTA and DEB of right SFA 2017

    RISK FACTORS
    - Impaired renal function CKD III
    - Hyperlipidemia, art. hypertension, diabetes mellitus

    PRESENT STATE
    - Severe claudication, walking distance <80 meters
    - ABI 0.5 left. 0.71 right

    PROCEDURAL STEPS
    1. Antegrade access
    - 5 F Terumo Destination 45 cm
    2. Crossing of the lesion
    - Advantage 0.018" wire (TERUMO) with CXI Support (COOK)
    3. PTA of TB-trunk
    - 3.0 x 40 mm balloon
    4. Stenting
    - Cr8-BTK (Alvimedica) if needed (after exchange to 0.014" wire)
    5. PTA of ATP and peroneal artery
    - 2.5 mm balloon
    6. Recanalisation of ATA and PTA
    - 2.5 mm x 200 mm balloon
    View image
  • - , Room 3 - Technical Forum

    Case 24 – Critical limb ischemia with restpain right, severely calcified right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 24 – LEI 08: male, 64 years (F-B)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Restpain right foot, livedo forefoot right, ABI 0.0, Rutherford class 4,
    - PTA/ stenting right iliac and left SFA 3/2016, CAD, PTCA 2/2015,
    - Hypertensive and ischemic cardiomyopathy, NYHA II

    RISK FACTORS
    Art. hypertension

    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)
    3. Retrograde guidewire passage
    Access via the proximal anterior tibial artery:
    - 7 cm 21 Gauge needle (COOK)
    - Command 18 guidewire, 300 cm (ABBOTT)
    - 4Fr-10cm 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 7.0/100 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)

    View image
  • - , Room 1 - Main Arena 1

    Case 06 – Severely calcified left SFA restenosis

    Center:
    Cotignola
    Case 06 – COT 01: male, 66 years (A-V)
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    CLINICAL DATA
    - Previous left SFA PTA (plain balloon) for severe claudication in February 2017
    (final angio attached).
    - Asymptomatic till mid November when he started complaining left leg pain for walking distances > 200 mt (very active lifestyle)

    RISK FACTORS
    - Hypertension
    - Severe claudication (walking distance 200 mt)

    DUPLEX
    Evidence of proximal SFA occlusion with flow demodulation in popliteal artery
    1. Right femoral access
    2. Cross-over approach
    - Terumo Destination 6F 45 cm long sheath
    3. Lesion crossing
    - 0.018'' wire, 0.035'' hydrophilic wire (TERUMO)
    4. Atherectomy for lesion preparation
    - HawkOne System (MEDTRONIC)
    5. Balloon dilatation
    - 5.0 and 6.0 mm In.Pact Admiral drug-eluting balloons (MEDTRONIC)
    6. Further postdilatation with long balloons, if needed
    View image
  • - , Room 1 - Main Arena 1

    Case 07 – CLI with multilevel disease right

    Center:
    Leipzig, Dept. of Angiology
    Case 07 – LEI 04: male, 65 years (J-G)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    - Critical limb ischemia with chronic ulceration right heel, Rutherford class 5
    - Restpain during night
    - ABI right 0.33
    - Failed recanalization-attempt of the posterior tibial artery elsewhere 1/2018
    - PTA of the popliteal artery right 7/2017

    RISK FACTORS
    - Diabetes mellitus type 2, CAD, PTCA 7/2017
    - Hypertensive cardiomyopathy, chronic renal failure, GFR 55ml/min
    - Art. hypertension

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    - 6F-55 cm Flecor Shetah (COOK)
    2. Guidewire passage into the anterior tibial artery and placement
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 4m Spider filter (MEDTRONIC)
    3. Atherectomy of the popliteal artery
    - JetStream atherectomy device (BOSTON SCIENTIFIC)
    4. Guidewire passage of the posterior tibial artery
    - 0.014" PT2 guidewire, 30 cm (BOSTON SCIENTIFIC)
    - 0.014" Coyote balloon (BOSTON SCIENTIFIC)
    5. PTA with DCBs of the popliteal and posterior tibial artery
    - Ranger DCB balloon 2.0 – 4.0 mm diameter (BOSTON SCIENTIFIC)

    View image
  • - , Room 3 - Technical Forum

    Case 25 – Long SFA occlusion right leg

    Center:
    Berlin
    Case 25 – BLN 02: female, 78 years (B-P)
    Operators:
    • Ralf Langhoff,
    • M. Boral
    CLINICAL DATA
    - Severe claudication right leg
    - 12 cm long SFA occlusion
    - Recanalisation of left SFA with focal stent and DEB 11/2017

    RISK FACTORS
    Art hypertension, hyperlipidemia, former smoker

    PRESENT STATE
    - Ablatio mammae left 1997
    - ABI: 0.57 right

    PROCEDURAL STEPS
    1. Antegrade access 5F right common femoral
    2. Wire passage
    - 0.018" Advantage (TERUMO) with CXI 0.018" support (COOK)
    - Back-up wire: Connect 0.018" 250T (ABBOTT VASCULAR)
    3. PTA
    - Passeo 18 4 mm balloon (BIOTRONIK)
    - Passeo 18 LUX DEB 5 mm balloon (BIOTRONIK)
    4. Stenting
    - Pulsar 18 5 x 150 mm stent on demand following REACT strategy (BIOTRONIK)
    5. Manual compression
    6. If antegrade recanalisation fails retrograde access via ATA

    View image
  • - , Room 3 - Technical Forum

    Case 26 – Chronic CTO left SFA, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 26 – LEI 09: female, 78 years (E-B)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - Critical limb ischemia, small interdigital ulceration
    - Rutherford class 5, ABI left 0.56
    - CAD, MI and PTCA 2007
    - Spinal surgery 2006

    RISK FACTORS
    Art. hypertension

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
    2. Recanalisation left SFA
    - 0.018" Advantage glidewire (TERUMO)
    - 0.018" CXI support catheter (COOK)
    Back-up material:
    - Connect 250T CTO-wire (ABBOTT)
    - Outback reentry system (CORDIS/ CARDINAL HEALTH)
    3. PTA
    - Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
    - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
    4. Stenting on indication, spot-stenting
    - Pulsar 18 stent (BIOTRONIK)
    View image
  • - , Room 2 - Main Arena 2

    Case 18 – Recanalization vena cava superior occlusion

    Center:
    Zürich
    Case 18 – ZUE 04: female, 65 years, (N-R.M.)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    - PM-associated occlusion of vena cava superior
    - Bi-parietotemporal headache
    - Sick-sinus syndrome with dual-champer PM implantation 2012
    - Persisting pericardial effusion

    CLINICAL IMAGE
    Epigastric collateral veins

    CT
    Occlusion V. cava superior and innominate vein, insufficient hemiacygos collateral vein,
    atypical mamarian and epigastric veins, PM-electrodes in situ

    PROCEDURAL STEPS
    1. Ultrasound-assisted access
    - Left common femoral vein 10F sheath
    - Right internal jugular vein 6F sheath
    2. Passage V. cava superior occlusion
    3. IVUS
    4. Balloon angioplasty
    - Atlas Gold Balloon (up to 16 mm) (BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 20 – Covera (Bard) covered stent graft to resitance venous stenosis

    Center:
    Galway
    Case 20 – GAL 05: male, 49 years (A-O-M)
    Operators:
    • M. Al Hajiry,
    • Gerard O'Sullivan
    CLINICAL DATA
    - Right arm AVF created 2010
    - treatment resistant cephalic vein stenosis
    - brachial artery to cephalic vein
    - recurrent high venous pressures prolonged bleeding – has been dilated every 6 weeks to 3/12 – we are looking for a bit more durability

    PRESENT STATE
    End stage renal disease

    PROCEDURAL STEPS
    1. Right arm AVF access using micropuncure set and then a pursestring suture
    2. Cross lesion using hydrophilic wire and then stiff wire into IVC
    3. Predilate with high pressure balloon to 10mm (its usual size)
    4. Covera stent graft (BARD) to cover the lesion and avoid covering much of subclavian vein beyond
    5. 3000u IV Heparin
    6. Purse-string suture
    7. Dialysis following day

    View image
  • - , Room 3 - Technical Forum

    Case 27 – Restenosis after TEA left internal carotid artery

    Center:
    Leipzig, Dept. of Angiology
    Case 27 – LEI 10: male, 70 years (KH-J)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Restenosis left ICA, TEA left 2013, asymptomatic
    - TEA right 3/2015, minor stroke 5/2006 right hemispheric
    - Congestive heartfailure, EF 45%, NYHA II
    - Chronic renal insufficiency, GFR 67ml/min
    - COPD

    RISK FACTORS
    Art. hypertension, nicotin abuse

    PROCEDURAL STEPS
    1. Right groin acces
    - 8F 25 cm Radiofocus introducer (TERUMO)
    - 5F Judkins Right diagnostic catheter (CORDIS/ CARDINAL HEALTH)
    - 0.035" soft angled glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore 190 cm guidewire (ABBOTT)
    2. Cerebral protection
    - MoMa proximal protection system, Mono-Balloon (MEDTRONIC)
    3. Predilatation and stenting
    - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
    - 8/30 mm CGuard stent (INSPIRE-MD)
    4. Postdilatation
    - Paladin® Carotid Post-Dilatation balloon with integrated embolic protection (CONTEGO MEDICAL)
    5. Aspiration and declamping with the Paladin filter in place
    6. Retrieval of the Paladin system
    View image
  • - , Room 3 - Technical Forum

    Case 28 – Symptomatic left internal carotid artery disease in a 68-year old high-risk patient

    Center:
    Cotignola
    Case 28 – COT 04: male, 68 years (A-S)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    - Known history of dilated cardiomyopathy (EF 35%).
    - Severe COPD.
    - Previous PTA to RICA in 2016.
    - In November 2017 sudden onset of right-sided hemyparesis with dysartria, full recovery after 24 hours.

    RISK FACTORS
    - Hypertension
    - Currently asymptomatic (previous stroke in Novmber 2017)

    DUPLEX
    Severe LICA disease (fibro-calcific disease)

    PROCEDURAL STEPS
    1. Femoral access
    2. Proximal protection
    - MoMa proximal protection system (MEDTRONIC)
    3. Direct stenting with 'closed-cell' stent
    - Carotid Wallstent (BOSTON SCIENTIFIC)
    4. Postdilatation
    - 5.0 mm Maverick XL balloon (BOSTON SCIENTIFIC)
    5. Debris aspiration (if any)
    View image
  • - , Room 1 - Main Arena 1

    Case 08 – Right superficial femoral artery occlusion – calcified

    Center:
    New York
    Case 08 – NYo2: male, 80 years, (H-P)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • S. Singla,
    • Rheoneil Lascano
    CLINICAL DATA
    - Progressively worsening right leg claudication x 1 year
    - No history of rest pain or ulceration
    - Has failed maximal medical therapy
    - Current claudication distance <1 block (Rutherford stage 3)
    - ABI: right 0.82, left 0.94

    RISK FACTORS
    - Type 2 diabetes mellitus, hypertension, dyslipidemia, ex smoker
    - History of CAD s/p CABG

    PROCEDURAL STEPS
    1. Left groin access with retrograde cross over approach
    - UF 4F diagnostic catheter (ANGIO DYNAMICS)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
    - 6F–45 cm Pinnacle sheath (TERUMO)
    2. Passage through the right SFA occlusion
    - 0.035" Tempo Aqua Vert support catheter, 125 cm (CORDIS)
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT VASCULAR)
    - If unable to cross with 0.018" guidewire, switch to an 0.035" stiff angled glidewire (TERUMO)
    3. Filter placement
    - Exchange to a Barewire through the support catheter (ABBOTT VASCULAR)
    - Emboshield Nav 6 filter placement (ABBOTT VASCULAR)
    4. Jetstream atherectomy of the right SFA calcified disease
    - Jetstream 2.4/3.4 mm atherectomy (BOSTON SCIENTIFIC)
    5. PTA with drug-coated balloon
    - In.Pact Admiral 6.0 x 120 mm DCB (MEDTRONIC)
    6. PTA with a non-compliant balloon
    - Dorado 6 x 100 mm balloon (BARD)
    7. Stenting and post-dilatation
    - 5.5 x 150 mm Supera interwoven self-expanding Nitinol stent (ABBOTT)
    - Dorado 6 x 100 mm balloon (BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 09 – Severely calcified SFA-stenosis right

    Center:
    Leipzig, Dept. of Angiology
    Case 09 – LEI 05: male, 72 years (D-W)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Severe claudication right calf, walking capacity 40 meters
    - ABI right 0.47, Rutherford class 3
    - PTA/ stenting left SFA 12/2017
    - CAD, MI 8/2016, PTCA
    - Ischaemic cardiomyopathy, EF 47%
    - Pace-maker 5/2016

    RISK FACTORS
    - Art. hypertension, former smoker

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 7F 55 cm Flexor Check-Flo introducer, Raabe Modifcation (COOK)
    2. Passage of the distal SFA-CTO
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
    - 0.018" QuickCross support catheter 135 cm (SPECTRANETICS)
    3. Angioplasty
    - 6.0/60 mm Lithoplasty balloon (SHOCKWAVE MEDICAL)
    - 6.0/80 mm iLuminor DCB (iVASCULAR)
    View image

Conference day 2

  • - , Room 5 - Global Expert Exchange

    Case 53 – Calcified CTO of the right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 53 – LEI 18: male, 70 years (M-N)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - PAOD Rutherford 3, walking capacity 50 m right, ABI right 0.6, left 0.8
    - PTA/stent of the left SFA 01/2018, of the left CIA 11/2011
    - CEA left 2008, AMI 1998, CABG 02/2017

    RISK FACTORS
    Arterial hypertension, former smoker, hyperlipidemia, renal impairment

    ANGIOGRAPHY
    During PTA left: severely calcifed occlusion of the right SFA

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Passage of the occlusion right 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 SFA
    - 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 and treatment with DCB
    - 6.0/40 mm Advance Enforcer balloon (COOK)
    - Luminor DCB 6.0/120 mm (iVASCULAR)
    5. Stenting on indication
    - 7/150 mm iVolution Self-Expanding stent (iVASCULAR)
    View image
  • - , Room 3 - Technical Forum

    Case 43 – Microwave ablation-HCC

    Center:
    Frankfurt/Main
    Case 43 – FRA 01: female, 76 years (K-M)
    Operators:
    • K. Eichler,
    • Bita Panahi
    CLINICAL DATA
    - HCC-lesion in liver segment 3 in alcoholic liver cirrhosis
    - BCLC B
    - 12/2014 atypical liver resection Seg 7 (G2,pT3a, R0)
    - 09/2016 microwave ablation seg 6
    - 10/2016 microwave ablation seg 8

    PRESENT STATE
    - MELD score:6
    - CHILD-PUGH: A
    - No ascites

    PROCEDURAL STEPS
    1. Pre-ablation imaging like CT (contrast enhanced)
    2. Local anesthesia, analgosedation
    3. One antenna is placed directly into the lesion
    - EMPRINT CA15L2, Short percutaneous Antenna with thermosphere technology (COVIDIEN)
    - Generator: EMPRINT (COVIDIEN)
    View image
  • - , Room 1 - Main Arena 1

    Case 30 – Calcified BTK-CTOs left, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 30 – LEI 11: male, 71 yeras (T-K)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    - PAOD Rutherford 5, D3-ulcerations and rest pain at night, walking capacity 10 m
    - PTA of the left popliteal artery 01/18

    RISK FACTORS
    - Diabetes mellitus type 2, arterial hypertension, former smoker
    - ABI right 0.7, left 0.5

    ANGIOGRAPHY
    During PTA 01/18: occlusion of ATP and ATA

    PROCEDURAL STEPS
    1. Left groin antegrade approach
    - 6F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
    2. Guidewire passage of the occlusion PTA with DCBs
    - 0.014" Command ES guidewire, 300 cm (ABBOTT)
    - 0.018" 90 cm Seeker support catheter (BARD)
    - 0.014" Ultraverse balloon (BARD)
    - Lutonix-BTK DCB (BARD)
    3. In case of dissections after DCB, provisional placement of nitinol "tacks"
    - Tack Endovascular System (Intact Vascular)
    View image
  • - , Room 2 - Main Arena 2

    Case 38 – Aorto iliac aneurysm - EVAR + Iliac branch device

    Center:
    Paris
    Case 38 – PAR 01: male, 86-years (G-J)
    Operators:
    • Stéphan Haulon
    CLINICAL DATA
    Right nephrectomy, pneumothorax, chronic renal insuffisency MDRD 46 ml/min

    RISK FACTORS
    Smoking

    PARACLINICS
    - Echocardiography: normal
    - Supra aortic trunks US: normal

    PROCEDURAL STEPS
    1. R: ZBIS (COOK) advanced into distal aorta, unsheath until tip of prelaoded catheter is released; advance 260 cm Terumo
    2. L: advance 12F sheath + snare
    3. L: snare 260 Terumo, through-and-through wire, advance 12F dilatator tip to tip of preloaded catheter – secure both ends of Terumo wire with clamps
    4. L: unsheath ZBIS to release internal branch – advance 12F sheath into ZBIS (pull and push), access hypogastric with parallel wire, advance 7F sheath-55 cm and bridging stent
    5. Release through and through wire, pull down ZBIS to position the branch at the IIA origin + bridging stent deployment
    6. Selective angiogram + ZBIS final deployment
    7. L: insert and deploy bifurcated component
    8. R: catheterize contro limb and deploy bridging ZSLE 16 limb
    9. Coda balloon, completion angiogram, CBCT
    View image
  • - , Room 3 - Technical Forum

    Case 44 – Radioembolization with Therasphere in recurrent liver metastasis of neuroendocrine tumor

    Center:
    Jena
    Case 44 – JEN 02: male, 59 years (J-M)
    Operators:
    • René Aschenbach,
    • R. Drescher
    CLINICAL DATA
    - Liver only metastasis of neuroendocrine tumor, dominant left liver burden
    - No risk factors, left liver first SIRT
    - No extrahepatic disease

    PROCEDURAL STEPS
    1. Puncture site: right groin
    - ST. JUDE (ABBOTT)
    2. Placement of coaxial catheter in main hepatic artery
    - Cobra 4F, alternative SIM-1, (CORDIS/ CARDINAL HEALTH)
    3. Placement of microcatheter in left hepatic artery therapy positions according to the evaluation session
    - Progreat 2.7F (TERUMO), alternative wire: Cirrus 14" (COOK)
    4. Radioembolization
    - SIRT with Therasphere® (BTG)
    View image
  • - , Room 1 - Main Arena 1

    Case 31 – Occlusion of the right popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 31 – LEI 12: male, 68 years (H-A)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - PAOD Rutherford 3, walking capacity 10–15 m, ABI right 0.55, left 0,8
    - PTA/stenting of left SFA and BTK 12/2107

    RISK FACTORS
    - Arterial hypertension, hyperlipidemia, diabetes mellitus type 2 with neuro- and angiopathy

    PROCEDURAL STEPS
    1. Left groin and cross-over approach
    - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0,035" SupraCore guidewire 30 cm (ABBOTT)
    - 6F–40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage of the occlusion
    - 0.035" Halfstiff Terumo 260 cm (TERUMO)
    - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
    3. PTA with scoring ballon
    - 4/40 mm AngioSculpt PTA scoring balloon (SPECTRANETICS-PHILIPS)
    4. PTA with DCBs
    - Stellarex 5.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
    View image
  • - , Room 2 - Main Arena 2

    Case 39 – Progressive infrarenal AAA

    Center:
    Leipzig, Dept. of Angiology
    Case 39 – LEI 16: male, 63 years (M-B)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    - Progressive asymptomatic AAA, diameter max. 59 mm
    - Coiling of 3 lumbar arteries L2-L3 1/2018
    - PAOD Rutherford 3, PTA left EIA 11/2007 and left SFA 2010

    RISK FACTORS
    Artrial hypertension, hyperlipidemia, nicotine abuse (30Y) and renal impairment

    PROCEDURAL STEPS
    1. Bifemoral percutaneous approach in local anaesthesia
    - Preclosing with 2 Proglide closure devices both sides (ABBOTT)
    2. Guidewire positioning
    - Lunderquist GW 180 cm (COOK)
    3. Implantation of a bifurcational stentgraft
    - Ovation Stentgraft (ENDOLOGIX)
    Cannulation of the contralateral limb:
    - 5F Amplatz Left diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" soft angled short Radiofocus glidewire (TERUMO)
    4. PTA
    - Proximal seal: Reliant balloon (MEDTRONIC)
    - Graft-bifurcation: 12/40 mm Admiral balloon (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 32 – Instent reoclusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 32 – LEI 13: male, 69 years (C-D)
    Operators:
    • Matthias Ulrich,
    • Sven Bräunlich
    CLINICAL DATA
    - PAOD Rutherford 3, walking capacity 150 m, ABI left 0,6
    - PTA/stent right EIA 12/2017, PTA/stent left SFA 08/2016
    - CAD, PTCA 06/2016

    RISK FACTORS
    Hyperlipidemia, nicotine abuse (20PY), arterial hypertension

    ANGIOGRAPHY
    During PTA right 12/2017: IRS left SFA

    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. Guidewire passage of the in-stent reocclusion
    - 0.035" Halfstiff Terumo 260 cm (TERUMO)
    - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
    - Exchange to a 0.014" Floppy ES guidewire 300 cm (ABBOTT)
    3. Laser atherectomy
    - 7F Excimer laser with Turbo Elite 2.3 mm cathether (SPECTRANETICS-PHILIPS)
    4. PTA with DCBs
    - Stellarex 6.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 54 – CTO of the distal SFA and Apop left

    Center:
    Leipzig, Dept. of Angiology
    Case 54 – LEI 19: male, 62 years (K-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - Severe claudication left calf, walking capacity 150 meters, ABI 0.5, Rutherford class 3
    - PTA / stenting right SFA 9/2017 elsewhere
    - CAD with MI and PTCA 2002, TIA 9/2017

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2, nicotine abuse

    PROCEDURAL STEPS
    1. Right groin and cross-over access
    - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Guidewire passage
    - 5.0/100 mm Sterling OTW balloon, 90 cm (BOSTON SCIENTIFIC)
    - 0.018" Victory guidewire, 18 gramm, 300 cm (BOSTON SCIENTIFIC)
    3. Atherectomy for vessel-preparation
    - Diamondback 360 Peripheral Orbital Atherectomy system (CSI CARDIOVASCULAR SYSTEMS)
    - VANGUARD IEP peripheral balloon with integrated embolic protection (CONTeGO MEDICAL)
    4. Direct stenting
    - Eluvia drug-eluting stent (BOSTON SCIENTIFIC)
    View image
  • - , Room 3 - Technical Forum

    Case 45 – Doxorubicin-DEB-TACE with 40μm Embozene Tandem of recurrent HCC after atypical liver resection 9/2017

    Center:
    Jena
    Case 45 – JEN 03: male, 77 years (M-D)
    Operators:
    • I. Diamantis,
    • René Aschenbach
    CLINICAL DATA
    Singular HCC, intraoperative thermal ablation

    PRESENT STATE
    - First diagnosis of HCC in 9/2017,
    - atypical resection, now recurrence,
    - tumor board decission: DEB-TACE
    - Exclusion of extrahepatic disease

    PROCEDURAL STEPS
    1. Puncture site: right groin
    - ST. JUDE (ABBOTT)
    2. Placement of coaxial catheter in the main hepatic artery
    - COBRA 4F, alternative SIM-1 4F both (CORDIS/ CARDINAL HEALTH)
    3. Placement of microcatheter in the feeding artery of HCC
    - Progreat 2.7F (TERUMO), alternative wire: Cirrus 14" (COOK)
    4. DEB-TACE
    5. Control angiogram
    6. If necessary additional bland embolization
    - Embozene Tandem 40μm (BOSTON SCIENTIFIC)
    View image
  • - , Room 2 - Main Arena 2

    Case 40 – Double-Chimney-EVAR for abdominal aortic aneurysm with a PAU at the level of the renal arteries

    Center:
    Münster
    Case 40 – MUN 01: male, 77 years (W-A)
    Operators:
    • Martin Austermann,
    • Marc Bosiers,
    • Konstantinos Stavroulakis
    CLINICAL DATA
    - Art. hypertension
    - PAD
    - COPD

    PRESENT STATE
    Growing aneurysm from 35 mm to >50 mm in 3 years

    PROCEDURAL STEPS
    1. Cut down left axillary artery and double puncture
    2. Placement of two 7 F Shuttle sheath from above
    3. Percutanous approach both groins Prostar XL 10F (ABBOTT) Placement of 14 F sheaths (COOK)
    4. Cannulation of both renal arteries from above
    5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
    6. Placement of the Chimney stent-grafts in both renal arteries
    - Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group) or Viabahn VBX balloon expandable endoprosthesis (GORE)
    7. Closure of the accesses
    View image
  • - , Room 3 - Technical Forum

    Case 46 – Conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC)

    Center:
    Frankfurt/Main
    Case 46 – FRA 02: female, 54 years (T-C)
    Operators:
    • T. Gruber-Rouh,
    • B. Bodelle
    CLINICAL DATA
    - 54 year old patient with HCC lesions in liver segments 8, 8/5 and 6
    - 12/2017: TACE

    RISK FACTORS
    liver cirrhosis, hepatitis B, BCLC-Stage-B, Type 2 diabetes mellitus, hypertension

    PROCEDURAL STEPS
    1. Right retrograde access
    - 5F sheath Introducer 2® (TERUMO)
    2. Catheterization and DSA of celiac trunk plus indirect porotgraphy
    - 5 F Side-Winder catheter (TERUMO)
    - 0.035'' angled guidewire (TERUMO)
    3. Selective catheterization of segmental and subsegmental branches of the hepatic artery in depending on location, size, and arterial feeding vessel of the target tumor
    - 2.8F coaxial microcatheter system Progreat (TERUMO)
    4. Chemoembolization with mitomycin C and lipiodol
    5. Puncture site closure with a percutaneous closure device
    - 6F Angio-Seal™ VIP (ST. JUDE Medical)
    View image
  • - , Room 3 - Technical Forum

    Case 47 – SFA vessel prep and DCB

    Center:
    Teaneck
    Case 47 – TEA 03: male, 63 years (J-D)
    Operators:
    • John Rundback,
    • Kevin Herman,
    • V. Gallo
    CLINICAL DATA
    - Status post kissing iliac stent placement in 2012
    - now presents with recurrent lifestyle – limiting claudication in the right thigh and calf, failed medical and exercise Rx

    RISK FACTORS
    HTN, Dyslipidemia, former 2pk/day smoker stopped 2012

    DUPLEX
    1/3/18 Mild right iliac in-stent restenosis and high grade distal right superficial femoral above knee popliteal artery stenosis

    PROCEDURAL STEPS
    1. Antegrade right SFA access
    - 6F SlenderTM sheath
    2. Distal filter placement (Medtronic Spider)
    3. Atherectomy, TBD, with filter placement
    4. POBA for additional vessel prep (Medtronic Charger)
    5. DCB (Medtronic In.Pact)
    6. Any necessary additional procedures
    View image
  • - , Room 3 - Technical Forum

    Case 48 – CLI; Trans-pedal

    Center:
    Teaneck
    Case 48 – TEA 04: female, 85 years (B-C)
    Operators:
    • Kevin Herman,
    • John Rundback,
    • V. Gallo
    CLINICAL DATA
    Left heel and left great toe ulceration and pain at rest now with difficulty ambulating

    RISK FACTORS
    DM, HTN, hyperlipidemia, emphysema

    HISTORY
    - Revasc of SFA/pop on 1/3/18, Flex peripheral scoring catheter, DCB In.Pact Admiral
    - Failed revascularization of AT from antegrade approach.

    PROCEDURAL STEPS
    1. Left groin access
    - 4F Terumo sheath
    2. Angiogram and methylene blue injection into peroneal artery
    3. DP access using US for guidance
    - 4F Pinnacle/Precision or 4F Pedal Access kit
    4. Attempt to cross from retrograde access
    5. Atherectomy
    - Laser (SPECTRANETICS-PHILIPS) vs. Orbital (CSI CARDIOVASCULAR SYSTEMS), either from antegrade or retrograde access
    6. PTA
    - 2 or 2.5 mm x 300 mm catheter
    7. Possible attempt to revascularize the pedal loop
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  • - , Room 2 - Main Arena 2

    Case 41 – Chronic aortic dissection – false lumen thoraco abdominal aneurysm evolution – 4-vessel FEVAR

    Center:
    Paris
    Case 41 – PAR 02: male, 70 years (J-L-C)
    Operators:
    • Stéphan Haulon
    CLINICAL DATA
    - Acute type A aortic dissection open repair in 2014
    - Aortic arch aneurysm 09/2015: left common carotid subclavian by pass + 2 branches arch endograft

    RISK FACTORS
    - Smoking, hypertension, dyslipidemia, BMI >30
    - Obstructive sleep apnea syndrome, transient stroke

    PARACLINICS
    - PFT: restrictive syndrome
    - CTscan: thoraco abdominal aneurysm, 70 mm maximal diameter
    - Cardiac stress test: negative
    - Supra aortic trunks US: no significative lesion

    PROCEDURAL STEPS
    1. Percutaneous access R and L CFA with Proglide systems; 100ULkg Heparin (Target ACT>250)
    2. R: Dilatators up to 20F, insertion of TEVAR
    3. L: 16F introducer + Pigtail angiocatheter
    4. Aortic angiogram / TEVAR deployment
    5. Insertion of FEVAR delivery system (COOK)
    6. Aortic angiogram / fusion regsitration + FEVAR deployment + access target vessels through fenestrations / bridging stents
    7. ZBIS deployment (COOK)
    6. Bifurcated component deployment
    7. Completion angiogram + non injected CBCT
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  • - , Room 1 - Main Arena 1

    Case 33 – Long SFA-occlusion left in a CLI-patient

    Center:
    Leipzig, Dept. of Angiology
    Case 33 – LEI 14: male, 63 years (AG-N)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    - Critical limb ischemia left, ulcerations dig 2/3 left, restpain
    - Previous femoro-popliteal bypass surgery left (in-situ) 2007 with bypass-thrombectomy 2017
    - Congestive heartfailure, NYHA III
    - Paroxysmal atrial fibrillation
    - COPD

    RISK FACTORS
    Art. hypertension, nicotine abuse

    PROCEDURAL STEPS
    1. Left groin and cross-over approach
    - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0,035" SupraCore guidewire 30 cm (ABBOTT)
    - 6F-40 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    - 0.035" stiff, angled glidewire, 260 cm (TERUMO)
    - 0.035" Seeker support catheter, 135 cm (BARD)
    3. Angioplasty
    - VascuTrak 5.0/300 mm balloon (BARD)
    - Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)
    4. Stenting on indication
    - LifeStent (BARD)
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  • - , Room 3 - Technical Forum

    Case 49 – Prostate artery embolization with 250μm Embozene in symptomatic benign prostatic hyperplasia

    Center:
    Jena
    Case 49 – JEN 04: male, 57 years (L-U)
    Operators:
    • Tobias Franiel,
    • René Aschenbach,
    • F. Bürckenmeyer
    CLINICAL DATA
    IPSS: 28, QoL: 6, IIEF-5: 11, prostatic volume: 72 ml, psa: 2.86 ng/l, Qmax: 4.2 ml/s

    PRESENT STATE
    - Lower urinary tract symptoms due to BPH, no successful medications for more than 6 month, refusing operative therapy such as TUR
    - Exclusion of prostatic cancer

    PROCEDURAL STEPS
    1. Puncture site: right groin
    - ST. JUDE (ABBOTT)
    2. Placement of coaxial catheter in distal aorta
    - RIM 4F (CORDIS) or alternative (MERRIT MEDICAL); Alternative Wire: Cirrus 14" (COOK)
    3. Large-FOV-dyna CT for determination of anatomy and origins of the prostatic arteries
    4. Placement of microcatheter in the left prostatic artery for embolization
    - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT MEDICAL)
    - Embozene 250μm (BOSTON SCIENTIFIC)
    5. Placement of the microcatheter in the right prostatic artery for embolization
    - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT MEDICAL)
    - Embozene 250μm (BOSTON SCIENTIFIC)
  • - , Room 3 - Technical Forum

    Case 50 – Transjugular intrahepatic portosystemic shunt (TIPSS)

    Center:
    Frankfurt/Main
    Case 50 – FRA 03: female, 59 years (B-H)
    Operators:
    • A. Thalhammer,
    • M. Nour Eldin,
    • S. Fischer
    CLINICAL DATA
    Alcoholic liver cirrhosis with portal hypertension, including refractory ascites and variceal bleeding

    RISK FACTORS
    Type 2 diabetes mellitus, hypertension

    PROCEDURAL STEPS
    1. Insertion of 10F sheath into the right jugular vein
    - 10F x 17-3%4'' sheath super Arrow-Flex® Psi Set, 45 cm, and tisue dilatator (Arrow International)
    - 0.035'' angled guide wire (TERUMO)
    2. Access to the a hepatic vein (right or middle) by inserting a 5F multi-purpose catheter
    - 5F MP A1 (CORDIS)
    - 0.035'' angled guide wire (TERUMO)
    3. Puncture of the portal vein under ultrasound or fluoroscopic control using a Tips puncture set
    - Tips puncture set with a spezial nitinol guide wire; needle size: ø 1.8 mm x 580 mm, 60° curved (OPTI MED)
    - 0.035'' straight guide wire (stiff type) (TERUMO)
    4. Placement of stiff guide wire and a catheter into the portal venous system to produce a direct portogram and to measure the direct portal pressure
    - 4F Berenstein catheter (ANGIO DYNAMICS)
    - Haemofix-Monitorin Kit Art/Ven BSS
    5. Dilatation of the parenchymateous tract using an angioplasty balloon
    - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
    - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
    - Inflation device (MERIT MEDICAL)
    6. Placement of the 10F sheath into the portal mainstem
    - 10 F Check Flo Performer® introducer (COOK)
    7. Implantation the portovenous PTFE covered stent under fluoroscopic control
    - VIATORR 10 mm x 8 cm/2 cm; 10F (GORE)
    8. Dilatation of stent using an angioplasty balloon
    - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
    - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
    - Inflation device (MERIT MEDICAL)
    9. Direct portography and measure the pressure gradients between the portal vein and the inferior vena cava
    - 5F- MP A1 (CORDIS)
    - F Check Flo Performer® introducer (COOK)
    10. Placement of a central venous catheter in the superior vena cava or right atrium
    - Mahurkar acute dual lumen catheter, 11.5F x 19.5 cm (COVIDIEN)

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  • - , Room 1 - Main Arena 1

    Case 35 – TASD aorto-iliac occlusive disease

    Center:
    Teaneck
    Case 35 – TEA 02: male, 57 years (J-D)
    Operators:
    • Z. Raval,
    • I. Zairis,
    • Kevin Herman
    CLINICAL DATA
    57 yo male with claudication x 1 yr, not improved with Cilostazol, he works in food delivery business and the symptoms have made his work difficult.

    RISK FACTORS
    HTN, long time smoker (trying to quit-currently with nicotine patch)

    PROCEDURAL STEPS
    1. Bilateral groin access
    2. Will plan for treatment using Endologix AFX Unibody Endograft
    3. Pre-close technique utilizing
    2 Per-Close devices (ABBOTT)
    4. Aortogram to size device
    5. Deploy device, possible extension to cover iliac disease using Ovation limb (ENDOLOGIX)
    6. Alternate plan: b/l groin access and kissing balloon stent graft, VBX (GORE)

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  • - , Room 3 - Technical Forum

    Case 51 – Aorto-iliac occlusion, Leriche-syndrome

    Center:
    Leipzig, Dept. of Angiology
    Case 51 – LEI 17: male, 64 years (K-F)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    - Critical limb ischemia, ulcerations left foot
    - Congestive heart-failure, EF 35%, NYHA II

    RISK FACTORS
    Diabetes mellitus type 2, art. hypertension, current smoker

    PROCEDURAL STEPS
    1. Transbrachial approach
    - 6F 90 cm Check-Flo performer sheath (COOK)
    - 5F 125 cm diagnostic Judkins Right catheter (CORDIS/ CARDINAL HEALTH)
    - SupraCore 300 cm 0.035" guidewire (ABBOTT)
    2. Passage of the occlusions
    - Stiff angled 0,035" guidewire, 260 cm (TERUMO)
    - Together with 5F-125 cm Judkins Right catheter
    3. Bilateral groin access
    - 7F 10 cm Radiofocus sheath (TERUMO)
    - Snaring of the antegrade guidewire form above into the groin-sheath or
    - Into 6F-Judkins-Right guiding catheter (CORDIS) inserted from below
    4. PTA via the groin access bilateral
    - SupraCore 300 cm 0,035" guidewire (ABBOTT)
    - Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
    5. Implantation of covered stents
    - Viabahn 8.0/150 mm in kissing-technique (GORE)
    - Reinforcement with balloon-expandable stents at the aortic bifurcation:
    - Palmaz Genesis 8.0/79 mm balloon-expandable stents in kissing-technique (CORDIS)
    - Bigraft covered stent for the medial sacral artery (BENTLEY)

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  • - , Room 2 - Main Arena 2

    Case 42 – Preloaded FEVAR for a rapid growing juxtarenal aneurysm 61 mm diameter

    Center:
    Münster
    Case 42 – MUN 02: male, 77 years (B-H)
    Operators:
    • Martin Austermann,
    • Marc Bosiers
    CLINICAL DATA
    Art. hypertension, CAD, PAD

    PRESENT STATE
    Rapid growing of a juxtarenal abdominal aortic aneurysm from 45 mm up to 61 mm in 6 month.

    PROCEDURAL STEPS
    1. Percutanous approach both groins (Prostar XL, ABBOTT); 14F sheats (COOK) both groins
    2. Change for the Lunderquist-wire (COOK) on the right side and pig-tail-cath on the left side
    3. Angiography to locate CT, SMA and RAs and use of the fusion-technology
    4. Placement of the 3-fenestrated Zenith-endograft (COOK) via the right groin
    5. Cannulation of the renal arteries through the introducer sheath and the fenestrations by using the preloaded wire
    6. Cannulation of the SMA through the left access
    7. Implantation of the bridging stentgrafts (Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group)) after deployment of the Top-Stent and removal of the preloaded wire
    8. Removal of the introducer sheath
    9. Implantation of the bifurcated endograft and the iliac limbs
    10. Closure of the accesses
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  • - , Room 1 - Main Arena 1

    Case 36 – CFA directional atherectomy with additional DCB angioplasty

    Center:
    Bad Krozingen
    Case 36 – BK 01: female, 64 years (B-R)
    Operators:
    • Aljoscha Rastan
    CLINICAL DATA
    - Claudication Rutherford-Becker class 3
    - DCB angioplasty and stenting of the left popliteal artery 2014
    - Stenting of the right CIA and CIE 2017

    RISK FACTORS
    Hypertension, tobacco use, diabetes, hypercholesterolemia

    PRESENT STATE
    - ABI at rest: 0.7
    - Duplex ultrasound/angiography: 80% stenosis of the left CFA

    PROCEDURAL STEPS
    1. Femoral access (cross-over)
    - 0.035" wire (TERUMO)
    - 7/8F 45 cm sheath (COOK)
    2. Directional atherectomy
    - 0.0014" wire (TERUMO)
    - Spider filter (MEDTRONIC)
    - TurboHawk/ HawkOne (MEDTRONIC)
    3. Post-dilatation
    - DCB (MEDTRONIC)
    4. Stenting on indication
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  • - , Room 1 - Main Arena 1

    Case 37 – Calcified stenosis left CFA

    Center:
    Leipzig, Dept. of Angiology
    Case 37 – LEI 15: male, 65 years (W-W)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    - Severe claudication left leg, walking capacity 200 meters
    - ABI left 0.53, Rutherford class 3, CAD

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2, current smoker

    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. PTA of the CFA left
    - Admiral balloon 7.0; 8.0/20 mm (MEDTRONIC)
    3. Stenting
    - 7.0/40 or 8.0/40 mm Supera Interwoven Nitinol stent (ABBOTT)

    View image

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 55 – Severely calcified occlusion of right popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 55 – LEI 20: male, 65 years (R-B)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    - PAD Rutherford 4 right, rest pain at night, walking capacity 10 m
    - Femoro-popliteal bypass right 2008 and recurrent reocclusion 2017 (11/17)
    - Failed recanalization attempt of the right popliteal 01/18

    RISK FACTORS
    Former smoker, arterial hypertension, renal impairement, atrial fibrillation

    ANGIOGRAPHY
    Occluded femoro-popliteal bypass right and severly calcified popliteal occlusion right

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 6F 90 cm Check-Flow Performer (COOK MEDICAL)
    2. Antegrade guidewire passage
    in casse of failure retrograde approach via the anterior tibial artery
    - 2.9F sheath (pedal puncture set) (COOK)
    - 0.014" CTO-Approach 25 gramm guidewire, 300 cm (COOK)
    - 0.018" CXI support catheter 90 cm (COOK)
    - Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
    3. PTA of the popliteal artery occlusion
    - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
    4. Stenting
    - 5.0/100 mm Supera Interwoven Self-expanding Nitinol stent (ABBOTT)

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  • - , Room 3 - Technical Forum

    Case 74 – Recanalisation of a chronic CIA CTO and stenting of bilateral IIA stenoses

    Center:
    Bad Krozingen
    Case 74 – BK 03: male, 62 years (FG)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    - PAOD Fontaine IIb, Rutherford 3
    - Recanalisation right SFA and proximal popliteal artery 12/2017
    - Recanalisation right popliteal and posterior tibial arteries 06/2014
    - Persistant CTO left CIA and bilateral IIA stenoses

    RISK FACTORS
    Smoking, hypertension, diabetes mellitus, hypercholesterolemia

    PRESENT STATE
    - Buttock, thigh and calf claudicatio left side
    - ABI: 0.8 / 0.4
    - MRA 2014: CTO of left CIA, high grade stenosis of bilateral IIA

    PROCEDURAL STEPS
    1. Bilateral retrograde femoral access
    - Right side 45 cm, left side 11 cm
    2. First crossing approach from contralateral side
    - 6F IMA- or 5 F SOS-catheter
    3. Additional retrograde crossing attempt in order to avoid impacting the left IIA origin (CART technique)
    4. Predilatation of left CIA
    5. Stent implantation left CIA
    6. Stent implantation left IIA (right side on indication)
    - Promus Stent (BOSTON SCIENTIFIC)
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  • - , Room 3 - Technical Forum

    Case 75 – CTO of the right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 75 – LEI 29: male, 59 years (S-K)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    - PAOD Rutherford 3, walking capacity 10 m
    - CAD; CABG MV-Reconstruction, 2010
    - NSTEMI 11/2107 with CPR, PTCA 11/17, ICM (LV-EF 40%)

    RISK FACTORS
    Diabetes mellitus type 2, arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Passage of the occlusion right SFA
    - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    - 0.035" CXC support catheter, 135 cm (COOK)
    - Exchange to 0.018" SteelCore guidewire (ABBOTT)
    3. PTA and stenting on indication
    - Legflow drug-coated balloon (CARDIONOVUM)
    - VascuFlex Multi-LOC (B.BRAUN)
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  • - , Room 1 - Main Arena 1

    Case 56 – BTK and BTA recanalization

    Center:
    Abano Terme
    Case 56 – ABT 01: male, 75 years (B-P)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    CLINICAL DATA
    DM, hypertension, hyperlipidemia

    PRESENT STATE
    Right foot: 3c TUC I°toe and 2c Tuc 2° and 3°

    PROCEDURAL STEPS
    1. US guided antegrade 6F 11 cm sheath
    2. CO2 angiography
    3. 4F Ber and V18 gw antegrade intraluminal recanalization attempt of pedal through AT
    4. Second 0,014" gw in PT and lateral plantar artery antegrade recanalization attempt; retrograde distal PT if failure
    5. POBA, Jetstream atherectomy (BOSTON SCIENTIFIC), Ranger DEB (BOSTON SCIENTIFIC) discussion
    6. US closure device deployment (6F Angio-Seal)

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  • - , Room 2 - Main Arena 2

    Case 68 – Progressive descending thoracic aortic aneurysm

    Center:
    Leipzig, Dept. of Angiology
    Case 68 – LEI 27: male, 72 years (L-J)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan,
    • Chang Shu
    CLINICAL DATA
    - Progressive thoracic AAA (max. diameter 67mm)
    - Coiling of intercostal arteries to reduce the risk of spinal cord ischemia during TEVAR in two sessions (3 arteries)
    - CAD

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Bilateral femoral access
    - Preloading of Proglide-Systems right (ABBOTT)
    2. Positioning of guidewire
    - LunderQuist 0.035" 260 cm (COOK)
    3. Implantation of 2 thoracic stentgrafts
    - Ankura thoracic graft (LIFE TECH)
    - Stengraft from left subclavian artery to the celiac trunk
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  • - , Room 2 - Main Arena 2

    Case 69 – Arch aneurysm – 3-branch arch endograft

    Center:
    Paris
    Case 69 – PAR 03: female, 78 years (E-V)
    Operators:
    • Stéphan Haulon,
    • P. Amabile
    CLINICAL DATA
    - Appendicectomy/ pulmonary lobectomy
    - Present state: asymptomatic

    RISK FACTORS
    Hypertension, smoking, dyslipidemia

    PARACLINICS
    - Echocardiography: LVEF 65% stress test negative
    - PTF: COPD

    PROCEDURAL STEPS
    1. Bilateral cervicotomy
    2. Percutaneous access R and L CFA with Proglide systems; 100UI/kg Heparin (Target ACT>300)
    3. L: Dilatators up to 22F + advance branched endograft to the arch
    4. Aortography + fusion fine tuning
    5. Branched endograft deployment under rapid pacing (COOK)
    6. From RCCA, access to the Inominate branch + deployment of the bridging stent
    7. From LCCA, access to the carotid branch + deployment of the bridging stent
    8. From the groin, access to the LSCA branch + artery + deployment of the bridging stent
    9. Completion angiography + non injected CBCT
    10. Close access sites
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  • - , Room 3 - Technical Forum

    Case 76 – Combined antegrade and retrograde recanalisation attempt of chronic calcified PTA & ATA occlusions left leg

    Center:
    Bad Krozingen
    Case 76 – BK 04: female, 81 years (G-E)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    - PAOD Fontaine IV, Rutherford 5 left leg
    - Chronic bilateral venous insufficiency
    - Intermittant atrial fibrillation
    - Unsuccessful recanalisation attempt of left PTA and ATA 04/2017
    - Chronic kidney diseases NKF III - IV (GFR 23–35 ml/min)

    RISK FACTORS
    Diabetes mellitus, obesity

    PROCEDURAL STEPS
    1. Left antegrade femoral access, 6F
    2. 5F STR guiding catheter (CORDIS)
    3. Balloon guided antegrade crossing attempt
    - 0.014'' Advantage wire (TERUMO) or 0.014'' Victory 14 wire (BSC)
    4. Predilatation on indication
    5. Optional atherectomy
    - Rotablator (BSC)
    6. Drug coated balloon angioplasty
    - Lotus (Acotec)
    7. Stenting on indication
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  • - , Room 3 - Technical Forum

    Case 77 – Distal AT calcified occlusion and long PT/Lateral plantar occlusion

    Center:
    Abano Terme
    Case 77 – ABT 02: male, 60 years (C-N)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    CLINICAL DATA
    - DM, previous SFA stenting (2001)
    - re-treated with directional atherectomy for IS restenosis 2017

    PRESENT STATE
    Ulcerations in IV and V toes TUC 2C right foot

    PROCEDURAL STEPS
    1. Right US guided antegrade 6F 11 cm sheath deployment
    2. CO2 angiography
    3. AT antegrade 0,014" CTO gw intraluminal attempt, retrograde when failure; antegrade PT subintimal attempt
    4. AT Predilatation, Phoenix debulking atherectomy (Philips), Stellarex DEB (SPECTRANETICS-Philips); PT POBA
    5. US guided closure device deployment (Angio-Seal)

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  • - , Room 1 - Main Arena 1

    Case 57 – Reocclusion of right SFA, in-stent-reocclusion

    Center:
    Leipzig, Dept. of Angiology
    Case 57 – LEI 21: male, 62 years (J-W)
    Operators:
    • Matthias Ulrich,
    • Johannes Schuster
    CLINICAL DATA
    - PAOD Rutherford 3, painfree walking distance 50 m
    - Stent-PTA right SFA 03/2017
    - ABI right: 0,5, left: 1,0

    RISK FACTORS
    Smoker, arterial hypertension, diabetes mellitus type 2

    DUPLEX
    ISR-occlusion of the right SFA

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Guidewire passage and thrombectomy
    - Rotarex 6F (STRAUB MEDICAL)
    3. Filter placement
    - 6 mm Spiderfilter (MEDTRONIC) in PIII segment
    4. PTA with DCBs
    - Ranger DCB 5.0/120 mm (BOSTON SCIENTIFIC)

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  • - , Room 1 - Main Arena 1

    Case 58 – Thrombotic occlusion of the right CIA

    Center:
    Leipzig, Dept. of Angiology
    Case 58 – LEI 22: male, 69 years (G-W)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    - POAD Rutherford 3, walking capacity 200 m
    - sudden deterioration of symptoms
    - ABI right 0.6

    RISK FACTORS
    Arterial hypertension, nicotine abuse (30PY)

    ANGIOGRAPHY
    Thrombotic iliac occlusion right

    PROCEDURAL STEPS
    1. Right femoral approach
    - 7F 25 cm sheath (TERUMO)
    2. Guidewire passage and thrombectomy
    - Rotarex 8F (STRAUB MEDICAL)
    3. Stenting
    - LifeStream covered stent for the common iliac artery (BARD)
    - Covera Plus self-expanding covered stent for the external iliac artery (BARD)

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  • - , Room 2 - Main Arena 2

    Case 70 – EVAR for a AAA with a hostile neck using endoanchors and chimney for the RRA

    Center:
    Münster
    Case 70 – MUN 04: male, 77 years (S-L)
    Operators:
    • Martin Austermann,
    • Marc Bosiers,
    • Konstantinos Stavroulakis
    CLINICAL DATA
    - Art. hypertension
    - Diab. mell. II
    - CAD - PTCA 1998 and 2015
    - SAS

    RISK FACTORS
    - Hostile abdomen, obesity

    PROCEDURAL STEPS
    1. Percutanous approach both groins
    - Prostar XL (ABBOTT)
    - Placement of 14F sheath (COOK)
    2. Cut down left axillary artery and cannulation of the right renal artery; Placement of a 7F sheath in the RRA
    3. Placement of Endurant bifurcated endograft (MEDTRONIC) just below the left RA
    4. Implantation of the Chimneygraft in the RRA from above
    5. Additional fixation of the proximal sealing zone with Heli-FX Endoanchors (MEDTRONIC)
    6. Closure of the groin
    - Prostar XL (ABBOTT)
    7. Closure of the axillary access
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  • - , Room 3 - Technical Forum

    Case 78b – Calcified CTO of the left SFA and popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 78b – LEI 30b: male, 54 years (S-K)
    CLINICAL DATA
    - PAOD Rutherford 3 left, painfree walking distance 150 m
    - PTA/ stent of the right SFA 11/2017
    - Pseudoxanthoma elasticum (vascular, ocular and cerebral affection)
    - ABI right: 0.8; left: 0.3
    - PTA/ stenting right SFA 11/2017

    RISK FACTORS
    Arterial hypertension, CAD, hyperlipidemia

    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)
    3. Retrograde guidewire passage
    Access via the peroneal artery:
    - 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 and stenting
    - 6.0/20 mm 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 7.0/100 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)


  • - , Room 3 - Technical Forum

    Case 79 – Critical limb ischemia left, complex BTK CTOs

    Center:
    Abano Terme
    Case 79 – ABT 03: male, 78 years (P-A)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    CLINICAL DATA
    DM, dyalisis, kidney transplant, ischemic heart disease

    PRESENT STATE
    Bilateral CLI with left toes gangrenes

    PROCEDURAL STEPS
    1. Retrograde access right CFA
    - 6F long sheath deployment and retrograde left P3 puncture + 6F 11 cm sheath
    2. Presto technique for SFA and popliteal artery
    - Balloon P3 aemosthasis
    3. Antegrade BTK and BTA reacanalization attempt
    4. Discussion for debulking and DEB
    5. Closure device
    View image
  • - , Room 2 - Main Arena 2

    Case 71 – TEVAR with the new GORE TAG Conformable Stent Graft with active control system for a 62 mm TAA

    Center:
    Münster
    Case 71 – MUN 05: male, 78 years, (K-G)
    Operators:
    • Martin Austermann,
    • Michel Bosiers
    CLINICAL DATA
    Art. hypertension, PAD

    PRESENT STATE
    62 mm thoracic aneuysm with a penetrating ulcer and a small AAA 41 mm in diameter

    PROCEDURAL STEPS
    1. Percutanous approach both groins
    - 5F sheath left groin
    - Prostar XL (ABBOTT) right groin
    - Placement of 14F later 24F Dry-Seal-sheath (GORE) through the right groin
    2. Implantation of the GORE C-TAG endograft with the active control system step by step
    3. Positioning of the graft and deploiment up to 50% diameter
    4. Agiography, correction of the graftposition and the C-arm angulation, if necessary angulation of the graft
    5. Complete deploiment of the graft and possibly some more angulation in order to achieve ideal wall apposition
    6. Final angiography, if needed post-dilation
    7. Closure of the groin
    - Right groin: Prostar XL (ABBOTT)
    - Left groin: Angioseal (ST. JUDE)
    View image
  • - , Room 1 - Main Arena 1

    Case 59 – Long SFA-occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 59 – LEI 23: female, 65 years (N-G)
    Operators:
    • Sven Bräunlich,
    • Manuela Matschuck
    CLINICAL DATA
    - POAD Rutherford 3, walking capacity 200 m, ABI right 0.43
    - Asymptomatic high grade stenosis of brachiocephalic trunc

    RISK FACTORS
    Smoker (40PY), arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over sheath, 40 cm (COOK)
    2. Passage of the occlusion right SFA
    - 0.018" Advantage guidewire (TERUMO)
    - 0.018" CXI support catheter (COOK)
    3. Vessel preparation right SFA
    - Sterling balloon (BOSTON SCIENTIFIC)
    4. Primary stenting
    - Eluvia DES (BOSTON SCIENTIFIC)
    5. Postdilatation left SFA
    - Mustang balloon (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 60 – In-Stent reocclusion right SFA

    Center:
    Bad Krozingen
    Case 60 – BK 02: male, 53 years (M-P)
    Operators:
    • Elias Noory
    CLINICAL DATA
    - PAOD Rutherford 3
    - Severe claudication right calf, walking capacity 50 meters
    - Recanalisation, rtPA-thrombolysis and stent implantation right prox-dist SFA 04/2011
    - Recanalisation and stent implantation right distal SFA 11/2004
    - Fogarty thrombectomy right distal SFA 2004
    - Testicular cancer, semicastratio and radio-chemotherapy 2003-2004
    - ABI: right 0.6 after excercise test 0.4

    RISK FACTORS
    Nicotine abuse (25 PY) to 2006, hypercholertinemia

    DUPLEX
    Long instent reocclusion of right SFA

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross over approach
    - 6F 45 cm sheath
    2. 0.035" or 0.018" Terumo GW, supported by vertebral catheter, 5F
    3. Rotarex thrombectomy
    - 6F (STRAUB MEDICAL)
    4. Predilatation on indication (Cutting balloon)
    5. Drug-coated balloon angioplasty
    View image
  • - , Room 1 - Main Arena 1

    Case 61 – Left popliteal occlusion and BTK-CTO left, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 61 – LEI 24: female, 75 years (P-H)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    - PAOD Rutherford 5 left, forefeet ulcerations and infections, restpain at night, mediasclerosis
    - Failed recanalization attempt 01/18 elsewhere
    - CAD, AMI, PTCA 2012

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    ANGIOGRAPHY
    Popliteal and BTK occlusions left

    PROCEDURAL STEPS
    1. Left groin antegrade approach
    - 6F 55 cm Flexor Check-Flo Sheath, Raabe Modification (COOK)
    2. Guidewire passage, second attempt from antegarde
    - 0.014" CTO Approach 25 gramm 300 cm (COOK)
    - 0.018" CXI support catheter, 90 cm (COOK)
    In case of failure of guidewire passage from antegrade:
    3. Retrograde approach via the distal anterior tibial artery and PTA
    - 2.9F sheath (pedal puncture set) (COOK)
    - 0.014" Hydro-ST 300 cm guidewire (COOK)
    - 0.014" CTO-Approach 25 gramm guidewire, 300 cm (COOK)
    - 0.018" CXI support catheter 90 cm (COOK)
    - Advance 3.0/120 mm, 90 cm (COOK)
    4. PTA of the popliteal artery
    - Advance LP balloon 0.018" (3, 4, 5 mm) (COOK)
    View image
  • - , Room 3 - Technical Forum

    Case 80 – Deep venous arterialization

    Center:
    Teaneck
    Case 80 – TEA 08: female, 83 years (F-G)
    Operators:
    • John Rundback,
    • Kevin Herman,
    • V. Gallo
    CLINICAL DATA
    Non-healing right hallux tip gangrene

    RISK FACTORS
    HTN, dyslipidemia, CAD, prior RLE revasc

    PROCEDURAL STEPS
    1. Antegrade RLE angio
    - 6F slender sheath (TERUMO)
    2. Retrograde pedal venous access (COOK)
    3. Retrograde snare placement in posterior tibial vein
    - EN Snare (MERIT)
    4. Outback (CORDIS) entry from posterior tibial artery to vein
    5. Placement of stent graft
    - Viabahn (GORE) or Graftmaster (ABBOTT)
    6. Flex angiotome or cutting balloon valvulotomy
    7. Selective embolization if needed
    View image
  • - , Room 3 - Technical Forum

    Case 81 – Severely calcified BTK CTO left, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 81 – LEI 31: male, 64 years (B-A)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    - POAD Rutherford 5, Dig. I ulceration left, restpain at night, walking capacity 20 m, ABI left 0.4
    - PTA/stenting left SFA and left ATA 05/17
    - CAD, CABG 2013

    RISK FACTORS
    Arterial hypertension, diabetes mellitus type 2, hyperlipidemia

    PROCEDURAL STEPS
    1. Left groin antegrade approach
    - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)
    2. Guidewire-passage from antegrade
    In case of failure retrograde approach via dorsal pedal artery:
    - 2.9F sheath (pedal puncture set) (COOK)
    - 0.014" CTO-Approach Hydro guidewire, 300 cm (COOK)
    - 0.018" CXI support catheter 90 cm (COOK)
    - Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
    3. In case of failure antegrade approach via posterior tibial artery
    - 0.018" Command 18 guidewire, 300 cm (ABBOTT)
    - 0.018" Quick-Cross support catheter (SPECTRANETICS-PHILIPS)
    4. PTA
    - 2.5/100 m Amphirion Deep ballon catheter (MEDTRONIC)


    View image
  • - , Room 3 - Technical Forum

    Case 82 – AT and PT recanalization with BTA intervention

    Center:
    Abano Terme
    Case 82 – ABT 04: male, 65 years (L-G)
    Operators:
    • Marco Manzi,
    • Luis Mariano Palena,
    • Cesare Brigato
    CLINICAL DATA
    DM, hypertension

    PRESENT STATE
    - Right CLI in previous 2°-3°-4°-5° amputation
    - plantar 2CTUC

    PROCEDURAL STEPS
    1. US guided antegrade Right CFA puncture and 6F 11 cm sheath deployment
    2. CO2 angiography
    3. Antegrade AT recanalization (V18 cw + 4F BER2) antegrade lateral plantar and arch recanalization (0,014 Command)
    4. Discussion for DEB/POBA
    5. US guided closure device deployment (Angio-Seal)

    View image
  • - , Room 3 - Technical Forum

    Case 83 – Combined antegrade and retrograde recanalisation left CIA, EIA, CFA and SFA

    Center:
    Bad Krozingen
    Case 83 – BK 05: male, 71 years (S-W)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    - PAOD Fontaine IIb/ Rutherford 3
    - Recanalisation right EIA, CFA & DFA with persistant SFA occlusion 11/2017
    - Infrarenal AAA
    - ABI: 0.6/ 0.4

    RISK FACTORS
    Hypertension, ex-smoker, hypercholesterolemia

    MRA
    Occlusion of left CIA, EIA, CFA and SFA

    PROCEDURAL STEPS
    1. Retrograde right femoral access (45 cm sheath)
    2. Retrograde puncture distal left SFA
    3. Primarily retrograde recanalisation attempt
    - 0.018'' or 0.035'' Glidewire (TERUMO)
    4. Stenting of iliac vessels
    5. DCB angioplasty of femoral arteries with stenting on indication
    - BioMimics (Veryan) or Supera (ABBOTT VASCULAR)

    View image
  • - , Room 1 - Main Arena 1

    Case 62 – ATA recanalization and dexamethason injection with a Bullfrog-device

    Center:
    Leipzig, Dept. of Angiology
    Case 62 – LEI 25: male, 63 years (B-F)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    - PAOD Rutherford 6 left, forefeet ulcerations, ABI 0.3 left
    - Renal imparement, kidney transplantation 2001, CAD

    RISK FACTORS
    Diabetes mellitus type 2 with neuro- and angiopathy, arterial hypertension, hyperlipidemia, former smoker

    PROCEDURAL STEPS
    1. Left antegrade access
    - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)
    2. Guidewire passage of the ATA-CTO
    - 0.014" Command ES guidewire, 300 cm (ABBOTT)
    - 3.5/120 mm Armada 14 balloon (ABBOTT)
    3. Arterial wall injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
    View image
  • - , Room 1 - Main Arena 1

    Case 63 – OCT-guided atherectomy of Tosaka III ISR right SFA and distal popliteal stenosis

    Center:
    Münster
    Case 63 – MUN 03: female, 65 years, (F-D)
    Operators:
    • Arne Schwindt,
    • N. Abu-Bakr
    CLINICAL DATA
    - Rutherford III right leg, painfree wd 50 m
    - ABI right leg 0,3
    - 2012 nitinol stent right SFA

    RISK FACTORS
    CVRF: hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Left femoral access
    - 7F 45 cm Destination x-over sheath (TERUMO) to right CFA
    2. Wire passage
    - 0,018" V18 wire (BOSTON SCIENTIFIC) and 0,035" Quick-cross (SPECTRANETICS) support catheter
    3. Filter placement
    - 4 mm Spiderfilter (MEDTRONIC) to peroneal artery
    4. OCT-guided atherectomy
    - Pantheris 3.0 7F directional atherectomy catheter (AVINGER) of SFA ISR and popliteal artery
    5. Post PTA
    - 5 x 120 mm paclitaxel eluting balloons, passeo lux (BIOTRONIK)
    6. Filter removal
    - 0,035" Quickcross
    7. Closure of access site
    - Proglide VCD (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 72 – Type IV thoraco abdominal aneurysm – 5-vessel FEVAR

    Center:
    Paris
    Case 72 – PAR 04: male, 71 years (J-P-H)
    Operators:
    • Stéphan Haulon
    CLINICAL DATA
    No medical history

    RISK FACTORS
    Smoking, hypertension

    CT-SCAN
    Type IV abdominal aneurysm/ 2 right renal arteries/ inferior mesenteric artery > 4 mm

    PROCEDURAL STEPS
    1. Percutaneous access R and L CFA with Proglide systems
    2. Inferior mesenteric artery embolization with 6 mm Amplatzer; 100UI/kg Heparin (Target ACT>250)
    3. L: 20F 25cm sheath in the LCFA over Lunderquist –Valve puncture with 6F and 7F 55cm + Pigtail angio catheter
    4. R: Dilatators up to 20F + insertion of fenestrated endograft
    5. Aortic angiogram/ Fusion registration/ FEVAR deployment (COOK)
    6. Access target vessels through fenestrations
    7. Bridging stents deployment
    8. Bifurcated component deployment
    9. Coda inflation at overlap
    10. Completion aortography + non injected CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 64 – Transradial radiocephalic hemodialysis fistulogram and DCB

    Center:
    Teaneck
    Case 64 – TEA 06: male, 66 years (O-S)
    Operators:
    • V. Gallo,
    • John Rundback,
    • Kevin Herman
    RISK FACTORS
    - HTN, dyslipidemia, hypertension, former 2pk/day smoker stopped 2012
    - Type 1 diabetes mellitus
    - End stage renal disease on maintance hemodialysis via left radiocephalic AV fistula
    - Atrial fibrillation, prior forced maturation, recurrent juxta-anastamotic stenosis

    DUPLEX
    - 1/3/18 mild right iliac in-stent restenosis and high grade distal right
    - Superficial femoral above knee popliteal artery stenosis

    PROCEDURAL STEPS
    1. US guided radial artery access (COOK)
    2. 5F Slender sheath insertion (TERUMO)
    3. POBA
    4. POBA for additional vessel prep
    - Conquest high pressure balloon (BARD)
    5. Bard Lutonix DCB
    6. Any necessary additional procedures
    View image
  • - , Room 1 - Main Arena 1

    Case 65 – Pelvic venogram and superficial venous ablation

    Center:
    Teaneck
    Case 65 – TEA 07: male, 70 years (D-R)
    Operators:
    • Kevin Herman,
    • John Rundback,
    • V. Gallo
    CLINICAL DATA
    Chronic LLE swelling, prior LLE fem-pop bypass

    PROCEDURAL STEPS
    1. US guided access into L GSV
    - 10F sheath (BOSTON SCIENTIFIC)
    2. Pelvic venogram
    3. IVUS
    - VOLCANO (PHILIPS)
    4. Iliac vein stent
    - Wallstent (BOSTON SCIENTIFIC)
    5. Post stent venogram and IVUS
    6. GSV Ablation via one access site
    - Venoseal (MEDTRONIC)
    View image
  • - , Room 2 - Main Arena 2

    Case 73 – Coiling of segmental arteries to reduce the risk of paraplegia in FEVAR

    Center:
    Leipzig, Dept. of Angiology
    Case 73 – LEI 28: male, 57 years (W-F)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    - Progressive throraco-abdominal aneurysm after Type B-dissection (diameter max. 61mm)
    - Adipositas, congestive heart failure, NYHA II-III

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, adipositas

    PROCEDURAL STEPS
    1. Right groin access
    - 6F 25 cm sheath (TERUMO)
    - 6F MACH 1 LIMA guiding catheter (BOSTON SCIENTIFIC)
    - 5F SOS diagnostic catheter (MERIT MEDICAL)
    2. Cannulation and embolisation of segmental arteries
    - 0.014 PT2, 300 cm guidewire (BOSTON SCIENTIFIC)
    - 2.7F Progreat Microcatheter, 130 cm (TERUMO)
    - 0.018" pushable microcoils (COOK)
    View image
  • - , Room 1 - Main Arena 1

    Case 66 – Combined antegrade and retrograde recanalisation right popliteal artery

    Center:
    Bad Krozingen
    Case 66 – BK 06: male, 64 years (T-B)
    Operators:
    • Aljoscha Rastan
    CLINICAL DATA
    - Claudication Rutherford-Becker 3
    - Unsuccessful recanalisation right popliteal artery with perforation 12/2017

    RISK FACTORS
    Hypertension, tobacco use, hypercholesterolemia

    PRESENT STATE
    - ABI: 0.3
    - Duplex ultrasound/ angiography: Occlusion of the right popliteal artery

    PROCEDURAL STEPS
    1. Femoral access (cross-over)
    - 0.035" wire (TERUMO)
    - 6F 45 cm sheath (COOK)
    2. Retrograde puncture ATA vs. ATP
    3. Recanalisation attempt
    - 0.018" wire (BOSTON SCIENTIFIC, TERUMO)
    - 3 x 40 mm balloon (BOSTON SCIENTIFIC)
    4. Pre-dilatation
    - DCB vs. POBA (MEDTRONIC, BOSTON SCIENTIFIC)
    5. Stenting on indication
    - Supera (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 67 – Occlusion right SFA after CEA right groin, flush-occlusion

    Center:
    Leipzig, Dept. of Angiology
    Case 67 – LEI 26: male, 64 years (N-M)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    - Chronic critical limb ischemia right forefoot, severe claudication right calf
    - Rutherford class 5, ABI right 0.46
    - PTA/stent of left SFA 12/2017, failed antegrade recanalisation attempt 01/2018 right
    - TEA right groin 8/2017 and left 11/2017
    - CAD, PTCA 2004

    RISK FACTORS
    Diabetes mellitus type 2, art. hypertension, hyperlipidemia, former smoker

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
    - 7F Balkin Up&Over sheath, 40 cm (COOK)
    2. Right SFA CTO puncture
    - 18 Gauge 7 cm needle
    - 0.035" stiff angled Glidewire, 190 cm (TERUMO)
    - 6F – 10 cm Radiofocus-Introducer (TERUMO)
    3. Passage of the CTO
    Retrograde passage into the right CFA:
    - Pioneer-Plus Reentry-system (philips)
    - 0.014" Floppy ES guidewire, 300 cm (ABBOTT)
    - Snaring of the retrograde guidewire into the the cross-over sheath
    4. PTA/stenting
    - Armada 35 5.0/100 mm balloon (ABBOTT)
    - Distal and proximal: Zilver PTX-DES (COOK)
    - SFA-ostium: Viabahn 7.0/250 mm (GORE)
    View image

Conference day 4

  • - , Room 1 - Main Arena 1

    Case 84 – Double chimney EVAR for a juxtarenal abdominal aortic aneurysm

    Center:
    Münster
    Case 84 – MUN 06: male, 71 years, (M-D)
    Operators:
    • Arne Schwindt,
    • Konstantinos Stavroulakis
    CLINICAL DATA
    - Art. hypertension
    - CAD - PTCA Riva 2001
    - Occlusion RCA
    - Occlusion right ICA and CAS left ICA some years ago
    - Bleeding from a gastric ulcer after NSAR 2016

    PRESENT STATE
    Progression of the aneurysm from 4.5 up to 61

    PROCEDURAL STEPS
    1. Cut down left axillary artery and double puncture
    2. Placement of two 7F Shuttle sheaths from above
    3. Percutanous approach both groins Prostar XL 10F (ABBOTT), placement of 14F sheaths (COOK)
    4. Cannulation of both renal arteries from above
    5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
    6. Placement of the Chimney stent-grafts in both renal arteries
    7. Closure of the accesses
    View image
  • - , Room 3 - Technical Forum

    Case 87 – High grade stenosis of an arteria lusoria

    Center:
    Leipzig, Dept. of Angiology
    Case 87 – LEI 33: female, 56 years (C-L)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    - Pain and paresthesia right hand during elevation followed by dizziness and headache
    - RR right: 110/ 60 mmHg ; RR left 140/80 mmHg

    RISK FACTORS
    Arterial hypertension, former smoker (40 py), hyperlipidema , diabetes mellitus Typ II

    PRESENT STATE
    - Subclavian-steal syndrome with retrograde flow in the vertebral artery
    - No dysphagia

    PROCEDURAL STEPS
    1. Right brachial approach
    - 5F 25 cm sheath (TERUMO)
    2. Right femoral approach
    - 7F 90 sheath, Flexor Check-Flo Introducer (COOK)
    3. Passage of the lesion
    - Snaring of the guide wire from femoral acces
    4. Predilation
    - 8 mm Admiral balloon (MEDTRONIC)
    5. Implantation of a self-expanding nitinol stent from femoral
    - Smart 10–12/60 mm stent (CORDIS)
    View image
  • - , Room 3 - Technical Forum

    Case 88 – Chronic occlusion iliac arteries TASC D and long SFA occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 88 – LEI 34: female, 76 years (C-H)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    - PAOD Rutherford 3, walking capacity 10 m left
    - ABI left 0.53

    RISK FACTORS
    - Arterial hypertension, diabetes mellitus type 2, hyperlipidemia
    - Chronic renal failure, GFR 40 ml/min/1.73 m2
    - CAD: NSTEMI and CABG 2009
    - Cerebral ischemia 1994
    - COPD

    PROCEDURAL STEPS
    1. Brachial approach
    - 6F 90 cm Check-Flo Performer (COOK)
    2. Left femoral approach
    - 7 25 cm sheath (TERUMO)
    3. Guidewire passage
    - 0.035" stiff angled Glidewire, 260 cm (TERUMO)
    - Pacific 5.0/120 0mm-Ballon (MEDTRONIC)
    4. Stenting
    - LifeStream covered stent (common iliac artery) (BARD)
    - Cover Plus covered stent (external iliac artery) (BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 85 – Juxtarenal aortic aneurysm

    Center:
    Leipzig, Dept. of Angiology
    Case 85 – LEI 32: female, 78 years (R-R)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    b>CLINICAL DATA
    - Incidental finding of a juxtarenal aortic aneurysm with progression to 75 mm max. diameter
    - Coiling of intercostal and lumbar arteries before FEVAR to reduce the risk of spinal ischemia and prevent type II endoleak, coiling performed during production period of the custommade device

    RISK FACTORS
    - Arterial hypertension, diabetes mellitus Type 2
    - chronic renal impairment, GFR 60 ml/min/1.73 m2

    PROCEDURAL STEPS
    1. Bilateral femoral access and left axillar percutaneous access
    - Preloading of Proglide-Systems (ABBOTT) for all 3 access-sites
    2. Implantation of the CMD thoracoabdominal stentgraft (JOTEC)
    3. Implantation of E-ventus covered stents into the visveral arteries (JOTEC)
    4. Implantation of the bifurcated component with extension into the common iliac arteries

    View image
  • - , Room 3 - Technical Forum

    Case 89 – Occlusion of the tibial trifurcation left

    Center:
    Leipzig, Dept. of Angiology
    Case 89 – LEI 35: male, 71 years (M-P)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    - PAOD Rutherford 3, claudication, walking capacity 100 m left
    - ABI left 0,68
    - Stenting SFA left (Supera) 2017, DEB angioplasty SFA right 2017
    - Angioplasty BTK arteries + stenting popliteal artery right 2014

    RISK FACTORS
    - Arterial hypertension, diabetes mellitus Type 2
    - Chronic renal impairment, GFR 60 ml/ min/ 1.73 m2

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross-over approach
    - 7 F 55 cm Check-Flo Performer, Raab Modification (COOK)
    2. Guidewire passage and filter positioning in the peroneal artery
    - PT2 0.014" guidewire, 300 cm (BOSTON SCIENTIFIC)
    3. Atherectomy and PTA with DCBs
    - Jetstream SC (BOSTON SCIENTIFIC)
    4. PTA with drug eluting balloons
    - Lutonix drug-coated balloon (BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 86 – CMD-5-BEVAR for a thoracoabdominal aneurysm

    Center:
    Münster
    Case 86 – MUN 07: female, 65 years (H-W)
    Operators:
    • Martin Austermann,
    • Marc Bosiers,
    • S. Mühlenhöfer
    CLINICAL DATA
    - Cardiac fibrillation-anticoagulation,
    - art. hypertension,
    - ventilation disorders due to scoliosis of the spine-O2 therapy

    PRESENT STATE
    Growing TAAA, turned down for OR

    PROCEDURAL STEPS
    1. Percutanous approach both groins
    - (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 12F 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
    View image