LINC 2022 live case guide

During the Leipzig Interventional Course 2022 more than 40 interventional and surgical live cases
are scheduled to be performed and transmitted to the auditorium.

 

 

LINC 2022 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 2

  • - , Main Arena 1

    Left SFA Long-CTO

    Center:
    Tokyo
    Case 09 – Tokyo 01: Male, 72 years, 171cm 66kg, BMI: 22.6 (M-H)
    Operators:
    • Tatsuya Nakama,
    • Shunsuke Kojima,
    • Kazuhiro Asano
    CLINICAL DATA
    – Cre: 0.68, eGFR: 87mL/min
    – ABI Right: 0.55, Left: error
    – Type 2 DM, Hypertension, Dyslipidemia

    RISK FACTORS
    – Prior history of intervention, 2022/05/20 Left CIA-EIA: SMART (8.0x120mm)

    PROCEDURAL STEPS
    1. Right CFA puncture

    2. Crossover approach from Right CFA
    – Radifocus stiff 1.5mm J (TERUMO), 6Fr Crossoversheath (CROSSROAD, NIPRO)

    3. Control angiography

    4. Antegrade approach
    – V18 Control (BOSTON SCIENTIFIC) + 4Fr Vertebral Tempo (CORDIS)

    5. Retrograde approach (if required)
    – V18 Control (BOSTON SCIENTIFIC) + 1.8Fr Carnelian suport (Tokai Medical)

    6. IVUS (BOSTON SCIENTIFIC)
    – Confirm the guidewire passage route and vessel size

    7. Pre-dilatation
    – 5.0 or 6.0x100mm MUSTANG (BOSTON SCIENTIFIC)

    8. Finalize
    – DCB (Ranger, BOSTON SCIENTIFIC) application or
    – Full cover DES (Eluvia, BOSTON SCIENTIFIC) implantation

    9. IVUS and final angiogram
    – End of the procedure
    View image
  • - , Main Arena 1

    Low profile devices for SFA total occlusion treatment

    Center:
    Leipzig, Universitätsklinikum, Abt. Angiologie
    Case 10 – LEI 03: Female, 65 years (H-S)
    Operators:
    • Axel Fischer
    CLINICAL DATA
    – Severe claudication left leg, walking capacity 100 meters
    – ABI left 0.60, Rutherford class 3
    – Angioplasty of iliac stenosis right and left 4/2022 with only little relief of symptoms
    – Diabetes mellitus type 2
    – Hypertension

    RISK FACTORS
    – Angiography left leg during PTA of iliac arteries showing small diameter infrainguinal arteries

    PROCEDURAL STEPS
    1. Cross-over approach from right to left
    – 5Fr Fortress Sheath (BIOTRONIK)

    2. Antegarde guidewire-passage attempt
    – Command 18 300cm Guidewire (ABBOTT)
    – Passeo 18 Balloon 4.0/120mm (BIOTRONIK)

    3. Retrograde approach in case of antegrade failure
    – proximal anterior tibial artery access with
    – 4Fr-10cm sheath (TERUMO)

    4. Drug-coated balloon treatment and stenting
    – Passeo Lux 5.0/120mm Drug-coated balloon (BIOTRONIK)
    – Pulsar-18 T3 6.0/120 (BIOTRONIK) implantation via retrograde or antegrade access
    View image
  • - , Main Arena 2

    Radio-Segment-Ectomy S VII in HCC

    Center:
    Jena
    Case 16 – Jena 01: Male, 70 years (S-M)
    Operators:
    • Philipp Seifert
    CLINICAL DATA
    – NTLC Child B, prior resection intrahepatic bile duct adenoma S VIII,
    prior stereotactic radiation therapy of HCC S VIII (60Gy), new HCC segment VII, TACE failure, ITB waived radiosegmentectomy

    RISK FACTORS
    – Prior TACE non responder, surgery due to cirrhosis contraindicated,
    prior evaluation showed perfect tumor-to-liver ration in uptake, no relevant extrahepatic deposition or lung shunt, no extrahepatic disease, bridging to transplant

    PROCEDURAL STEPS
    1. Arterial puncture right groin

    2. Insertion 5F-sheath. (5F Radiofucus Introducer, TERUMO)

    3. Cannulation of the hepatic common artery origin from the mesenteric artery as a anatomical variant, (4F SIM 1 Super Torque, CORDIS)

    4. Cannulation of the right hepatic artery using microcatheter (Progreat 2.7F, TERUMO)

    5. Advance microcatheter to segment artry VII with dominant tumor supply

    6. Application of the calculated therapeutic dose of 0.5GBq Theraspheres (>350Gy tumor dose), Therasphere (BOSTON SCIENTIFIC)

    7. Removal of all catheters

    8. Vascular closure device right groin (Exoseal 5 F/CORDIS)
    View image
  • - , Main Arena 1

    IVUS controled atherectomy of popliteal artery in patient with CLI

    Center:
    Münster
    Case 11 – Münster 03: Male, 84 years (H-R)
    Operators:
    • Yousef Shehada
    CLINICAL DATA
    – Patient with gangrene of first digit right foot, Rutherford VI, ABI 0,3

    RISK FACTORS
    – CVRF: Hypertension, IDDM
    – CTA: Subtotal stenosis of right popliteal artery,
    – occlusion of posterior tibial artery and stenosis of anteror tibial artery

    PROCEDURAL STEPS
    1. Antegrade access right common femoral artery and intrduction 7F 10cm sheath (TERUMO)

    2. Canulation of popliteal artery stenosis with 0,018 wire (V12 BOSTON SCIENTIFIC) and 0,018 support catheter (Quickcross/PHILIPS), change to 0,014 300cm Phoenix wire (PHILIPS)

    3. Analysis of lesion with IVUS catheter (Visions PV .018, PHILIPS)

    4. Atherectomy of lesion with Phoenix 2.2 deflected cathete (PHILIPS)

    5. DCB-PTA of popliteal artery with Stellarex Ballon (PHILIPS)

    6. Control of lesion with IVUS catheter (Visions PV .018, PHILIPS)

    7. Adjunctive stenting if needed with either InTact Tack (PHILIPS) or Supera stent (ABBOTT)

    8. Treatment of BTK-vessels with Phoenix 1,5 (PHILIPS) and DCB (Stellarex, PHILIPS)

    9. Angiographic and IVUS control of result
    View image
  • - , Main Arena 2

    Recurrent varicosis right leg and vulva varicosis due to pelvic congestion syndrome right ovarian vein

    Center:
    Zurich
    Case 17 – Zurich 01: Female, 33 years (M-D)
    Operators:
    • Nils Kucher,
    • Erik Holy
    CLINICAL DATA
    – Chronic venous insufficiency with recurrent symptomatic leg and vulva varicosis
    – History of embolization therapy of ovarian veins and right internal iliac vein
    – History of crossectomy and stripping of right great saphenous vein
    – History of foam sclerotherapy varicosities right leg

    RISK FACTORS
    – Duplex: nutcracker anatomy (image 2), no May Thurner anatomy,
    – right ovarian vein dilated with reflux
    – MRV: nutcracker, no May Thurner, both ovarian veins dilated and recanalized (image 1)
    – PCS Score (Kucher): 5 point

    PROCEDURAL STEPS
    1. Access right IJ ultrasound guided 5F

    2. Use 5F vertebral catheter or multipurpose catheter for selective venography of left renal vein and ovarian veins

    3. Valsalva venograms to both ovarian veins

    4. Catheter-directed sclerotheraphy to parauterine veins during Valsalva (Aethoxysclerol 3%)

    5. Coil embolization right ovarian vein and possibly left ovarian vein if reflux is present (Interlock, BOSTON SCIENTIFIC) in Sandwich-technique
    View image
  • - , Main Arena 2

    Pelvic congestion syndrome with nutcracker anatomy and left ovarian vein reflux in a nulliparous adolescent

    Center:
    Zurich
    Case 18 – Zurich 02: Female, 17 years (A-Y-E)
    Operators:
    • Nils Kucher,
    • Erik Holy
    CLINICAL DATA
    – Lower abdominal pain, aggravated by menstruation and upright position
    – Suspected endometriosis not confirmed, hormon treatment without improvement
    – No hematuria, no flank pain, no venous claudication
    – Pollakisuria
    – PCS score (Kucher): 5 points

    RISK FACTORS
    – Duplex: mild May Thurner anatomy, no reflux to left internal iliac vein,
    nutcracker anatomy with dilated left ovarian vein with reflux (image 1)
    – MRV: nutcracker anatomy with dilated left ovarian vein (8mm)

    PROCEDURAL STEPS
    1. Venous access to right IJ ultrasound guided 6F

    2. Selective venography with and without Valsalva of left renal vein

    3. If no left renal flow into IVC is visible, may consider transient balloon occlusion of left ovarian vein with simultaneous selective venography of left renal vein (requires second venous access)

    4. Foam sclerotheraphy (aethoxysclerol 3%) to parauterine veins

    5. Coil embolization left renal vein (Interlock BOSTON SCIENTIFIC) in Sandwich technique
    View image
  • - , Main Arena 1

    Chronic, Calcified Occlusion right Common Iliac Artery

    Center:
    Leipzig, Universitätsklinikum, Abt. Angiologie
    Case 12 – LEI 04: Male, 52 years (M-E)
    Operators:
    • Sandra Düsing
    CLINICAL DATA
    – Severe claudcation right leg (buttock, thigh and calf)
    – Walking capacity 100 meters
    – PTA / stenting of a left external iliac occlusion 12/2021 elsewhere

    RISK FACTORS
    – Current smoker
    – Hypertension
    – ABI right 0.58; left 0.81

    PROCEDURAL STEPS
    1. Transbrachial and right femoral access
    – 7F 90cm Check-Flo Performer Sheath (COOK)
    – 7F 25cm Radiofocus Introducer II (TERUMO)
    – SupraCore 300cm 0.035" Guidewire (ABBOTT)

    2. Passage of the CTO right common iliac artery
    Via brachial access:
    – Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
    – 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
    – 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)

    3. Passage into the CTO left CIA from right retrograde for reversed CART-technique
    – Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
    – 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)

    4. Balloon-angioplasty and stenting in kissing-technique
    – Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
    – Viabahn VBX Balloonexpandable Endoprosthesis (GORE)
    – 8.0/59mm right CIA; 8.0/39mm left CIA
    View image
  • - , Main Arena 1

    Chronic, Calcified Occlusion right Common Iliac Artery

    Center:
    Leipzig, Universitätsklinikum, Abt. Angiologie
    Case 12 – LEI 04: Male, 52 years (M-E)
    Operators:
    • Sandra Düsing
    CLINICAL DATA
    – Severe claudcation right leg (buttock, thigh and calf)
    – Walking capacity 100 meters
    – PTA / stenting of a left external iliac occlusion 12/2021 elsewhere

    RISK FACTORS
    – Current smoker
    – Hypertension
    – ABI right 0.58; left 0.81

    PROCEDURAL STEPS
    1. Transbrachial and right femoral access
    – 7F 90cm Check-Flo Performer Sheath (COOK)
    – 7F 25cm Radiofocus Introducer II (TERUMO)
    – SupraCore 300cm 0.035" Guidewire (ABBOTT)

    2. Passage of the CTO right common iliac artery
    Via brachial access:
    – Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
    – 6Fr Launcher Guiding-Catheter 100cm (MEDTRONIC)
    – 5Fr 125cm Judkins Right Diagnostic Catheter (CORDIS)

    3. Passage into the CTO left CIA from right retrograde for reversed CART-technique
    – Stiff straight 0.035" Radifocus Guidewire 260cm (TERUMO)
    – 5.0/40mm Mustang Balloon (BOSTON SCIENTIFIC)

    4. Balloon-angioplasty and stenting in kissing-technique
    – Mustang-balloons 6/40 (BOSTON SCIENTIFIC)
    – Viabahn VBX Balloonexpandable Endoprosthesis (GORE)
    – 8.0/59mm right CIA; 8.0/39mm left CIA
    View image
  • - , Main Arena 2

    Persistent severe nutcracker syndrome post surgical transposition of the left renal vein and ligation of left ovarian vein

    Center:
    Zurich
    Case 19 – Zurich 03: Female, 21 years (A-B)
    Operators:
    • Nils Kucher,
    • Erik Holy
    CLINICAL DATA
    – Left flank pain accompanied with hematuria
    – History of non-thrombotic May Thurner Syndrome treated with Beyond stent with improvement of lower abdominal pain and leg claudication 10/2021
    – History of transposition of the left renal vein and ovarian vein ligation 12/2021
    – History of ballon angioplasty of left renal vein with no imrpovement of nutcracker syndrome 05/2022

    RISK FACTORS
    – Duplex: severe nutcracker with no flow in left renal vein (image 1)
    – MRV: severe nutcracker with recanalized left ovarian vein (image 2)
    – Venography: severe nutcracker with recanalized left ovarian vein (image 3)

    PROCEDURAL STEPS
    1. Venous access ultrasound guided puncture 10F right CFV

    2. Selective venography left renal vein using Cobra 5 F catheter. May use IVUS

    3. Left renal vein stenting (Arbre Stent, MEDTRONIC) or Wallstent (BOSTON SCIENTIFIC) or Epic Stent (BOSTON SCIENTIFIC)

    4. Postdilatation to 12 mm (Mustang, BOSTON SCIENTIFIC). May use IVUS to rule out stent compression
    View image
  • - , Main Arena 1

    Directional Atherectomy and Antirestenosis Treatment (DAART) of a SFA-CTO

    Center:
    Leipzig, Universitätsklinikum, Abt. Angiologie
    Case 13 – LEI 05: Male, 58 years (J-F)
    Operators:
    • Axel Fischer
    CLINICAL DATA
    – Severe claudication bilateral, walking capacity 150 meters
    – ABI right 0.62; left 0.6
    – SFA total occlusions both side, PTA right iliac 4/2022
    – Hypertension, Current smoker

    RISK FACTORS
    – Angiography during iliac PTA showing bilateral SFA CTOs, moderately calcified

    PROCEDURAL STEPS
    1. Right groin cross-over approach
    – 7Fr Balkin Up&Over Sheath 45cm (COOK)

    2. Antegrade guidewire-passage, preferably intraluminal
    – Command 18 300cm Guidewire (ABBOTT)
    – 0.018" TrailBlazer Support-Catheter 130cm (MEDTRONIC)

    3. Retrograde access in case of failure to pass from antegrade or subintimal passage
    – 9cm 21 Gauge needle (B Braun) for distal SFA-puncture
    – Command 18 300cm Guidewire (ABBOTT)
    – 0.018" TrailBlazer Support-Catheter 90cm (MEDTRONIC)

    4. Filter-Protection and atherectomy
    – Spider-Filter 7mm (MEDTRONIC)
    – HawkOne LX Directional Atherectomy System (MEDTRONIC)

    5. PTA with drug-coated balloons
    – In.Pact Admiral 6/120 (MEDTRONIC)
    View image
  • - , Main Arena 2

    Pelvic congestion snydrome due to non-thrombotic May Thurner anatomy

    Center:
    Zurich
    Case 20 – Zurich 04: Female, 18 years (A-K-P)
    Operators:
    • Nils Kucher,
    • Erik Holy
    CLINICAL DATA
    – Lower abdominal pain with aggravation during exercise and upright position
    – Pain radiation to left groin and venous claudication during exercise left leg
    – Pollakisuria

    RISK FACTORS
    – Known endometriosis post laparoscopic removal 6/2020 with no improvement of symptoms
    – Treadmill test with 12% inclination, 3,2 km/h: lower abdominal pain after 70 meter, pain left groin and left leg after 150 meter. Venous claudication persists after termination of exercise.
    – Duplex: No nutcracker but May Thurner anatomy (image 1), spontaneous permanent retrograde flow in left internal iliac vein
    – MRV: May Thurner anatomy

    PROCEDURAL STEPS
    1. Venous access ultrasound guided 10 F left CFV

    2. Venography left common iliac vein

    3. IVUS May Thurner

    4. Sinus obliquus stent into May Thurner lesion (OPTIMED)

    5. IVUS
    View image
  • - , Main Arena 1

    Transradial approach for iliac stenting in PAD patient

    Center:
    Münster
    Case 14 – Münster 04: Male, 60 years (B-D)
    Operators:
    • Yousef Shehada
    CLINICAL DATA
    – Rutherford III WD 100mABI bilateral 0,6 CTA: High grade bilateral common iliac artery stenosis, right side external iliac artery stenosis
    – CVRF: Hypertension, Nicotine use

    PROCEDURAL STEPS
    1. Radial puncture left side with micropuncture set (COOK)

    2. Change to 120cm 6F (8.5FOD) guiding catheter (SheathLessPV ASAHI INTECC)

    3. Canulation of right iliac lesions with 0,035 wire (Advantage TERUMO)

    4. Treatmet of external iliac artery with 8x60mm SES and common iliac artery with 8x38mm cobalt chromium stent, 170cm delivery system (Dynetic BIOTRONIK)

    5. Treatment of left common iliac with 10x38 cobalt chromium stent,
    170cm delivery system (Dynetic BIOTRONIK); Puncture site management with radial compression device (TR-band TERUMO)


    6. Withdrawal of catheters ad puncture site management with radial compression device (TR-band, TERUMO)
    View image
  • - , Main Arena 1

    Calcified BTK-Disease, CLI-Patient

    Center:
    Leipzig, Universitätsklinikum, Abt. Angiologie
    Case 15 – LEI 06: Male, 65 years (K-B)
    Operators:
    • Sandra Düsing
    CLINICAL DATA
    – Ulceration right lateral forefoot, severe claudication right calf
    – Walking-capacity 50 meters
    – Complex recanalization of an extremely calcified long femoropopliteal occlusion 5/2022
    – Planned BTK-recanalization right
    – Stenting right SFA 2017 elsewhere, reoccluded
    – CAD, CABG 2017

    RISK FACTORS
    – Angiography before and after femoropopliteal recanalization 5/2022
    – ABI right 0.2

    PROCEDURAL STEPS
    1. Rigth groin antegrade access and retrograde anterior tibial artery access
    – 6Fr 55cm sheath (COOK)
    – Micropuncture pedal access kit (COOK)

    2. Antegrade and retrograde intraluminal wiring of the anteroir tibial artery CTO
    – Connect 250 T 0.018" Guidewire 300cm (ABBOTT)
    – Winn 200 T 0.014" 300cm Guidewire (ABBOTT)

    3. Atherectomy of the calcified ATA
    – Stealth 360 Peripheral Orbital Atherectomy System, Solide-Crown 1.5mm (CSI)

    4. Drug-coated balloon angioplasty
    – Litos 0.014" Drug-Coated Balloon (ACOTEC)
    View image
  • - , Main Arena 2

    Trans-jugulary-intrahepatic portosystemic stent shunt (TIPSS) in refractory ascites and Child C cirrhosis

    Center:
    Jena
    Case 21 – Jena 02: Female, 52 years (S-A)
    Operators:
    • Florian Bürckenmeyer
    CLINICAL DATA
    – Child C cirrhosis with ascites, otherwise refractory to therapy

    RISK FACTORS
    – CT confirmed cirrhosis and patency of the right hepatic vein, rule out of HCC in estimated puncture tract, no PVT, no large cysts

    PROCEDURAL STEPS
    1. Ultra-sound guided puncture of right jugulary vein

    2. Insertion of Flexor Check Flo II Introducer Set 10F (COOK)

    3. Cannulation of right hepatic vein using Turcon NB Advance Catheter (COOK) TIPS-Configuration and road-runner guide wire 0.018" (COOK)

    4. Advancing introducer-sheath into right hepatic vein using Amplatzer super stiff wire (BOSTON SCIENTIFIC)

    5. Ultrasound-guided puncture of intrahepatic right portal vein using Transjugulary liver access and biopsy Needle Set (COOK)

    6. Advancing diagnostic catheter into portal vein using PIG-Vessel sizing catheter-20B UHF (MERIT MEDICAL) to define lenght of TIPSS-Stentgraft

    7. Measurement of pressure in inferior caval vein, right hepatic vein and portal vein

    8. Dilatation of liver-tract using Passeo 35-XEO 8mm (BIOTRONIK) and advancement of the transjugulary sheath into the portal vein

    9. Implantation of Viatorr 8-10 mm controlled expandable stentgraft (GORE) and repeating of pressure measurement, target pressure of <10mm Hg for HVPG
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