LINC 2019 live case guide


Find all live cases and live case centers listed below.

 

 

Conference day 1

  • - , Room 1 - Main Arena 1

    Case 01 – Calcified SFA-occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 01 – LEI 01: male, 75 years (M-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 100 meters,
    ABI right 0.54, Rutherford class 3
    PTA both EIA 10/2014 and left SFA 12/2014
    CAD, AMI 02/2014
    Mild renal impairment

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, former smoker

    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
    - Command 18 and Armada 18 balloon (ABBOTT) or
    - 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO)
    3. In case of failure to pass the CTO
    - GoBackTM Crossing Catheter (Upstream Peripheral)
    4. PTA
    - 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
    - Conquest high pressure balloon on indication (BARD)
    5. Stenting
    - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 09 – Woven nitinol stent for chronic total occlusion of common femoral vein

    Center:
    Zürich
    Case 09 – ZUE 01: male, 39 years (FJ-C)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    Severe post-thrombotic syndrome right leg
    History of provoked deep venous thrombosis left leg 2009

    PRESENT STATE
    Villalta score: 12 points
    Hetercygote Faktor-V Leiden mutation

    DUPLEX
    Right leg: chronic thrombosis of common femoral and femoral vein
    Patent iliac veins

    PROCEDURAL STEPS
    1. Analgosedation propofol, fentanyl; ultrasound-guided access: of the size and location of metastases.
    2. Lesion examination with selective venography in two orthogonal views, deep femoral vein imaging using balloon occlusion venography of common femoral vein, provisional IVUS
    3. Passage of femoral vein occlusion using stiff angled glidewire 0.035“, Astato 0.018“ 30 g tip load, angled 0.035“ CXI support catheter
    4. Balloon angioplasty up to 12 mm high pressure of common femoral vein, provisional cutting ballon up to 8 mm
    5. Placement of Blueflow stent (14 x 100 mm or 14 x 150 mm) likely from the jugular approach
    6. Postdilatation high pressure of Blueflow up to 14 mm (ATLAS GOLD, BARD)
    7. Final venograms and assessment of peak flow velocity in common femoral vein by Duplex sonography
    View image
  • - , Room 1 - Main Arena 1

    Case 02 – Calcified CTO of the left distal SFA and left popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 02 – LEI 02: male, 73 years (W-H)
    Operators:
    • Sven Bräunlich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0,5
    CAD, ICM (EF 32%), AMI 2014 and 12/2018, CABG 2014, PTCA 12/18
    Renal impairment

    RISK FACTORS
    Arterial hypertension, diabetes mellitus type 2 with angio- and neuropathy, hyperlipidemia

    PROCEDURAL STEPS
    1. Right 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)
    - 5.0/40 mm Armada 35 balloon (ABBOTT)
    3. Stenting
    - 5.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
    View image
  • - , Room 2 - Main Arena 2

    Case 10 – Live case from Galway

    Center:
    Galway
    Case 10 – Live case from Galway
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 20 – Asymptomatic very high grade LICA-Stenosis in a young vascular polytrauma

    Center:
    Berlin
    Case 20 – BLN 02: male, 52 years (R-V)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    High grade bilateral ICA stenosis (left>right)
    Diabetic foot syndrom left
    Bilateral total SFA occlusions (PTA with DEB and Ultrascore 08/2018)
    Bilateral high grade CIA&EIA steosis (PTA and Stenting 08/2018
    Coronary disease (2 vessel, symptomatic)
    High grade left renal stenosis
    Left Subclavian artery high grade stenosis

    RISK FACTORS
    Smoker, diabetes mellitus, art. hypertension

    CT
    Aortic Arch Type 1, left ostial subtotal carotid artery stenosis

    DUPLEX
    High grade stenosis, not much calcium, straight vessel, soft plaques, high grade stenosis

    PROCEDURAL STEPS
    1. Transfemoral access
    - Short 8F sheath (TERUMO)
    2. Sheath placement
    - 8F MP-shape guiding catheter sheath into the left CCA (VISTA BRITE IG, CORDIS)
    3. Distal Protection
    - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
    4. Predilatation
    - 3 x 40 mm Maverick balloon (BOSTON SCIENTIFIC)
    5. Secondary protection/ stenting/ postdilatation
    - Neuroguard IEP stent 9 mm (CONTEGO MEDICAL) filter, Nitinol stent and postdilation balloon in one system
    6. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
    7. Control angiography extra – and intracranial DSA
    8. Access care
    - Angioseal 8F (TERUMO)
    View image
  • - , Room 2 - Main Arena 2

    Case 11 – TASC D calcified iliac occlusion right

    Center:
    Leipzig, Dept. of Angiology
    Case 11 – LEI 06: male, 59 years (L-G)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right, walking-capacity 50-100 meters
    Rutherford class 3, ABI right 0.46
    COPD

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, strong smoker (50PY)

    PROCEDURAL STEPS
    1. Right femoral access
    - 7F 25 cm Radiofocus Introducer (TERUMO)
    - 0.035“ SupraCore guidewire 300 cm (ABBOTT)
    Left brachial approach:
    - 6F 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 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
    - Covera Plus vascular covered stent for the external iliac artery (BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 03 – Occlusion of the right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 03 – LEI 03: male, 74 years (P-V)
    Operators:
    • Sven Bräunlich,
    • Manuela Matschuck
    CLINICAL DATA
    PAOD Rutherford 3, walking capacity 100 m, ABI right 0.55, left 0.6
    Failed recanalisation attempt of the right SFA 08/12 elsewhere
    Renal impairment grade 2

    RISK FACTORS
    Aterial hypertension, former nicotine abuse (20PY), hyperlipidemia

    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 (PHILIPS)
    3. PTA with scoring ballon
    - 4/40 mm AngioSculpt PTA scoring balloon (PHILIPS)
    4. PTA with DCBs
    - Stellarex 5.0/120 mm DCBs (PHILIPS)
    View image
  • - , Room 3 - Technical Forum

    Case 21 – Symptomatic left carotid artery disease in a patient with coronary artery disease

    Center:
    Bergamo
    Case 21 – BG 02: male, 64 years (D-V)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    Stable angina during the last 12 months, 1 hospital admission for TIA (transient dysartria) 1 month ago

    RISK FACTORS
    Hypertension, hypercholesterolemia

    DUPLEX
    Critical LICA stenosis with evidence of a ‚soft‘ plaque

    PROCEDURAL STEPS
    1. Femoral access
    2. Selective angiography
    3. Cerebral protection
    - MOMA 9F (MEDTRONIC) positioning
    4. Stenting
    - C-Guard (Inspire MD)
    5. Postdilatation
    - 5,0/20 mm balloon (BOSTON SCIENTIFIC )
    6. Femoral access haemostasis
    View image
  • - , Room 2 - Main Arena 2

    Case 12 – Endovascular Y-reconstruction of chronic total occlusion of infrarenal inferior vena cava and iliofemoral veins

    Center:
    Zürich
    Case 12 – ZUE 02: male, 24 years, (F-A)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    Massive descending bilateral iliofemoral DVT in September 2018 including the infrarenal IVC diagnosed late
    and treated conservatively, ongoing shortness of breath, ongoing severe spinal and biliateral leg claudication,
    limited physical performance since childhood

    PRESENT STATE
    Villata score: 6 points;
    Spiroergometry: limited oxygen uptake during exercise due to impaired venous return

    CT VENOGRAPHY
    Obtained 4 weeks after onset of symptoms:
    - chronic total occlusion of perirenal inferior vena cava with descending DVT into both iliac and common femoral veins
    - acygos collaterals

    DUPLEX
    Preserved leg inflow veins

    PROCEDURAL STEPS
    1. General anaesthesia, ultrasound-guided access bilateral femoral veins (below occlusion) and possibly right jugular vein (10F)
    2. Passage of occlusion of vena cava and iliac veins stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load
    3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
    4. High pressure balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
    5. Stenting of IVC with 20 mm Venovo stent (BARD) with high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
    6. Y-reconstruction of iliac confluens using Venovo (BARD) 14 mm kissing stents
    7. Kissing balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
    8. Stent extension to both common femoral veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
    9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography
    View image
  • - , Room 2 - Main Arena 2

    Case 13 – Live case from Galway

    Center:
    Galway
    Case 13 – Live case from Galway
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 14 – Endovascular Y-reconstruction of chronic total occlusion of entire suprarenal and infrarenal inferior vena cava and iliac veins

    Center:
    Zürich
    Case 14 – ZUE 03: male, 46 years (W-C)
    Operators:
    • Nils Kucher,
    • Dai-Do Do
    CLINICAL DATA
    Limited physical performance
    History of acute venous thrombosis right common iliac vein (2013)
    Several catheterizations as newborn

    IMPORTANT ITEMS
    MR-venography: atresia of entire inferior vena cava starting from the liver veins, bilateral common iliac vein occlusion, prominent collateral veins (vena azygos and lumbar veins)
    Spiroergometry: limited oxygen uptake during exercise due to impaired venous return (60% of norm)
    Villalta score: 9 points

    DUPLEX
    patent common femoral veins

    PROCEDURAL STEPS
    1. General anaesthesia, Ultrasound-guided access:
    right and left common femoral veins and possibly right jugular veins (10F)
    2. Passage of occlusion of vena cava and iliac veins using stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load, angled CXI 0.035“ support catheter
    3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
    4. High pressure Balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
    5. Stenting of IVC with two overlapping 20 mm Venovo (BARD) stents and high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
    6. Y-reconstruction of iliac confluens using Venovo 14 mm kissing stents (BARD)
    7. Kissing Balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
    8. Possibly stent extensions to both external iliac veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
    9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography
    View image
  • - , Room 3 - Technical Forum

    Case 23 – Long calcified SFA-occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 23 – LEI 07: male, 61 years (R-F)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf, walking capacity 50 meters, ABI left 0.62
    Femoro-popliteal bypass right 2012, thrombendatherectomy left groin 01/2019
    CEA left 11/2012 and right 12/16, CAD, AMI 1997

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2, nicotine abuse (80PY), hyperlipidemia

    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 (ABBOTT)
    - 7F Balkin Up&Over sheath, 40 cm (COOK)
    2. Antegrade guidewire-passage
    In case of failure from antegrade:
    Retrograde GW-passage via proximal ATA
    - 21 Gauge 9cm needle (B.BRAUN)
    - 0.018” V-18 Control GW, 300cm (BOSTON SCIENTIFIC)
    - 0.018” CXC Support-Catheter, 90cm (COOK)
    3. In case of failure to pass the guidewire
    - retrograde approach via distal SFA or GoBackTM Crossing Catheter (Upstream Peripheral) from antegrade
    4. Tumescent anesthesia of the SFA
    - Bullfrog-Device (MERCATOR)
    5. PTA/ vessel preparation
    - Sterling 5/100 mm balloon (BOSTON SCIENTIFIC)
    - Conquest High pressure balloon on indication (BARD)
    6. Differential stenting
    - Eluvia DES in case of minor recoil (BOSTON SCIENTIFIC)
    - Supera Interwoven Nitinol-Stent in case of severe recoil (ABBOTT)
    View image
  • - , Room 5 - Global Expert Exchange

    Case 28 - Live case from Bergamo

    Center:
    Bergamo
    Case 28 - Live case from Bergamo
    Operators:
    • Antonio Micari,
    • Fausto Castriota
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 04 – Chronic total occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 04 – LEI 04: female, 76 years (M-R)
    Operators:
    • Matthias Ulrich,
    • Manuela Matschuck
    CLINICAL DATA
    Severe claudication both calves, walking capacity 20 meters
    Obesitiy, renal impairment G3, ICM, mycardial infarction 2009
    ABI right: 0.53 and left: 0.64

    RISK FACTORS
    Arterial hypertension, former smoker

    ANGIOGRAPHY
    11/2018: long SFA-occlusions both sides, moderate calcification

    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 of the right SFA
    - 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
    - 0.035“ TrailBlazer support catheter, 135 cm (MEDTRONIC)
    - Exchange to 0.018“ SteelCore guidewire (ABBOTT)
    3. PTA with DCBs
    - 5.0 mm Chocolate balloon (MEDTRONIC)
    - 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)
    4. Stenting on indication
    - Complete Selfexpanding Nitinol stent (MEDTRONIC)
    View image
  • - , Room 2 - Main Arena 2

    Case 15 – Live case from Galway

    Center:
    Galway
    Case 15 – Live case from Galway
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 05 – Severe diffuse left SFA disease with distal occlusion

    Center:
    New York
    Case 05 – NY 01: female, 75 years, (S-C)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur
    CLINICAL DATA
    Left leg claudication x 6 months (< 3 blocks)
    Failed exercise therapy and a trial of Cilostazol
    ABI (R/L) 0.92/0.71

    RISK FACTORS
    Type 2 DM, HTN, dyslipidemia

    DUPLEX
    Suggestive of distal left SFA occlusion

    PROCEDURAL STEPS
    1. Right CFA access
    - Micropuncture sheath (COOK)
    2. Access sheath
    - 6F 45 cm crossover Destination sheath (TERUMO)
    3. Antegrade lesion crossing
    - 0.035“ stiff angled glidewire (TERUMO)
    4. Embolic protection
    - Emboshield Nav 6 (4-7) filter deployment (ABBOTT)
    5. Ultrasound
    - Vision PV 0.14 intravascular ultrasound (PHILIPS)
    6. Atherectomy
    - Directional atherectomy, Hawk M (MEDTRONIC)
    7. Angioplasty
    - Drug coated balloon angioplasty IN.PACT Admiral balloon (MEDTRONIC)
    8. Stenting
    - Stent scaffold for severe flow limiting dissection
    View image
  • - , Room 3 - Technical Forum

    Case 25 – Live case from New York

    Center:
    New York
    Case 25 – Live case from New York
    Information will follow in due time. Thank you for your understanding.
  • - , Room 5 - Global Expert Exchange

    Case 29 – Diabetic foot syndrome with CTO of tibioperoneal trunc and distal occlusion of the ATP

    Center:
    Berlin
    Case 29 – BLN 04: male, 62 years, (J-B)
    CLINICAL DATA
    Gangrene Dig. ped. II right, persistend occlusion of right tibioperoneal trunc
    Diabetes mellitus
    Minor amputation of right foot Dig ped I ex-articulation of end-phalanx
    PTA and Supera stenting right SFA & popliteal artery 01/2019
    Impaired renal function
    TEA and Patch bilateral common femoral artery (2015)

    RISK FACTORS
    Hyperlipidemia (Lipidapharesis since 2016), art. hypertension
    CHD (post-MI), recanalisation of inflow was done by cross-over approach,
    wound is only slowly improving

    PROCEDURAL STEPS
    1. Antegrade access
    - Destination 5F sheath (45 cm) right CFA (TERUMO)
    2. Recanalisation
    - supported by CXI Supportcatheter 0.018“ (COOK) and Advantage Glidewire 0.018“ (TERUMO)
    3. PTA
    - 2 x 40 mm ballon Passeo 18 (BIOTRONIK)
    4. Recanalisation of the tibioperoneal trunc & distal ATP to the pedal arch and PTA
    5. Stenting of the tibioperoneal trunc
    - 3.0 x 31 mm Cre8 BTK dedicated DES (ALVIMEDICA)
    6. BACK-UP: transpedal-loop recanalisation of the ATP via the ATA
    - 0.014“ Corsair Microcatheter (ASAHI) and 0.014“ Advantage Wire (TERUMO)
  • - , Room 2 - Main Arena 2

    Case 16 – Rapidly progressing right carotid artery disease in a 55-yrs old patient

    Center:
    Bergamo
    Case 16 – BG 01: female, 55 years (C-C)
    Operators:
    • Fausto Castriota,
    • Antonio Micari
    CLINICAL DATA
    CVRFs: hypertension, hypercholesterolemia
    Unstable angina treated with PCI to LAD (DES) in December 2018 (need for 12-month double antiplatelet therapy)

    DUPLEX
    Critical RICA stenosis (NASCET 80%) with evidence of a ‚soft‘ fast-growing plaque (40% at Duplex scan performed in January 2018)

    PROCEDURAL STEPS
    1. Femoral access
    2. Selective angiography
    3. Cerebral protection
    - MOMA 9F (MEDTRONIC) positioning
    4. Stenting
    - Roadsaver (TERUMO) stent
    5. Postdilatation
    - 5,0/20 mm balloon (BOSTON SCIENTIFIC)
    6. Femoral access haemostasis
    View image
  • - , Room 2 - Main Arena 2

    Case 17 – High-grade, progressive RICA post radiation and open surgery for parotid tumor

    Center:
    Berlin
    Case 17 – BLN 01: male, 62 years, (J-B)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    Radiation and open surgery due to parotid cancer (years ago)
    Renal insufficiency (last Creatinin level 2.3 mg/dl)

    DUPLEX
    High grade RICA, PSV 364 cm/sec, EDV >100 cm/sec, MDV 100 cm/sec

    RISK FACTORS
    Ex-nicotine, art. hypertension

    PRESENT STATE
    CTA and MRA not available due to impaired renal function

    PROCEDURAL STEPS
    1. Transfemoral access
    - Short 8F sheath (TERUMO)
    2. Placement of the guiding catheter
    - 8F MP-shape guiding catheter sheath into the right CCA (VISTA BRITE IG, CORDIS)
    3. Distal Protection
    - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
    4. Predilatation
    - 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
    5. Stenting
    - Roadsaver 8 x 25 mm Micromesh-stent (TERUMO)
    6. Postdilatation
    - 5 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
    7. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
    8. Control angiography extra – and intracranial DSA
    9. Access care
    - Angioseal 8F (TERUMO)
    View image
  • - , Room 2 - Main Arena 2

    Case 19 – Live case from Galway

    Center:
    Galway
    Case 19 – Live case from Galway
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 27 – Restenosis of the left common carotid artery after TEA

    Center:
    Leipzig, Dept. of Angiology
    Case 27 – LEI 09: female, 56 years (L-K)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Asymptomatic highgrade stenosis of the the common carotid artery left, dizziness
    M. Hodgkin 1984 with cervical radiation
    CEA right 09/16 and CEA of left common carotid artery 05/17

    RISK FACTORS
    Art. hypertension, hyperlipidemia, former smoker

    DUPLEX
    4.8 m/sec. Left distal common carotid artery

    PROCEDURAL STEPS
    1. Right groin access
    - 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0.015“ SupraCore guidewire (ABBOTT)
    - 7F 90cm Check Flo Performer sheath (COOK)
    2. Cerebral protection
    - Filter-wire EZ (BOSTON SCIENTIFIC)
    3. Predilatation and Stenting
    - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
    - 8/30 mm CGuard stent (InspireMD)
    View image
  • - , Room 1 - Main Arena 1

    Case 07 – Chronic CTO left SFA, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 07 – LEI 05: male, 64 years (P-W)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia left, ulceration dig 4, Rutherford class 5
    Severe claudication left calf, walking capacity 50–100 meters,
    PTA/stenting left EIA 11/2018
    ABI left: 0.45

    RISK FACTORS
    Diabetes mellitus type 2, arterial hypertension, former smoker

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
    2. Passage of the occlusion left 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
    - 9 cm 20 Gauge spinal needle (BD)
    - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 4F 10 cm Radiofocus introducer (TERUMO)
    - Passeo 18 4.0/40 mm balloon, 90 cm (BIOTRONIK)
    4. PTA
    - Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
    - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
    5. Stenting on indication, spot-stenting
    - Pulsar 18-T3 stent (BIOTRONIK)
    View image
  • - , Room 1 - Main Arena 1

    Case 08 – Live case from New York

    Center:
    New York
    Case 08 – Live case from New York
    Information will follow in due time. Thank you for your understanding.

Conference day 2

  • - , Room 5 - Global Expert Exchange

    Case 53 – CTO, multilevel disease right

    Center:
    Leipzig, Dept. of Angiology
    Case 53 – LEI 17: male, 70 years (B-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford class 4, claudication right calf, walking capacity 50 m, restpain during night, ABI right 0.52, EVAR and stenting right renal artery 11/2018, chronic pancreatitis
    Failed recanalization attempt right popliteal 12/18 elsewhere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    - 7F 55 cm Flexor sheath (COOK)
    2. Antegrade guidewire passage
    in case of failure retrograde approach via the proximal 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. Atherectomy of the popliteal artery
    - JetStream atherectomy device (BOSTON SCIENTIFIC)
    4. Angioplasty
    - VascuTrak 4.0/120 mm balloon (BARD)
    - Luminor DCB (iVascular)
    5. Stenting on indication
    - Spot-stenting with Multi Lock (B.BRAUN)
    View image
  • - , Room 3 - Technical Forum

    Case 44 – Live case from Frankfurt/Main

    Center:
    Frankfurt/Main
    Case 44 – Live case from Frankfurt/Main
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 39 – Live case from Münster

    Center:
    Münster
    Case 39 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 30 – CLI with CTO BTK left

    Center:
    Leipzig, Dept. of Angiology
    Case 30 – LEI 10: female, 79 years (G-H)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Critical limb ischemia both lower legs with chronic ulcerations, Rutherford class 5
    ABI left 0.34, ABI right 0.45
    Recanalization right peroneal artery 01/07/2018
    PTA SFA/popliteal artery left and PTA anterior tibial right 11/2018
    Amputation forefoot left
    Amputation D1 right

    RISK FACTORS
    Diabetes mellitus type 2 with diabetic neuropathy, arterial hypertension, chronic renal impairment

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 6F 55 cm sheath (COOK)
    2. Guidewire-passage anterior/posterior tibial
    - 0.014“ Command (ABBOTT)
    - 0.014“ PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)
    - In case of failure: retrograde approach
    3. PTA
    - Vessel preparation – scoring balloon (VascuTrak, BARD)
    - Lutonix BTK DCB (BARD)
    4. In case of dissections after DCB, provisional placement of nitinol „tacks“
    - Tack Endovascular System (Intact Vascular)
    View image
  • - , Room 3 - Technical Forum

    Case 45 – Selective internal radiation therapy in hepatocellular carcinoma

    Center:
    Jena
    Case 45 – JEN 01: male, 63 years (D-J)
    Operators:
    • René Aschenbach,
    • S. Witting,
    • R. Drescher
    CLINICAL DATA
    HCC Stage IIIa (pT3 Nx M0) 6/18
    Atypical segmentectomy segment III 6/18
    cTACE performed in referring hospital
    Multifocal HCC in both liver lobes
    Primary outside MILAN
    Universal liver tumor board waived sequential SIRT, starting right
    Evaluation showed a 2.5% shunt to the lung and estimated dose of 2.5GBq for Therasphere (BTG)
    No extrahepatic deposition of radioactivity in test-dose

    RISK FACTORS
    Liver cirrhosis CHILD A, MELD 6
    Diabetis mellitus, arterial hypertonia

    PROCEDURAL STEPS
    1. Right groin retrograde access
    - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
    - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
    2. Placement of diagnostic catheter in main hepatic artery
    - 0.035‘‘Radiofocus angled guidewire, 180 cm (TERUMO)
    - Diagnostic catheter SIM 1, 4F 0.035‘‘, 100 cm (CORDIS)
    3. Placement of microcatheter in right hepatic artery
    - Progreat 2.7F (TERUMO)
    - alternative wire: Cirrus 14‘ (COOK)
    4. Radioembolisation
    - SIRT with TheraSphereR yttrium-90 glass microspheres (BTG)
    5. Puncture site occlusion
    - Vascularclosure Device Exoseal (CORDIS)
    View image
  • - , Room 2 - Main Arena 2

    Case 40 – Infrarenal AAA

    Center:
    Leipzig, Dept. of Angiology
    Case 40 – LEI 15: male, 77 years (G-G)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Asymptomatic infrarenal AAA, diameter max. 58 mm
    Coiling of lumbar arteries 12/2018

    RISK FACTORS
    Art. hypertension, chronic renal impairment, hyperlipidemia

    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 31 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 31 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 5 - Global Expert Exchange

    Case 54 – Long occlusion of the left popliteal artery

    Center:
    Leipzig, Dept. of Angiology
    Case 54 – LEI 18: female, 67 years (B-U)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    PAOD Rutherford 3, claudication left calf, walking capacity 30 m
    ABI left 0.3
    Hypotyhreosis

    RISK FACTORS
    Arterial hypertension, current smoker, hypelipidemia

    PROCEDURAL STEPS
    1. Right groin cross-over approach
    - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0,035“ SupraCore guidewire 30 cm (ABBOTT)
    - 6F 55 cm Balkin Up&Over sheath (COOK)
    2. Guidewire passage of the occlusion and 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 3 - Technical Forum

    Case 46 – Transarterial chemoembolization with drug-eluting-beads (DEB-TACE) in hepatocellular carcinom

    Center:
    Jena
    Case 46 – JEN 02: female, 58 years (H-L)
    Operators:
    • René Aschenbach,
    • S. Witting
    CLINICAL DATA
    Differentiated hepatocellular carcinoma (G1)

    RISK FACTORS
    Liver cirrhosis CHILD A
    Chronische hepatitis

    PROCEDURAL STEPS
    1. Right groin retrograde access
    - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
    - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
    2. Placement of diagnostic catheter in main hepatic artery
    - 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
    - Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
    3. Placement of microcatheter in right hepatic artery
    - Progreat 2.7F (TERUMO)
    - alternative wire: Cirrus 14‘ (COOK)
    4. Superselective placement of microcatheter in feeding artery
    5. Embolization
    - 40μm Embozene-Tandem (BOSTON SCIENTIFIC) loaded with 150 mg Doxorubicin till stasis
    6. If still perfusion after administration of the whole 3ml Embozene Tandem 40μm then additional embolization with blande microparticals Embozene 400μm till stasis is reached
    7. Control angiography
    8. Puncture site occlusion
    - Vascular closure device Exoseal (CORDIS) and pressure dressing
    View image
  • - , Room 2 - Main Arena 2

    Case 41 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 41 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 32 – BTK intervention Orbital atherectomy system (360° Stealth, CSI

    Center:
    Münster
    Case 32 – MUN 01: male, 69 years (A-S)
    Operators:
    • Arne Schwindt,
    • Konstantinos Donas
    CLINICAL DATA
    CAD, PTCA 2015, art. hypertension, PAD, COPD, calf claudication on the left side after 50 m with progress

    PRESENT STATE
    Subtotal occlusion with calcification of the popliteal artery

    PROCEDURAL STEPS
    1. Percutaneous approach from the contralateral femoral artery
    2. Use of 6F 45 cm long sheath with placement in the external iliac artery
    3. Recanalisation of the subtotal occlusion of the popliteal artery
    4. Use of the orbital atherectomy system (360°, Stealth) CSI as lithoplasty option of the severe calcified lesion to prepare the vessel
    5. Use of a DCB balloon
    6. Closure of the groin with Angioseal 6F system
    View image
  • - , Room 3 - Technical Forum

    Case 47 - Live case from Frankfurt/Main

    Center:
    Frankfurt/Main
    Case 47 - Live case from Frankfurt/Main
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 33 – CLI, deep vein arterialization of a "desert foot" left

    Center:
    Leipzig, Dept. of Angiology
    Case 33 – LEI 12: male, 68 years (J-K)
    Operators:
    • Andrej Schmidt,
    • Steven Kum,
    • Daniela Branzan
    CLINICAL DATA
    PAOD Rutherford 5, non-healing forefoot gangrene, mediasclerosis, ABI > 1.4
    PTA left peroneal artery 07/18 and left TPA 08/18
    Terminal kidney disease
    Paroxysmal atrial fibrilation, pacemaker 12/17

    RISK FACTORS
    Arterial hypertension, hyperlipdemia, dialysis

    PROCEDURAL STEPS
    1. Left groin antegrade access
    - 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
    Left distal venous tibial retrograde access
    - 5F sheath Introducer 2R (TERUMO)
    Arteriography and phlebography to define the optimal level for arterio-venous crossing
    2. Crossing from artery to vein
    - LimFlow Arterial Catheter 7F (LIMFLOW)
    - LimFlow Venous Catheter 5F (LIMFLOW)
    - LimFLow Ultrasound System (LIMFLOW)
    - PT2 0.014“ Guidewire to pass from artery into vein (BOSTON SCIENTIFIC)
    - Predilatation with MiniTrek 3.5/20 mm OTW Coronary Balloon (ABBOTT)
    3. Guidewire passage through vein and vein preparation
    - PT2 0.014“ guidewire (BOSTON SCIENTIFIC) or
    - Command 18 guidewire (ABBOTT)
    - Push Valvulotome 4F (LIMFLOW)
    - 4.0/120 mm Pacific ballon (MEDTRONIC)
    4. Implantation of covered stentgrafts
    - LimFlow Extension stentgrafts 7F 5.5 mm x 150 mm (LIMFLOW) for vein coverage
    - LimFLow Crossing Stentgraft 7F 3.5 x 60 mm (LIMFLOW) for connection artery to vein
    View image
  • - , Room 3 - Technical Forum

    Case 48 – Live case from Columbus

    Center:
    Columbus
    Case 48 – Live case from Columbus
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 34 – Occlusion of the left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 34 – LEI 13: male, 65 years (G-Z)
    Operators:
    • Matthias Ulrich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford 3, walking capacity of 40 m, claucation left calf
    ABI left 0.6

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, strong smoker (50PY)

    PROCEDURAL STEPS
    1. Right groin cross-over approach
    - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
    - 0,035“ SupraCore guidewire 30 cm (ABBOTT)
    - 6F-55 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)
    In-case of inability to reenter distal:
    - either retrograde approach via distal SFA or GoBack Crossing Catheter (UPSTREAM PERIPHERAL)
    3. Angioplasty
    - ULTRASCORE Balloon 5.0/100 mm (BARD)
    - Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)
    View image
  • - , Room 2 - Main Arena 2

    Case 42 – 4-CMD-BEVAR for a thoracoabdominal aneurysm type 4 – Bridging stentgrafts: VBX

    Center:
    Münster
    Case 42 – MUN 03: male, 81 years (F-E)
    Operators:
    • Martin Austermann,
    • Michel Bosiers,
    • S. Mühlenhöfer
    CLINICAL DATA
    Art. hypertension, CAD, deep vein thrombosis and LE 10/2018, prostate carcinoma 2014 healed

    IMPORTANT ITEMS
    Incidental finding of the aneurysm during therapy of the LE

    PROCEDURAL STEPS
    1. Left axillary access 5F sheath via cut down
    2. Percutanous approach both groins (Prostar XL, ABBOTT)
    14F (COOK) both groins
    3. Lunderquist wire through the right groin
    Pig tail catheter through the left groin for imaging
    Registration of the Fusion technology
    4. Placement of the CMD-branched-endograft (COOK) with 4 branches by using the Fusion system
    5. Placement of the bifurcated graft: Unibody (COOK) and the iliac extensions
    Then closure of the groins to avoid paraplegia
    6. Connection of all targetvessels through the corresponding branches using Viabahn BX (GORE) from above
    7. Closure of the axillary access
    View image
  • - , Room 1 - Main Arena 1

    Case 35 – Severe, asymptomatic left internal carotid artery stenosis

    Center:
    Columbus
    Case 35 – COL 01: 71 years (W-M)
    Operators:
    • Michael Jolly,
    • Gary Ansel
    CLINICAL DATA
    Yearly carotid artery surveillance given diffuse vascular disease.
    Asymptomatic patient with progressive LICA disease over past year.
    On optimal medical therapy (ASA, clopidogrel, atorvastatin 80 mg, losartan 100 mg).
    Pt unwilling to undergo carotid surgery

    RISK FACTORS
    CAD s/p 4vCABG 2000, prior subsequent PCI, HTN, HLD,
    ischemic cardiomyopathy (EF 40%), stable angina

    PRESENT STATE
    Asymptomatic, denies TIA/CVA/amarosis fugax

    DUPLEX
    Carotid duplex Nov 2018 – RICA 157/21 cm/s ratio 2.0, LICA 290/104, ratio 5.2;
    CT neck: 70-80% LICA stenosis, no significant LCCA stenosis

    ANGIOGRAM
    Carotid angiogram: 80% LICA bifurcation stenosis by NASCET

    PROCEDURAL STEPS
    1. Micropuncture femoral artery access
    2. Sheath placement
    - 6F 90 cm braided sheath delivery into LCCA
    3. Distal embolic protection
    - Nav6 Emboshield wire (ABBOTT)
    4. Stenting
    - Xact 10-8 x 40 mm (ABBOTT)
    5. Predilatation
    - 4x20 mm NC balloon (ABBOTT)
    4. Postdilatation
    - 5 x 30 mm NC balloon (ABBOTT)(if necessary)
    View image
  • - , Room 3 - Technical Forum

    Case 49 – Prostatic artery embolization for symptomatic benign prostatic hyperplasia

    Center:
    Jena
    Case 49 – JEN 03: male, 58 years (M-K)
    Operators:
    • Tobias Franiel,
    • F. Bürckenmeyer
    CLINICAL DATA
    Prostatic volume 80 ml
    Negative TRUST-guided systematic biopsy due to increased PSA 6.0
    IPSS: 19 (0-35), QoL: 3 (0-6), Qmax: 13.0 ml/s with voided volume of 160 ml
    IIEF-5: 15 (1-25)

    RISK FACTORS
    Arterial hypertension

    DUPLEX
    Post void residual urine of 100ml

    PRESENT STATE
    Lower urinary tract symptoms due to BPH (confirmed by urology department)
    No successful medication therapy for more than 6 month, refusing operative therapy

    PROCEDURAL STEPS
    1. Right groin access
    - 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 250 μm (BOSTON SCIENTIFIC), alternative: 400 μm (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 250 μm (BOSTON SCIENTIFIC)
  • - , Room 3 - Technical Forum

    Case 50 – Live case from Frankfurt/Main

    Center:
    Frankfurt/Main
    Case 50 – Live case from Frankfurt/Main
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 36 – Live case from Columbus

    Center:
    Columbus
    Case 36 – Live case from Columbus
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 37 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 37 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 43 – Double Chimney EVAR in order to extent a existing bifurcated endograft with insufficiant proximal sealing and growing aneurysm

    Center:
    Münster
    Case 43 – MUN 04: male, 82 years (W-K)
    Operators:
    • Martin Austermann,
    • E. Beropoulis,
    • S. Mühlenhöfer
    CLINICAL DATA
    CAD, MI and PTCA 2007, art. hypertension

    PRESENT STATE
    Previous Onyx Embolization of type2 EL‘s
    Still growing aneurysm
    Degeneration of the aneurysm neck with loss of sealing

    PROCEDURAL STEPS
    1. Cut down left axillary artery and double puncture
    2. Placement of two 7F Shuttle sheaths from above
    3. Percutanous approach right groin Prostar XL 10F (ABBOTT)
    Placement of 14F sheaths (COOK)
    Puncture of the left groin for imaging through a 5F sheath
    4. Cannulation of both renal arteries from above
    5. Placement of the Endurant aortic extension ETCF 36 36 C 49 (MEDTRONIC)
    6. Placement of the Chimney stent-grafts in both renal arteries: Advanta V12 (Getinge)
    7. Closure of the accesses
    View image
  • - , Room 3 - Technical Forum

    Case 51 – Aneurysma embolization (coiling) of the splenic artery

    Center:
    Jena
    Case 51 – JEN 04: female, 74 years (V-S)
    Operators:
    • F. Bürckenmeyer,
    • I. Diamantis
    CLINICAL DATA
    16 mm neurysm of the lienal artery with growth tendency

    RISK FACTORS
    Arterial hypertension, rheumatoid arthritis

    PROCEDURAL STEPS
    1. Right groin retrograde access
    - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
    - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
    2. Placement of diagnostic catheter in main hepatic artery
    - 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
    - Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
    3. Placement of microcatheter in splenic artery
    - Progreat 2.7F (TERUMO)
    - alternative wire: Cirrus 14‘ (COOK)
    4. Embolization
    - PENUMBRA Coils system
    5. Control angiography
    6. Puncture site occlusion
    - Vascular Closure System Exoseal (CORDIS) and pressure dressing
    View image
  • - , Room 3 - Technical Forum

    Case 52 – Live case from Frankfurt/Main

    Center:
    Frankfurt/Main
    Case 52 – Live case from Frankfurt/Main
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 38 – Instent restenosis case

    Center:
    Columbus
    Case 38 – COL 03: male, 58 years
    Operators:
    • Mitchell Silver,
    • Michael Jolly,
    • Christopher Huff,
    • Gary Ansel
    CLINICAL DATA
    Pt with 4 year history of PAD, s/p multiple interventions of the iliac, femoropopliteal and tibial vessels for claudication and previous critical limb Ischemia. Originally treated multilevel for left foot ulceration in 2015, restenosis of iliacs treated wtih stent grafts, SFA occlusion attempted to be treated with cilostazol but no effect at 3 months. Now s/p Super stent in 2015 that occluded, treated with DCB and proximal DES extension in 2017. Now with recurrent RC II claudication and duplex scan with restenosis
    ABI R: .96 and L: .88

    RISK FACTORS
    DM II, CAD, HTN, hyperlipidemia, past smoker

    DUPLEX
    Peak velocity of 343 within the stent

    PROCEDURAL STEPS
    1. Contralateral femoral access
    2. Placement of 7F or 8F braided sheath
    3. Excimer Laser debulking
    4. Hig pressure PTA
    5. If good result DCB, if poor result consider DES
    6. Suture based sheath removal
    View image

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 55 – Live case from Abano Terme

    Center:
    Abano Terme
    Case 55 – Live case from Abano Terme
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 73 – Directional atherectomy of DFA origin and recanalization of SFA flush occlusio

    Center:
    Bad Krozingen
    Case 73 – BK 03: male, 54 years (D-K)
    Operators:
    • Thomas Zeller
    CLINICAL DATA
    POAD Fontaine IIb / Rutherford 3 right leg, walking distance < 100 m
    Unsuccesful recanalisation attempt December 2018 in referring clinic
    ABI: 0.6/1.0

    RISK FACTORS
    Smoker, hypercholesterinemia

    ANGIOGRAM
    80% ostial DFA stenosis, flush occlusion of SFA origin, reconstitution distal SFA

    PROCEDURAL STEPS
    1. Access
    - 7F cross-over Sheath (TERUMO)
    2. Directional atherectomy of DFA origin
    - SilverHawk (MEDTRONIC)
    3. Recanalisation of SFA
    - Woodpecker (Upstream Medical)
    4. Placement of a filter protection device into the popliteal artery
    - Spider (MEDTRONIC)
    5. DA of SFA
    - SilverHawk (MEDTRONIC)
    6. DCB angioplasty
    - IN.PACT Pacific (MEDTRONIC)
    7. Stent on indication
    - BioMimics (Veryan/Otsuka)
    View image
  • - , Room 1 - Main Arena 1

    Case 66 – Live case from Münster

    Center:
    Münster
    Case 66 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 56 – Complex BTK-CTO in a CLI-patient

    Center:
    Leipzig, Dept. of Angiology
    Case 56 – LEI 19: female, 74 years (M-C)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Critical limb ischemia, minor gangrene dig 1 left,
    restpain and severe claudication left, ABI left 0.2
    Multiple interventions both legs, D4-Amputation right 11/2018

    RISK FACTORS
    Art. Hypertension, diabetes mellitus type 2 with multiple complications

    PROCEDURAL STEPS
    1. Antegrade approach left groin
    - 6F 55 cm sheath (COOK)
    2. Guidewire passage antegrade into posterior tibial artery
    - 0.014“ Command (ABBOTT)
    - 0.014“ PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
    - In case of failure: retrograde approach
    3. PTA
    - Vessel preparation – scoring balloon (VascuTrak, BARD)
    - Lutonix BTK DCB (BARD)
    4. In case of dissections after DCB, provisional placement of nitinol „tacks“
    - Tack Endovascular System (Intact Vascular)
    View image
  • - , Room 1 - Main Arena 1

    Case 57 – Subacute occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 57 – LEI 20: female, 72 years (R-V)
    CLINICAL DATA
    Critical limb ischemia bilateral, ulcerations both feet (right forefoot, left lateral foot)
    ABI left 0.54, Rutherford class 5
    PTA right SFA 12/2018
    Iliac stenting 2013/2014
    CAD with PTCA 2018
    CEA right internal carotid artery 2015
    Renal transplantation 2006

    RISK FACTORS
    Art. hypertension, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Right femoral retrograde and cross-over approach
    - 8F Balkin Up&Over 40 cm sheath (COOK)
    2. Guidewire passage
    - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
    3. Rotarex-thrombectomy
    - 8F (STRAUB MEDICAL)
    4. PTA/stenting on indication
    - Pacific 5/120 mm balloon (MEDTRONIC)
    - Eluvia DES 6.0/120 mm stent (BOSTON SCIENTIFIC) or Zilver PTX (COOK)
  • - , Room 2 - Main Arena 2

    Case 67 – Live case from Paris

    Center:
    Paris
    Case 67 – Live case from Paris
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 58 – Chronic in-stent reocclusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 58 – LEI 21: male, 65 years (L-P)
    Operators:
    • Sven Bräunlich,
    • Johannes Schuster
    CLINICAL DATA
    Severe claudication left calf, walking capacity 200 meters
    ABI left 0.68, Rutherford class 3
    PTA/stenting left SFA 2015 (Zilver-PTX)
    PTA right SFA, DCB-treatment 12/2018
    Dilatative cardiomyopathy, EF 35%

    RISK FACTORS
    Arterial hypertension, former smoker

    ANGIO
    Complete in-stent reocclusion left SFA

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - 8F Balkin Up&Over sheath (COOK)
    2. Guidewire passage
    - 0.018“ Command 18, 300 cm (ABBOTT)
    - 0.018“ Quick-Cross support catheter, 135 cm (PHILIPS)
    3. Thrombectomy
    - Rotarex 8F (STRAUB MEDICAL)
    4. PTA
    - Luminor 5.0/200 mm DCB (iVASCULAR)
    - potentially with filter protection Spider-filter 6 mm (MEDTRONIC)
    View image
  • - , Room 3 - Technical Forum

    Case 75 – Extremely calcified SFA CTO left, "pave and crack"-technique

    Center:
    Leipzig, Dept. of Angiology
    Case 75 – LEI 26: male, 62 years (S-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford Class 3, severe claudication left, walking capacity 50m, ABI left 0.45
    PTA both CIA 2012, multiple interventions right,
    failed recanalization attempt left SFA 12/2018
    CAD, CABG 2012, atrial fibrillation, renal impairment

    RISK FACTORS
    Arterial hypertension, hyperlipdemia, former smoker (30PY)

    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)
    - GoBack Crossing-Catheter (UPSTREAM-PERIPHERAL)
    3. Retrograde guidewire passage
    Access via the proximal anterior tibial artery:
    - 9 cm 20 Gauge Spinal Needle (BD)
    - 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
    - 6.0/20mm 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 6.0/150 mm (GORE)
    - Relining with Supera Interwoven Nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 59 – Chronic central venous occlusion of the anonymous vein treated by covered stent

    Center:
    Münster
    Case 59 – MUN 05: female, 34 years (G-A)
    Operators:
    • Arne Schwindt,
    • S. Mühlenhöfer
    CLINICAL DATA
    Multiple skleroses since 2015, plasmapheresis via central venous catheter since 2016, central venous catheter
    removal 06/2018 due to thrombosis of right anonymous vein

    PRESENT STATE
    Chronic swelling of right arm and neck due to venous CTO of right anonymous vein

    PROCEDURAL STEPS
    1. Duplex guided puncture and access via right common femoral vein and right subclavian vein
    - Insertion of 5F 90 cm shuttle sheath femoral (COOK) and 8F 45 cm destination sheath via subclavian vein
    2. Recanalization of anonymous vein occlusion
    - Command 18 wire (ABBOTT) and 0,018“ Quickcross caheter (PHILIPS)
    3. Predilatation
    - 4 mm ULTRAVERSE balloon (BARD)
    4. Stent implantation
    - 10 mm COVERA covered stent (BARD)
    5. Postdilatation
    - 10 mm CONQUEST high pressure balloon
    6. Access managment by manual compression and pressure dressing
    View image
  • - , Room 2 - Main Arena 2

    Case 68 – Live case from Münster

    Center:
    Münster
    Case 68 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 69 – MISACE: Minimal Invasive Segmental Artery CoilEmbolisation

    Center:
    Leipzig, Dept. of Angiology
    Case 69 – LEI 24: male, 67 years, (R-H)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Thoracoabdominal aneurysm (max. diameter 61mm), progressive (41mm 2014)
    Open repair of an infrarenal aortic aneurysm 10/2014
    CAD, PTCA 2014

    RISK FACTORS
    Arterial hypertension

    CT
    Progressive aneurysm, max. diameter 61 mm

    IMPORTANT ITEMS
    Endovascular repair planned (CMD, COOK)
    Staged segmental artery coilembolisation
    for prevention of spinal-cord-ischemia planned

    PROCEDURAL STEPS
    1. Right femoral approach
    - 6F 25 cm sheath (TERUMO)
    2. Angiography
    of the segmental arteries Th 12 - Th 10 bilateral
    Selection of the arteries to be embolized during the first session
    3. Coilembolisation
    - IMA 6F guiding catheter (MEDTRONIC)
    - SIM-I 5F diagnostic catheter (CORDIS-CARDINAL HEALTH)
    - 0.014“ PT2 guidewire (BOSTON SCIENTIFIC)
    - Progreat Micro Catheter System 2.7F 130 cm (TERUMO)
    - Micro-Coils (COOK)
    View image
  • - , Room 3 - Technical Forum

    Case 78 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 78 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 60 – Live case from Leipzig

    Center:
    Leipzig, Dept. of Angiology
    Case 60 – Live case from Leipzig
    Information will follow in due time. Thank you for your understanding.
  • - , Room 2 - Main Arena 2

    Case 70 – Live case from Münster

    Center:
    Münster
    Case 70 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 61 – CFA, SFA and popliteal artery atherectomy plus DCB angioplasty

    Center:
    Bad Krozingen
    Case 61 – BK 01: female, 71 years (O-E)
    Operators:
    • Elias Noory
    CLINICAL DATA
    PAOD Fontaine IV / Rutherford 5 both legs
    Stent angioplasty distal infrarenal aorta & DCB SFA left leg 12.12.2018
    Recanalisation & stentimplantation both CIA & EIA and SFA recanalisation left leg 2011
    ABI non-diagnostic due to mediacalcification

    RISK FACTORS
    Hypertension, hyperlipidemia

    DUPLEX
    Moderate stenosis of right CFA & SFA origin, high grade stenosis of popliteal artery

    PROCEDURAL STEPS
    1. 7F cross-over sheath
    2. Lesion crossing
    - 0.035“ Glidewire (TERUMO) guided by a 5F vertebral catheter (CORDIS)
    3. Embolic protection
    - Introduction of a Spider embolic protection system (MEDTRONIC)
    4. Atherectomy
    - Directional atherectomy (HawkOne, MEDTRONIC) of CFA, SFA origin, and popliteal artery
    5. Angioplasty
    - Drug coated balloon angioplasty (IN.PACT Pacific, MEDTRONIC or Tulip, ACOTEC)
    6. Sheath removal with closure device
    - Femoseal (TERUMO)
    View image
  • - , Room 1 - Main Arena 1

    Case 62 – Live case from Münster

    Center:
    Münster
    Case 62 – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 63 – Long SFA-occlusion left, moderate calcification

    Center:
    Leipzig, Dept. of Angiology
    Case 63 – LEI 23: male, 53 years (H-B)
    Operators:
    • Matthias Ulrich,
    • Axel Fischer
    CLINICAL DATA
    PAOD Rutherford class 3, claudication left calf, walking capacity 150 m, ABI left 0.65
    Failed recanalization attempt (thrombectomy) 07/18 elsewere

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
    2. Passage of the occlusion left 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 ATA
    - 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 with DCBs
    - Passeo 18 balloon 5 x 150 mm (BIOTRONIK)
    - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
    5. Stenting on indication
    - Pulsar 18-T3 stent (BIOTRONIK)
    View image
  • - , Room 2 - Main Arena 2

    Case 71 – FEVAR for type 4 thoraco abdominal aortic aneurysm

    Center:
    Paris
    Case 71 – PAR 02: female, 72 years (V-M)
    Operators:
    • Stéphan Haulon,
    • Dominique Fabre,
    • J. Mougin,
    • L. Freycon,
    • B. Pochulu
    CLINICAL DATA
    Type 2 diabetes, HTA, obesity (BMI >30)
    Incisional hernia, splenectomy

    PROCEDURAL STEPS
    1. L: Advance 16F 30cm GORE Dryseal sheath in the LCFA over Lunderquist
    - 2 x 6F 55 cm COOK Ansel sheaths
    - 100 U/kg Heparin (Target ACT≥250)
    - L (through one of the 6F): advance long pigtail catheter
    - R: 10F sheath
    - Lunderquist (dilators up to 20)
    2. Fluoroscopy to locate fenestrations gold markers
    - R: Advanced fenestrated endograft
    - Aortic angiogram
    - Fenestrated endograft deployment
    3. R: Rosen wire advanced through preloaded catheter
    - Exchange preloaded catheter for a 6F 90 cm COOK Ansel sheath
    - Exchange Rosen for a V18 300 cm wire
    - Retrieve 6F to the level of the fenestration
    - Retrieve the 6F dilator
    - Puncture valve
    - DAV + TERUMO Roadrunner through 6F for renal artery catheterisation
    - Renal angiogram
    - Exchange TERUMO for Rosen
    - Retrieve V18 wire
    - Advance 6F into the renal artery
    - Advance BENTLEY Begraft bridging stent to parking position
    4. Same for controlateral renal artery
    5. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen
    - Advance 6F below the fenestration (SMA/CT)
    - USL + TERUMO Roadrunner through 6F sheath to catheterise target vessel (SMA/CT)
    - Vessel angiogram
    - Exchange TERUMO for Rosen wire
    - Advance 6F into target vessel
    - Advance BENTLEY Begraft bridging stent to parking position
    6. R: Release diameter-reducing ties
    - Proximal and distal attachments
    - Nose retrieval under fluoroscopy
    7. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval
    - Flare the aortic portion of stent with 9-20 mm balloon
    - Advance 6F back into the renal stent
    - Angiogram
    - same for left renal artery
    8. L: SMA/CT stent deployment (3-4cmm protruding in the aortic lumen) after 6F retrieval
    - Flare the aortic portion of stent with 10-20 mm balloon
    - Advance 6F in the SMA
    - CT stent
    - Angiogram (SMA: exchange Rosen for TERUMO wire)
    9. R : Remove nose under fluoroscopy
    - Remove fenestrated device delivery system
    L: Withdraw 6F sheath in 16F
    - insert and deploy bifurcated device and iliac limbs
    10. CODA balloon to mold overlaps and distal sealing zones
    - Pigtail catheter
    - Angiogram + non-contrast CBCT
    View image
  • - , Room 1 - Main Arena 1

    Case 64 – Live case from Bad Krozingen

    Center:
    Bad Krozingen
    Case 64 – Live case from Bad Krozingen
    Information will follow in due time. Thank you for your understanding.
  • - , Room 1 - Main Arena 1

    Case 65 – Live case from Abano Terme

    Center:
    Abano Terme
    Case 65 – Live case from Abano Terme
    Information will follow in due time. Thank you for your understanding.

Conference day 4

  • - , Room 1 - Main Arena 1

    Case 80c – Live case from Münster

    Center:
    Münster
    Case 80c – Live case from Münster
    Information will follow in due time. Thank you for your understanding.
  • - , Room 3 - Technical Forum

    Case 83 – Reocclusion right SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 83 – LEI 31: male, 56 years (G-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, ABI 0.67; walking-capacity 150 meters
    Rutherford class 3
    PTA/Stenting ot the infrarenal aorta and iliac arteries 2015
    PTA stenting both SFA 2016
    PTA of a reocclusion left SFA 12/2018

    RISK FACTORS
    Art. Hypertension, heavy smoker

    PRESENT STATE
    Reocclusion right SFA since 2 months, slow onset of symptoms

    PROCEDURAL STEPS
    1. Left retrograde and cross-over approach
    - 7F 40 cm Up&Over sheath (COOK)
    2. Guidewire passage from antegrade
    - 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
    - GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
    3. Potentially retrograde stent puncture
    4. Guidewire passage of the tibioperoneal trunk occlusion
    - 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
    5. Pre-treatment
    - Rotarex 6F Thrombectomy (STRAUB MEDICAL)
    6. PTA + Stenting
    - RANGER DCB within the stents (BOSTON SCIENTIFIC)
    - Evaluation of the stentfracture and potentially relinining with Supera stents (ABBOTT)
    - Eluvia DES for the proximal SFA (BOSTON SCIENTIFIC)
    View image