LINC 2019 live case guide


Find all live cases and live case centers listed below.

 

 

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 – Percutaneous CT-guided microwave ablation of hepatocellular carcinoma post TACE therapy

    Center:
    Frankfurt/Main
    Case 44 – FRA 01: female, 74 years
    Operators:
    • M. Nour Eldin,
    • E. Elhawash
    CLINICAL DATA
    Liver cirrhosis.
    2 hepatocellular carcinoma lesions, one lesion in segment 7 and the other lesion in segment 3.
    The patient recieved 4 cycles of TACE for tumor downsizing followed by ablation of the HCC lesion in segment 7.

    PRESENT STATE
    Minimal ascites
    Portal hypertension
    Low platelet count. 40.000/cc
    The lesion is near the liver hilum

    PROCEDURAL STEPS
    1. Revision of the previous images for confirmation of the size and location of the lesion
    The targeted lesion is at segment 3 subcapsular
    2. Non contrast enhanced CT scan of the liver for planning
    The lipiodol uptake within the lesion by previous TACE facilitates the localization of the under CT guidance.
    3. Surface marking of the location of the lesion as well as the site of puncture on the skin
    4. Sterile covering followed by infiltration of the local anesthetic
    Conscious sedation would be given
    5. Stepwise isertion of the Microwave antenna (Covidien Emprint Ablation System, MEDTRONIC) within the lesion
    6. The energy required for ablation will be given to induce complete ablation of the lesion
    Intermittent CT images to observe the changes during the ablation procedure
    7. After applying the required energy for ablation, needle track ablation will be done followed by removal of the antenna
  • - , Room 2 - Main Arena 2

    Case 39 – Iliac side branch endografting on both sides for a common iliac aneurysm on the right side and a hypogastric artery aneurysm on the left side

    Center:
    Münster
    Case 39 – MUN 02: male, 69 years (N-H)
    Operators:
    • Martin Austermann,
    • E. Beropoulis
    CLINICAL DATA
    CAD, art. hypertension

    IMPORTANT ITEMS
    Incidental finding by ultrasound

    PROCEDURAL STEPS
    1. Percutanous approach both groins Prostar XL 10F (ABBOTT)
    Placement of 14F sheaths (COOK)
    2. Placement of a ZBIS 12 45 41 (COOK) on the left side
    Catching a stiff TERUMO wire through the preloaded catheter with an indy snare and build a pull through wire
    3. Placement of a 12F Flexor sheath over the pull through wire after deploiment of the IBD insight the hypogastric branch
    4. Cannulation of the hypogastric artery (smooth wire TERUMO) and changing for the Rosen wire (COOK)
    5. Placement of the bridging stentgraft (Advanta V12 + Viabahn) down to the posterior division of the IIA. Ev. coiling of the second branch
    6. Same procedure on the right side
    7. Placement of the aortic endograft. (TFFB 28 82 COOK) and connection with the IBD‘s by ZSLE legs
    8. Final angiography and closure of the groins
    View image
  • - , 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 – Calcified distal SFA-occlusion, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 31 – LEI 11: female, 76 years (R-S)
    Operators:
    • Matthias Ulrich,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford class 5, forefoot ulcerations, restpain and severe claudication right, ABI 0.4
    Aortic valve replacement 2013, NSTEMI 09/2018, PTCA 09/18
    Renal impairment grade 4

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross-over approac
    - 7F 55 cm Check-Flo Performer, Raab Modification (COOK)
    2. Guidewire passage and filter placement
    - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 5 mm Spider filter (MEDTRONIC)
    3. Atherectomy
    - 2.4/3.4 mm JetStream atherectomy device (BOSTON SCIENTIFIC)
    4. PTA with DCBs and stenting on indication
    - RANGER DCB balloon (BOSTON SCIENTIFIC)
    - Eluvia drug-eluting stent (BOSTON SCIENTIFIC)
    View image
  • - , 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 – Aortoiliac aneurysm – EVAR and iliac branch device

    Center:
    Leipzig, Dept. of Angiology
    Case 41 – LEI 16: male, 67 years (G-G)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Asymptomatic infrarenal AAA (max. diameter 64 mm) and aneurysm of the left common iliac artery (max.
    diameter 39 mm)
    Coiling of segmental arteries and IMA 11/2018
    Renal impairment G2

    RISK FACTORS
    Arterial hypertension, hyperlipidemia, current smoker

    PROCEDURAL STEPS
    1. Bifemoral percutaneous approach
    - Preloading with 2 Proglide systems/side (ABBOTT)
    - Lunderquist GW 260 cm (COOK)
    2. Implantation of the iliac Side-Branch-Device
    - ZBIS 12-45-41 via left side (COOK)
    - 12F 45 cm sheath Flexor Check-Flo Introducer, Ansel Modification 1 via right groin (COOK)
    - Pullthrough guidewire: 0.035“ glidewire 260 cm (TERUMO)
    - Snare for pullthrough-GW: Amplatzer Goose Neck Snare Kit 10 mm (MEDTRONIC)
    3. Implantation of bridging-stents into the hypogastric artery left
    - 8.0/57 mm BeGraft Peripheral covered stent (BENTLEY)
    4. Implantation of a bifurcational stengtgraft
    - Zenith Alpha (COOK)
    Cannulation of the contralateral limb:
    - 5F Amplatz Left Diagnostic catheter (CORDIS - CARDINAL HEALTH)
    - 0.018“ Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    5. PTA of the graft
    - Coda balloon catheter (COOK)
    View image
  • - , 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 - Transjagular intrahepatic portosystemic shunt with coil embolization of esophageal varices

    Center:
    Frankfurt/Main
    Case 47 – FRA 02: female, 65 years
    Operators:
    • M. Nour Eldin,
    • N. Naguib,
    • E. Elhawash
    CLINICAL DATA
    Liver cirrhosis, portal hypertension, refractory ascites

    CT-SCAN
    Dilated portal vein, gastero-oesophageal varices, ascites

    PROCEDURAL STEPS
    1. Sterile covering of the patient
    2. US-guided puncture of the right internal jagular vein
    3. Insertion of the 10F vascular sheath (Super Arrow-Flex, TELEFLEX)
    4. Using the Multipurpose catheter (CORDIS), canulation of the right hepati vein
    5. Performance of the wedge venous portography
    6. Puncturing of the portal vein using the TIPS-System (OPTIMED).
    7. After passing the guide-wire pushing a 4F catheter (PERLSTEIN-Catheter).
    8. Performance of direct portography
    Measurement of the portal vein pressure as well as the CVP
    9. Insertion of stent graft (Viator Stent, viabahn).
    10. Demonstration of the flow within the TIPS.
    11. Selective catheterization of esophageal varices using microcatheter (Progreat, TERUMO)
    12. Selective catheterization of esophageal varices using microcatheter (Progreat, TERUMO)
    Embolization of the varices using PENUMBRA Coils (PENUMBRA)
    13. Removal of materials and interstion of a Sheldon catheter
  • - , 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 – Long SFA occlusion with hx of iliac stenting

    Center:
    Columbus
    Case 48 – COL 04: female, 52 years (A-B)
    Operators:
    • Gary Ansel,
    • Christopher Huff,
    • Michael Jolly,
    • Mitchell Silver
    CLINICAL DATA
    52 year old female with history of 3 months of rest pain to the lower extremity.
    Previous history of common iliac stenting 12 years ago.

    RISK FACTORS
    Long history of smoking and continues to smoke 1.5 pks/day.
    PMX = Essential hypertension, hyperlipidemia.

    PRESENT STATE
    ABI .37 and .1.1

    PROCEDURAL STEPS
    1. Contralateral femoral ultrasound guided access, placement of a 7 french braided sheath.
    2. Will attempt hydrophilic wire traversal, if unsuccessful will utilise re-entry catheter
    3. Predilation with undersized balloon, and if reasonable predilation result will dilate with POBA 1:1 to native vessel, if that has a acceptable result will use DCB 1 mm larger. If any predilation problems will use DES or if more focal continue on with DCB with plan to spot stent
    4. Will then proceed to POBA tibioperoneal trunk which has a high grade stenosis and post tibial is main vessel to foot
    5. If dissection with use coronary DES
    6. Sheath removal with suture based device
    View image
  • - , 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, 80 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 – Uterine artery embolization for fibroids

    Center:
    Frankfurt/Main
    Case 50 – FRA 03: female, 53 years
    Operators:
    • N. Naguib,
    • M. Nour Eldin
    CLINICAL DATA
    Multiple fibroids, dysmenorrhia, menorrhagia, presurre symptoms on the urinary bladder and rectum
    Lymphangioleiomatosis, lungemphysema

    PROCEDURAL STEPS
    1. Performance of contrast enhanced MRA of the pelvic arteries
    2. Puncture of the right femoral artery in Seldinger‘s technique followed by application of a 5F sheath (TERUMO)
    3. Performance of pelvic angiography using Pigtail catheter
    4. Selective catheterisation of the right uterine artery using sidewinder-1 cath using microcatheter (Progreat, TERUMO) with superselective demonstration of the right uterine artery
    5. Injection of the Embozene particles (700-900 microns) through the microcatheter till stasis
    6. Then catheterization of the left uterine artery using sidewinder-1 and Progreat microcatheter (TERUMO)
    7. Injection of the Embozene microsphere particles (500-700 microns, BOSTON SCIENTIFIC) through the microcatheter till stasis
    8. Removal of the catheters and closure of femoral puncture using angioseal system
  • - , Room 1 - Main Arena 1

    Case 36 – Severe asymptomatic right internal carotid artery stenosis

    Center:
    Columbus
    Case 36 – COL 02: male, 73 years (R-B)
    Operators:
    • Gary Ansel
    CLINICAL DATA
    Presented in January, 2019, for evaluation of progressive right internal carotid artery stenosis with small penetrating ulcer/pseudoaneurysm of the lateral wall and stable moderate disease of the left carotid bulb. Had recent coronary CTA with high level readings but stress echo negative for ischemia.

    RISK FACTORS
    CAD, PAD, tobacco abuse, HLD

    PRESENT STATE
    No CVA/TIA-like symptoms or angina

    DUPLEX
    Carotid Duplex 11/2018: RICA max PSV 319 cm/s, RICA/CCA ratio= 3.45;
    LICA max PSV 121 cm/s, LICA/CCA ratio= 1.01

    CTA
    CTA head/neck 12/18: Severe focal stenosis (90% stenosis) at origin of right internal carotid artery, with an associated 5 x 5 x 15 mm atherosclerotic penetrating ulcer or pseudoaneurysm at the lateral aspect of the origin of the right internal carotid artery. NO flow limiting stenois of left carotid system.

    PROCEDURAL STEPS
    1. Femoral access
    2. Shuttle sheath (COOK)
    3. Mo.ma proximal protection device (MEDTRONIC)
    4. Xact Stent (ABBOTT Vascular)
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  • - , Room 1 - Main Arena 1

    Case 37 – SFA-occlusion left, treatment according to BEST-SFA study randomization

    Center:
    Leipzig, Dept. of Angiology
    Case 37 – LEI 14: female, 76 years (U-C)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left calf, ABI 0.65; walking-capacity 100 meters
    Rutherford class 3
    PTA / Stenting right SFA
    TEA right CFA 2017, PTA/stent right SFA 2017
    CAD, CABG 1988, PTCA 2012

    RISK FACTORS
    Arterial hypertension, heavy smoker

    ANGIOGRAPHY
    Obtained during PTA right SFA: Calcified SFA-CTO left

    PROCEDURAL STEPS
    1. Right 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. After guidewire passage
    randomization to either
    - ‚best‘ stenting strategy Eluvia DES (BOSTON SCIENTIFIC)
    and/or Supera (ABBOTT) or
    - ‚best‘ DCB treatment (potentially including atherecomty) Inpact (MEDTRONIC)
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  • - , 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
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  • - , 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
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  • - , Room 3 - Technical Forum

    Case 52 – Chemoembolization of liver metastases from neuroendocrine tumor

    Center:
    Frankfurt/Main
    Case 52 – FRA 04: male, 68 years
    Operators:
    • M. Nour Eldin,
    • E. Elhawash
    CLINICAL DATA
    Male patient with uncontrolled carcinoid syndrome due to endocrine liver metastases.
    Status post surgical resecetion of bronchial neuroendocrine tumor of the left lung lower lobe. Hormonal treatment for control of symptoms.

    PROCEDURAL STEPS
    1. Revision of MRI and CT images for demonstration of the size and location of metastases.
    2. Puncture of the right femoral artery in Seldinger‘s Technique followed by application of a 5F sheath (TERUMO).
    3. Performance of direct angiography fi the coeliac trunc using Sidewinder catheter
    4. Selective catheterisation of the common hepatic artery
    5. Superselective catheterization of the arteries supplying the tumors using progreat microcatheter (TERUMO)
    6. Injection of the chemotherapy: Mitomycin c (10 mg), Irrinotecan (50 mg) and Lipoiodol 5-10 ml
    7. Demonstration of the hepatic artery post embolization.
    8. Removal of the catheters and closure of femoral puncture using angioseal.
  • - , 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
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