LINC 2013 live case guide

Clinical data
Symptomatic Type B Dissection with acute thoracic pain
with malperfusion left kidney 12/2012
Arterial hypertension, obesity (BMI 35 kg/m2)

Procedural steps
1. Cut down right common femoral artery

2. Right brachial access
- 6F, 25 cm Radiofocus Introducer (TERUMO)

3. Zenith TX2 TAA Endovascular Graft (COOK)

4. Stenting of the SMA on indication
- Herculink 6,5/18 mm (ABBOTT)

5. Implantation of a Zenith Dissection Endovascular Stent 46-164 mm (COOK)

Clinical data
Hypertension, COPD, hyperlipidaemia, former smoker

Duplex
Fibrotic plaque determining severe stenosis of the right ICA (3.4 m/sec.)

Procedural steps
1. Navigation of a diagnostic catheter into the Right ECA
- 5F JR diagnostic catheter, 100 cm (CORDIS)
- 0.035" Radifocus Terumo angled soft guide-wire, 180 cm (TERUMO)

2. Introduction of the cerebral protection device and endovascular clamping
- 9F–25 cm Radifocus Introducer II (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- Endovascular Clamping Device – MoMa Ultra (MEDTRONIC)

3. Passing of the lesion and stenting
- 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
- 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
- 8.0/40 mm Precise PRO Rx Carotid Stent (CORDIS)

4. Postdilatation
- 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)#



Clinical data
Duplex
Procedural steps

Clinical data
Office blood pressure: 180/95 mmHg
Ambulatory BP
Cerebrovascular disease: 70% stenosis ICA right
LV Hypertrophy
Renal function: GFR 93 ml/min
Medikation: Ca++ Blocker, ACE Inhibitor, betablocker, diuretic

Procedural steps
1. Femoral access right groin

2. Placement of a 8F 70 cm sheath (COOK)

3. Wiring the renal arteries (0.014")

4. Renal Denervation
- Vessix V2 System (BOSTON SCIENTIFIC)

Clinical data
PAOD Rutherford 3, claudication at 150 meters left calf
CAD, PTCA 12/2012
Hypertension, hyperlipidaemia, former smoker
ABI left 0.71

Procedural steps
1. Cross-over-access from right to left
- 7F 40 cm Flexor Check-Flo Introducer (COOK)

2. Attempt to pass the lesion intraluminally
- TruePath System (BOSTON SCIENTIFIC)
- Supported by a TrailBlazer 0.018" 135 cm Support-Catheter (COVIDIEN)

3. Introduction of a Spider-filter 6mm (COVIDIEN)

4. Atherectomy
- TurboHawk LX-C (COVIDIEN)

5. PTA
- Drug-eluting balloons: LEGFLOW® (CARDIONOVUM)
In case of flow limiting dissection:
- Tack-IT Endovascular Stapler SystemTM (INTACT VASCULAR)

Clinical data
PAOD Rutherford 4, pretibial skin ulcers
CAD, MI 2008; TIA, DVT right calf 2011
10/2012: elsewhere successful PTA of the left SFA,
however failure to recanalize the left popliteal artery
Arterial hypertension, hyperlipidemia, GFR 50 ml/min

Procedural steps
1. Antegrade left femoral access and sheath insertion
- 6F 10 cm Radiofocus Introducer (TERUMO)

2. Passage of the lesion
- 4 F Berenstein (MERIT MEDICAL)
- 0.018" Connect Flex (ABBOTT)
- Re-entry device OUTBACK (CORDIS) on indication
- 0.014" HT Command (ABBOTT)

3. Predilatation and Dilatation
- Armada 14, Fox SV (ABBOTT)

4. Stenting on indication
- Absolute (above knee), Xpert (below knee) selfexpanding nitinol stents (ABBOTT)

5. Retrograde access via ATA, if antegrade access fails

Clinical data
PAOD Rutherford 5, ulceration toe I left foot
ABI left 0,4
Stenting left proximal ATA with DES 4/2012
Stenting right SFA 9/2012
Coronary artery disease, stenting RCX, RCA, LAD 9/2012
Atrial fibrillation with phenprocoumon-therapy
Hypertension, hyperlipidemia, DM, former smoker (~60 py)

Procedural steps
1. Antegrade access left groin
- 5F 55 cm Check Flo Introducer sheath, Ansel Modification (COOK)

2. Guide wire Passage of the lesion with
- Hi-Torque Command 300 cm (ABBOTT)

3. Dilatation of the lesion
- 2,5/200 mm Armada 14 PTA Catheter (ABBOTT)

4. Stenting on indication
- Xience Prime BTK Everolimus eluting stent (ABBOTT)

5. Optionally PTA of the posterior tibial artery

Clinical data
Office BP: 170/ 80 mmHg
Ambulatory BP: 147/ 78 mmHg
non dipping profile
Renal function: GFR 78 ml/min
BMI 31 kg/m2, diabetes mellitus 2, Hyperlipidemia
Secondary causes of HTN excluded
Medication: AT1- Blocker, betablocker, diuretic, centrally acting agent (clonidine)
Drug intolerance: ACE Inhibitor (allergic), Ca++ -blocker (peripheral edema)

Procedural steps
1. Femoral access right groin (7F)

2. Placement of a 7F 70 cm guiding catheter
- HS / IMA (Mach-1, BOSTON SCIENTIFIC)

3. Buddy wire renal artery
- 0.014" Hi-torque Spartacore 14 (ABBOTT)

4. Renal artery denervation
- Simplicity® RF Catheter (MEDTRONIC)

Clinical data
PAOD Rutherford 3, claudication at 50 meters both legs
Art. hypertension, former smoker, diabetes mellitus
ABI bilateral 0.65

Procedural steps
1. Left brachial approach
- 5F Pigtail-catheter (CORDIS)
- 0.035" angled soft Terumo 180 cm (TERUMO)
- 0.035" 300 cm Supra Core (ABBOTT)
- 6F – 90 cm Flexor Check-Flo Sheath (COOK)

2. Passage of the occlusion from brachial
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" angled stiff Terumo 260 cm (TERUMO)

3. Snaring of the Terumo via 7F groin sheath bilateral
- 7F and 11F 25 cm Introducer Sheath (TERUMO)

4. Exchange
- to 0.035" SupraCore 300 cm guidewires via groin-access (ABBOTT)

5. PTA of the occlusion
- Armada 35 6/120 mm (ABBOTT)

6. Stenting
- Aorta: Sinus Aortic Stent 22/80 mm (OPTIMED)
- Iliac arteries: Omnilink Elite Peripheral Stent System 8/59 mm (ABBOTT)
Optional: Advanta 12 Covered Stent (ATRIUM/Maquet Getinge Group)

Clinical data
Severe post-thrombotic syndrome of the right leg with
Venous claudication, varicose veins, leg swelling
History of acute iliofemoral DVT right leg & massive
PE 6 months ago
DVT treated with anticoagulation & compression
PE treated with catheter assisted thrombolysis

Procedural steps
1. Popliteal venous access with ultrasound guidance (7F-sheath)

2. Phlebography

3. Wire crossage
- Astato 20 0.014"; Astato 30 0.018"; Conquest 0.014" (ASAHI)

4. Predilation of lesion
- Amphirion 0.014" 1.5-2.0 mm (MEDTRONIC)
- Fox SV 0.018" 3.0-6.0 mm (ABBOTT)

5. Implantation of dedicated venous stents over Terumo angled wire 0.035
- Iliac veins: Sinus-Venous 14-18 mm (OPTIMED), Zilver Vena 14-16 mm (COOK)
- Common femoral vein: Sinus-Super-Flex 12 mm (OPTIMED), Wallstent 12 mm (BOSTON SCIENTIFIC)

6. High-pressure post-dilation of stents
- Fox Cross 0.035" 8.0-12.0 (ABBOTT)

Clinical data
PAOD Rutherford 4, claudication at 50 meters left calf
ABI 0.4 left
Antegrade recanalization attempt with failed distal re-entry 12/2012
Hypertension, hyperlipidaemia, adipositas, diabetes mellitus, former smoker (25 py)
Cerebrovascular disease: stroke 2006
Chronic renal impairment (GFR 35 ml/min)
Infrarenal AAA (max. diameter 39 mm)

Procedural steps
1. Antegrade access left groin
- 6F 55 cm Flexor Check-Flo Introducer, Ansel Modification (COOK)

2. Left peroneal artery retrograde sheathless approach
- 21 Gauge 4 cm puncture needle (COOK)
- Quick-Access Needle Holder (SPECTRANETICS)
- 0.018" V-18 Control 300 cm guidewire (Boston Scientific) supported by
- 0.018" Quick Cross support catheter, 90 cm (SPECTRANETICS)

3. Snaring of the wire from antegrade access
- Quick Cross Capture-Wire Connector (SPECTRANETICS)

4. Predilation
- Exchange to a 0.014" guidewire (PT2, Boston Scientific)
- 2.5/80 mm Chocolate PTA Balloon Catheter (TriReme MEDICAL)

5. PTA
- 3.0/80 and 4.0/120 mm In.Pact Amphirion Drug Eluting Balloon (MEDTRONIC)

6. Stenting on indication
- Complete-SE for ATK, Maris Deep for BTK (MEDTRONIC)

Clinical data
PAOD Rutherford 4, restpain and severe claudication left thigh and calf
Aortic valve replacement 02/2011
Interventional thrombectomy right groin 02/2011
Arterial hypertension, former smoker (30py)

Procedural steps
1. TEA left common femoral artery

2. Cross-over PTA/Stent of the external iliac artery
- Armada 35 LL PTA Catheter 6/80 mm (ABBOTT)
- Complete selfexpanding stent 7/100 mm (MEDTRONIC)

3. Recanalization of the SFA and PTA with DEBs
- InPact Pacific (MEDTRONIC)

4. Stenting on indication
- Innova selfexpanding nitinol stent (BOSTON SCIENTIFIC)

Clinical data
PAOD, Rutherford 3, PTA/Stent right and left SFA 2010
Claudication right limb
Arterial hypertension, COPD, former smoker, hyperlipidaemia
Diabetes mellitus
CAD (Previous Anterior AMI and PCI LAD)

Duplex
Severe in stent stenosis right SFA (3.4 m/sec; PSVR: 4.67)

Procedural steps
1. Contralateral access and placement of a cross-over sheath
- 5F JR4 Radifocus Angiographic Catheter (TERUMO)
- 0.035" Radifocus Terumo angled soft guide-wire, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- 8F – 45 cm Destination Guiding Sheath (TERUMO)

2. Passage of the lesions
- 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)

3. Lesion debulking
- Turbo Booster ELCA Laser Ablation Catheter (SPECTRANETICS)

4. Drug Eluting Balloon Dilation
- 5/120 mm Admiral IN.PACT Balloon Catheter (MEDTRONIC)

Clinical data
PAOD, Rutherford 4
Arterial hypertension, former smoker, hyperlipidaemia, diabetes mellitus
CAD (CABG 2009 and PCI 2011)

Duplex
Fibrotic Plaque determining severe stenosis of the tibioperoneal trunk and occlusion of the anterior tibial artery

Procedural steps
1. Contralateral access and placement of a cross-over sheath
- 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- 6F-90 cm Destination Guiding Sheath (TERUMO)

2. Passage of the lesions and predilation
- 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)
- 3/80 mm Amphirion DEEP Balloon Catheter (MEDTRONIC)

3. Drug Eluting Balloon Dilation, Intravascular Ultrasound Assessment and Bail-Out Stenting
- 3/80 mm Amphirion IN.PACT Balloon Catheter (MEDTRONIC)
- Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
- Stenting on indication Inperia Advance (CID)

Clinical data
Chronic venous insufficiency (C5-6EsAd9Po) right leg with
– Recurrent venous ulcers
– Leg swelling despite compression
Pelvic Vein Thrombosis 01/1995
Right Renal Vein Thrombosis 1962
– Nephrectomy right kidney 1963
Suspected coagulation disorder treated with
Permanent oral anticoagulation
PTS treated with compression hosiery

Procedural steps
1. Bilateral popliteal venous access with ultrasound guidance
(10F-sheath), may use additional jugular vein access (6F-sheath), general anaesthesia

2. Phlebography

3. Wire crossage
- Astato 20 0.014"; Astato 30 0.018"; Conquest 0.014" (ASAHI)

4. Predilation of lesion
- Amphirion 0.014" 1.5-2.0 mm (MEDTRONIC)
- Fox SV 0.018" 3.0-6.0 mm (ABBOTT)

5. Implantation of dedicated venous stents over Terumo angled wire 0.035
- Iliac veins: Sinus-Venous 14-18 mm (OPTIMED), Zilver Vena 14-16 mm (COOK),
- Common femoral vein: Sinus-Super-Flex 12 mm (OPTIMED), Wallstent 12 mm (BOSTON SCIENTIFIC),
- IVC: Optimed XL 18-22 mm (OPTIMED)

6. High-pressure post-dilation of stents
- Fox Cross 0.035" 8.0-12.0 (ABBOTT)

Clinical data
PAOD Rutherford 5, ulceration right heel
Stenting right SFA 2009, left SFA 2010
History of myocardial infarction, CAD, CABG 2002
Arterial hypertension, obesity, former Smoker (30py)

Procedural steps
1. Right antegrade access
- 6F 55 cm Flexor Check-Flo Performer (COOK)

2. Antegrade passage of the popliteal lesion

3. PTA and implantation of a Supera-Stent into the popliteal artery (IDEV)

4. Antegrade attempt to pass the TPT occlusion
- 0.018" CXI Support-Catheter 90 cm (COOK)
- 0.014" Approach Hydro ST Guide wire, 300 cm (COOK)

5. In case of failure retrograde approach via posterior tibial artery
- Micropuncture® Transpedal Access Set (COOK) with
- 21 Gauge 4 cm needle and 3F Sheath (COOK)
- 0.018" CXI Support-Catheter 90 cm (COOK)
- 0.014" Approach CTO Guidewire 18 g, 300 cm (COOK)

6. PTA of TPT and PA from retrograde with
- Advance Micro 14 Balloon (COOK)

7. Optional drug-eluting balloon PTA
- In.Pact Deep (MEDTRONIC)

Clinical data
St.p. AAA (Gore Excluder Endograft 2006)
Contralateral PAA treated 2012
Art. hypertension, hyperlipidemia, smoking (quit 6 years ago)
St.p. colon cancer (42 years ago)
St.p. breast cancer (2009), TURP (1997)
St.p. pacemaker due to arrhythmia
Hiatal hernia, gastritis / GERD, mild COPD

Procedural steps
1. Right antegrade access
- 6F vascular sheath
- straight marking catheter
- torque wire

2. Exchange to 7F/8F sheath and 0.018 BMW wire (ABBOTT)

3. 7 x 15 Viabahn stent (GORE)

4. 8 x 15 Viabahn stent (GORE)

5. Balloon dilatation with 8 x 4 Cook balloon (COOK)

6. AngioSeal (St. Jude Medical)

Clinical data
PAOD Rutherford 5, ulceration left D1
Claudication at 150 meters left calf
Stenting left SFA 09/2011
PTA right SFA and popliteal artery 12/2012
Art. hypertension,
ABI left 0.41

Procedural steps
1. Left antegrade access
- 8F 10 cm Sheath (TERUMO)

2. PTA of the In-Stent Restenosis
- DEB, Lutonix Drug-Coated-Balloon 5/80 (BARD)

3. Guide wire Passage of the Popliteal artery
- V18 Control wire (BOSTON SCIENTIFIC)

4. Atherectomy
- Jetstream Navitus Atherectomy Catheter (BAYER HEALTH CARE)

5. PTA
- Drug-eluting balloons: In.Pact Deep 4.0/120 mm (MEDTRONIC)

6. Stenting on indication
- LifeStent (BARD)

Clinical data
PAOD Rutherford 5, CLI, forefoot-gangrene
Diabetes mellitus
Hypertension, former smoker
ABI right not measurable
CAD with urgent CABG 1/2013

Procedural steps
1. Right antegrade approach
- 5F 55 cm Flexor Check-Flo Performer Introducer Sheath (COOK)

2. Intraluminal passage of the occlusion of the peroneal artery
- Command 0.014" GW 300 cm (ABBOTT)
- Armada 14 2.5/120 mm 120 cm (ABBOTT)

3. In case of failure exchange to
- Winn 80 or 200 T 0.014" guidewire 300 cm (ABBOTT)

4. PTA and potentially implantation of a DES (P3-stenosis)
- Xience Prime BTK 3.5/38 mm (ABBOTT)

Clinical data
Hypertension, hyperlipidaemia, NIDDM
03/99 AMI and CABG; 10/12 PCI RCA
10/01 Right CEA; 02/02 Right CAS
08/09 PAD (Aorto – Right CFA Graft)

Duplex
Fibrotic hyperplasia determining severe stenosis of the left ICA (3.2 m/sec.)

Procedural steps
1. Introduction of the carotid guiding sheath and cerebral protection device
- 6F-90 cm Destination Carotid Guiding Sheath (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
- 5.0 Spider Fx Embolic Protection System (ev3)

2. Passing of the lesion, intravascular ultrasound evaluation and stenting
- 0.014" Balance Middle Weight guide-wire, 190 cm (ABBOTT)
- Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
- 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
- 8.0 – 10.0 / 40 mm XACT Carotid Stent System (ABBOTT)

3. Postdilatation
- 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)

Clinical data
PAOD Rutherford 3, claudication left calf at 150 meters, ABI 0.67
Stenting left common iliac artery 10/2012 for restpain
PTA right SFA for claudication 11/2012
Bilateral groin hematoma and dissection 11/2012
Diabetes mellitus type 2, art. hypertension, current smoker

Procedural steps
1. Right brachial access
- 5F Flexor 110 cm Check-Flo Performer Tibial sheath (COOK)

2. Passage of the occlusion
- 0,035" stiff angeled Terumo Glidewire 300 cm (TERUMO)
- Supported by a Trailblazer 0,035", 150 cm (COVIDIEN)

3. Exchange
- for a V18 control guide wire (BOSTON SCIENTIFIC)

4. PTA
- Powercross PTA Balloon catheter 5/150 mm, 150 cm (COVIDIEN)

5. Implantation
- of a 6/120 mm Everflex Self-expanding Peripheral Stent with 5 French Entrust Delivery System (COVIDIEN)

Clinical data
Recurrent left sided varicosis with
– Leg & groin discomfort
– Swelling of the leg
Recurrent PE’s & femoro-popliteal DVT’s treated with anticoagulation & compression
Symptomatic varicose veins
Stripping of left GSV

Procedural steps
1. Popliteal venous access with ultrasound guidance (7Fr-sheath)

2. Phlebography

3. Wire crossage
- Terumo angled wire 0.035", may use Astato 0.018" 30 (ASAHI)

4. IVUS only if angiographic significance of lesion is doubtful

5. Implantation of dedicated venous stent over Terumo angled wire 0.035
- Iliac vein: Sinus-Venous 14-18 mm (OPTIMED), or Zilver Vena 14-16 mm (COOK)

6. High-pressure post-dilation of stent
- Fox Cross 0.035" 10.0-12.0 (ABBOTT)

Clinical data
12/12 TIA (Dysarthria and right hand paresis)
Hypertension, hyperlipidaemia, NIDDM
06/12 ACS – PCI LM (DES)

Duplex
Fibrolipidic Plaque determining severe stenosis of the Left ICA (1.8 m/sec)
Calcific plaque determining severe stenosis of the ostial left CCA

Procedural steps
1. Introduction of the Carotid Guiding Catheter and cerebral protection device
- 8F JR4 4.0 Launcher Guiding Catheter (TERUMO)
- 4.0 – 7.0 Emboshield NAV Embolic Protection System (ABBOTT)

2. Stenting the lesions
- 3.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
- 8.0/19 mm PALMAZ GENESIS Peripheral Stent (CORDIS) for CCA
- 8.0/40 mm Precise PRO Rx Carotid Stent (CORDIS) for ICA

3. Postdilatation
- 5.5/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)

Clinical data
PAOD Rutherford 3, claudication right calf at 100 m, ABI 0.69 right
Failure to recanalize the occlusion 12/2012
Arterial hypertension, current smoker (40py)

Procedural steps
1. Left femoral cross-over approach
- 5F, 55 cm, Flexor Check-Flo Introducer (COOK)

2. Second attempt to pass the occlusion from antegrade:
Subintimal passage of the occlusion
- 0.035" Terumo Guidewire 260 cm (TERUMO)
- and 0.035" Trailblazer Support Catheter, 135 cm (COVIDIEN)
- Reenter the true lumen with the Enteer Re-Entry System (COVIDIEN)

3. PTA
- Powercross PTA Balloon Catheter 5/100 mm Balloon (COVIDIEN)

4. Implantation
- of a 5F compatible Stent (7/120 cm) Everflex Self-expanding Peripheral Stent with Entrust Delivery System (COVIDIEN)

Clinical data
PAOD Rutherford 6, heel-ulceration right
PAOD Rutherford 5 left, PTA 1/2013
Stenting right SFA 2008
Occlusion of the posterior tibial artery
Diabetes mellitus type 2, art. Hypertension

Procedural steps
1. Right antegrade access
- 5F 55 cm Flexor Check-Flo Performer (COOK)

2. PTA and stenting of the anterior tibial artery
- Xience Prime BTK drug-eluting stent (ABBOTT)

3. Passage of the occlusion of the posterior tibial artery
- 0.018" Glidewire Advantage 300 cm (TERUMO)
- 0.035" NaviCross angeled support-catheter 135 cm (TERUMO)

4. PTA
- Senri RX PTA Balloon dilatation catheter (2.0/150m, TERUMO)

Clinical data
CVI I (Widmer)
Recurrent oedema and pain right lower leg
Varicose tributaries

Procedural steps
1. Duplex ultrasound of the varicose veins

2. Retrograde access SSV mid lower leg with permanent venous catheter

3. Placement of the ELVeS Radial SLIM fiber (BIOLITEC) into the SSV until 1 cm up to the sapheno-popliteal junction

4. Anesthesia with anesthesia with 200 ml ultracaine, 5 ml sodium carbonate, 5 ml epinephrine diluted in 500 ml cooled saline around the fibre

5. Connecting the fiber to the 1470 nm diode laser (BIOLITEC)

6. Laser treatment from proximal to distal (application of 60 J/cm vein laser energy)

7. Application of 1% polidocanol foam sclerotherapy (KREUSSLER) in tributaries distally with use of ultrasound guidance

Clinical data
PAOD Rutherford 5, minor tissue loss on the right foot,
walking capacity 20m and rest pain at night
Bilateral diabetic foot syndrome
Recanalization of the left popliteal artery 12/2012,
Diabetes mellitus (IDDM, HbA1c >8,5), art. hypertension
Renal insufficiency (CKD III), CAD, atrial fibrillation with oral anticoagulation

Procedural steps
1. Antegrade access
- 45 cm 6 F braided sheath (TERUMO)

2. Lesion passage into the posterior tibial artery
- Truepath CTO Device (BOSTON SCIENTIFIC)
- Add on wires: Victory 0,014/0,018 and V18 control (BOSTON SCIENTIFIC)
- Add on Support: Rubicon Catheter (BOSTON SCIENTIFIC) and angled CXI support catheter (COOK)

3. PTA
- 3 mm resp. 4 mm Coyote balloon (BOSTON SCIENTIFIC)

4. Stenting on indication
- Promus Element Plus BTK (BOSTON SCIENTIFIC)

Clinical data
CVI II (Widmer)
Dysaesthesia and chronic oedema both lower leg
History of erysipelas right lower leg
Night Cramps in the calf

Procedural steps
1. Duplex ultrasound of the varicose veins

2. Retrograde access GSV upper right lower leg calf with a 6F sheath

3. Placement of the ELVeS Radial fiber (BIOLITEC) into the GSV until 1 cm up to the sapheno-femoral junction

4. Anesthesia with 25 ml ultracaine diluted in 500 ml cooled saline around the fiber

5. Connecting the fiber to the 1470 nm diode laser (BIOLITEC)

6. Laser treatment from proximal to distal (application of 60 J/cm vein laser energy)

7. Application of 1% polidocanol foam sclerotherapy (KREUSSLER) in tributaries distally with use of ultrasound guidance

Clinical data
PAOD Rutherford 3, painfree walking-capacity 100 meters
ABI left 0.67
Asymptomatic Internal carotid artery stenosis
Small abdominal aneurysm (35 mm)
Diabetes mellitus type 2, art. hypertension, hyperlipidemia

Procedural steps
1. Right femoral access and cross-over approach
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

2. Attempt to pass intraluminally
- TruePath-system (BOSTON SCIENTIFIC)
- Rubicon 18 Support-Catheter, 135 mm (BOSTON SCIENTIFIC)

3. In case of subintimal passage and inability to reenter distal
- V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
- OffRoad Reentry System (BOSTON SCIENTIFIC)

4. PTA
- Mustang 5/120 mm Balloon (BOSTON SCIENTIFIC)
- LegFlow Drug-eluting-balloon proximal (CARDIONOVUM)

5. Stenting
- Innova Selfexpanding Nitinol-Stents (BOSTON SCIENTIFIC)

Clinical data
3/2013 EVAR (main body Zenith Flex, iliac extensions Zenith spiral COOK)
CT-control 11/12: axial diameter increase from initially 53 mm to 58 mm

Procedural steps
1. Right femoral approach
- 5F 10 cm sheath (TERUMO)

2. Cannulation right ileolumbar artery
- 0.035" Glidewire, 5F Glidecath MP (TERUMO)

3. Cannulation Endoleak
- 0.014" Choice PT II (BOSTON SCIENTIFIC) and
- 0.014" Echelon™ Microcatheter (COVIDIEN)

4. Embolisation inflow and outflow vessel with Ethylene-Vinyl-Alcohol

5. Copolymer Onyx® 34 (COVIDIEN)

Clinical data
PAOD Rutherford 5, heel-ulceration right
SFA-Angioplasty bilateral 2011 and 2012
Arterial hypertension

Procedural steps
1. Antegrade Access right groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)

2. Antegrade passage of the occlusion
- Connect 250 T Guidewire (ABBOTT)
- QuickCross Support-Catheter 0.018” 90 cm (SPECTRANETICS)

3. In case of antegrade failure retrograde puncture of the proximal ATA
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018” 90 cm (SPECTRANETICS)

4. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)

5. Antegrade angioplasty
- 5/40 Savvy-Balloon (CORDIS)

6. Stent-implantation
- Supera Veritas Interwoven Selfexpanding Nitinol-Stent (IDEV)

Clinical data
PAOD Rutherford 5 impaired wound healing and minor tissue loss right foot after amputation D1 11/2012
Recanalisation of the right SFA and right TPT
Diabetes mellitus with diabetic foot syndrome
Renal insufficiency (CKD III)
Left ventricular dysfunction, oral anticoagulation
Current smoker, stroke in the past

Procedural steps
1. Right antegrade access
- 4F Fortress 45 cm Sheath (BIOTRONIK)

2. Passing the lesion
- XT-14 or a Cruiser-18 guide wire (BIOTRONIK)

3. Predilation
- 2mm Passeo-14 or Passeo-18 (BIOTRONIK)

4. PTA
- Passeo-18 Lux drug coated balloon 2.5 mm (BIOTRONIK)

5. Stenting on indication
- Orsiro 3 x 40 mm coronary DES or Pulsar-18 self-epxanding stent system (BIOTRONIK)

6. Prepare for a retrograde pedal access via ATA as a backup option

Clinical data
Bilateral stenosis of the internal carotid arteries
Left ICA (80%): vmax = 3,5 m/s; ED vmax = 120 cm/s
Right ICA (60%): vmax = 2,5 m/s; ED vmax = 60 cm/s
Arterial hypertension, hyperlipidemia, adipositas (BMI 32 kg/m2)

Procedural steps
1. Femoral access right groin
- 8F 10 cm sheath (TERUMO)
- 8F Sidewinder II Guiding-Catheter (CORDIS)

2. Distal protection
- Filterwire EZ (BOSTON SCIENTIFIC)

3. Primary stenting
- 9/30 Carotid Wallstent (BOSTON SCIENTIFIC)

4. Post Dilatation
- 5.0/30 mm Sterling (BOSTON SCIENTIFIC)

5. Closure of the access site
- Perclose Proglide (ABBOTT)

Clinical data
PAOD Rutherford 3, painfree walking-capacity 20 meters
ABI left 0.57
CAD, NSTEMI 12/2012, COPD
Atrial fibrillation with oral anticoagulation
Chronic renal failure (GFR 65 ml/min)
Diabetes mellitus type 2, art. hypertension, hyperlipidemia

Procedural steps
1. Right femoral access and cross-over approach
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

2. Passage of the lesion
- Passeo 18 Balloon 5.0/170 mm (BIOTRONIK)
- Cruiser S 0.018" Guidewire 300 cm (BIOTRONIK)
- Exchange for XT-14 Guidewire (BIOTRONIK)

3. Lesion preparation
- AngioSculpt XL Scoring-Balloon 5/80 mm (BIOTRONIK)

4. Exchange to 0.035" guidewire
- SupraCore (ABBOTT)

5. Stent-Implantation
- Pulsar-35 Selfexpanding Nitinol-Stent (BIOTRONIK)

6. Postdilation
- Passeo-35 5/80 mm (BIOTRONIK)

Clinical data
2nd transient blindness in 2012 left eye
Bilateral ICA Stenosis L>R, PSV ICA left >300cm/s, EDV 90 cm/sec
CAD with stenting left main 12/2012
PAOD with bilateral EIA stenosis
Arterial hypertension, former smoker (till 12/2012), hyperlipidemia

Premedication
Aspirin 100 mg, Clopidogrel 75 mg since 12/2012, Simvastatin 40 mg
Ramipril 5 mg and HCT 12,5 mg

Procedural steps
1. Femoral access right groin

2. Stenting of the right EIA
(Dynamic Balloon-Expandable Stent System 7 x 38 mm, BIOTRONIK)

3. 260 cm stiff angeled Radiofocus guide wire (TERUMO)

4. Weinberg Catheter for left CCA (COOK)

5. Vista Brite Tip IG Guiding Catheter 8F MP Shape (CORDIS)

6. Filterwire EZ Protection System (BOSTON SCIENTIFIC)

7. 9/30 mm Wallstent (BOSTON SCIENTIFIC)

8. PTA with 5 x 30 mm Sterling Balloon Dilatation Catheter (BOSTON SCIENTIFIC)

Clinical data
PAOD Rutherford 3, claudication left calf 50 m
ABI left 0.7
Arterial hypertension, current smoker (15 py)

Procedural steps
1. Right femoral access and cross-over approach
- 6 Fr Balkin Up & Over Contralateral Flexor Check-Flo Performer 40cm (COOK)

2. Intra-luminal passage of the lesion
- 0.018" Connect guide wire, 300 cm (abbott)

3. Predilatation
- 4/120 Bantam OTW PTA catheter (C. R. BARD)

4. PTA
- Three Lutonix Drug-Coated-Balloons 5/100 (C. R. BARD)

5. Stent implantation (spot stenting)
- 6/170 mm LifeStent (C. R. BARD)

Clinical data
PAOD Rutherford 3, claudication right leg
PTA right SFA with DEB 2011
PTA/Stent left ICA 10/12
Hypertension, COPD, former smoker, hyperlipidaemia,
Diabetes mellitus

Duplex
Fibroclacific plaque determining severe restenosis PSV: 4.9 m/sec

Procedural steps
1. Contralateral access and placement of a cross-over sheath
- 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
- 0.035" Radiofocus angled soft guide-wire M, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- 6F–45 cm Destination Guiding Sheath (TERUMO)

2. Passage of the lesions and predilation
- 0.018" V-18™ Control Wire® Guide Wire 300 cm (BOSTON)
- 5/100 mm Pacific Balloon Catheter (Medtronic)

3. Endovascular graft implantation
- 6/150 mm 6 F VIABAHN® Endoprosthesis (GORE)
- 6/120 mm Pacific Balloon Catheter (Medtronic)

Clinical data
PAOD Rutherford 3-4
Severe claudication both sides (hip, buttock, thigh)
Restpain / paraesthesia during night both feet
Risk factors: Diabetes mellitus type 2, former smoker, hyperlipidaemia
Left ventricular cardiomyopathy, EF 45%

Procedural steps
1. Left brachial approach
- 7F-90 cm Destination guiding sheath (TERUMO)

2. Passage of the occlusion from brachial
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" angled stiff Terumo 260 cm (TERUMO)

3. Snaring of the Terumo via 7F groin sheath bilateral
- 7F and 11F 25 cm Introducer Sheath (TERUMO)

4. Exchange to
- 0.035" SupraCore 300cm guidewires via groin-access (ABBOTT)

5. Implantation of
- Advanta 12 7/38 mm-Covered Stents (ATRIUM/Maquet Getinge Group) in both renal arteries

6. PTA of the occlusion
- Admiral 5/80 mm (MEDTRONIC)

7. Stenting
- Aorta: Advanta 12 Covered Stent 12/61 mm (ATRUIM/Maquet Getinge Group)
- Iliac arteries: Advanta 12 Covered Stents 7/59 mm (ATRUIM/Maquet Getinge Group)
- EIA: right: Complete 9/80 (MEDTRONIC), left: Absolute 9/100 (ABBOTT)

8. Postdilation of the abdominal stent
- Maxi LD 15/40 mm (CORDIS)

Clinical data
PAOD Rutherford 3, claudication left calf at 100 meters
PTA left SFA and stenting for claudication 11/2011
Elsewhere failed recanalization-attempt 12/2012 left SFA
Inability to direct the guidewire into the stent
Diabetes mellitus type 2, art. hypertension, hyperlipidaemia

Procedural steps
1. Right femoral access and cross-over approach
- 2.6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)

2. Retrograde puncture of the SFA-stent
- 18 Gauge 7cm needle (COOK)
- Quick-Access Needle Holder (SPECTRANETICS)
- 0.035" stiff, angled Terumo, 300 cm (BOSTON SCIENTIFIC)

3. Retrograde passage of the stent and snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)

4. PTA / stenting from antegrade
- Advance 18 Balloon (COOK)
- Zilver-PTX stents (COOK)

Clinical data
Arterial Hypertension, insufficiently controlled by 5 antihypertensive drugs, hyperlipidemia, former smoker
PAOD, thrombectomy and PTA Stent left SFA 01/2012

Procedural steps
1. Retrograde access right groin and guiding catheter
- 6F Radiofocus Introducer II Sheath, 25 cm (TERUMO)
- 6F MACH 1 Guiding Catheter (BOSTON SCIENTIFIC)

2. Passing of the lesion, Pre-dilation and Stenting
- 0.014" Galeo ES guide-wire, 175 cm (BIOTRONIK)
- 3.0/20 mm Falcon Bravo RX PTA Balloon Catheter (MEDTRONIC)
- 6.0/18 mm ArchStent Ostial System (Ostial Inc.)

Clinical data
Progressive juxtarenal aortic aneurysm
Arterial hypertension, hyperlipidemia, coronary heart disease
Atrial fibrillation with oral anticoagulation

Procedural steps
1. Placement of a Zenith Endograft (2 fenestrations, 1 scallop, COOK)

2. 3D Dyna CT run (Siemens Artis Zeego)

3. Cannulation of the renal arteries with Virtual Guidance

4. Implantation of the bridging stentgrafts
(Advanta V12, ATRIUM/Maquet Getinge Group)

5. Implantation of the distal bifurcated Endograft (COOK)

Clinical data
PAOD Rutherford 4, rest pain right limb
Hypertension, former smoker, hyperlipidaemia, diabetes mellitus

Duplex
Fibrotic plaque determining severe stenosis of the tibioperoneal trunk and occlusion of the posterior tibial artery

Procedural steps
1. Contralateral access and placement of a cross-over sheath
- 5F JR4 Radiofocus Angiographic Catheter (TERUMO)
- 0.035" Radiofocus angled soft guide-wire M, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 300 cm (ABBOTT)
- 6F-90 cm Destination Guiding Sheath (TERUMO)

2. Passage of the lesions and distal embolic protection positioning
- 0.014" Balance Middle Weight guide-wire, 300 cm (ABBOTT)
- 4.0 Spider Fx Embolic Protection Sysytem (COVIDIEN)

3. Lesion debulking
- Turbo-Hawk small vessel Peripheral Plaque Excision System Catheter (COVIDIEN)

4. Drug Eluting Balloon Dilation, Intravascular Ultrasound Assessment and Bail-Out Stenting
- 4/80 mm Amphirion IN.PACT Balloon Catheter (MEDTRONIC)
- Eagle Eye Platinum RX digital IVUS Catheter (VOLCANO)
- Stenting on indication Inperia Advance (CID)

Clinical data
PAOD Rutherford 5, ulceration D2 left
ABI left 0.4
Failed antegrade recanalization of the ATA 01/2013
Diabetes mellitus type 2, art. Hypertension
Renal failure, on dialysis for 3 years
Amputation right lower limb after car accident
CAD, PTCA/Stent LAD/D1, RIM 02/2012

Procedural steps
1. Antegrade Access left groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)

2. Retrograde puncture of the anterior tibial artery
- Quick-Access Needle Holder (SPECTRANETICS)
- Micropuncture Pedal Access Set (COOK)
- 21 Gauge / 4 cm needle (COOK)
- 3 French pedal sheath (COOK)
- 0.014" Hydro ST 300 cm guidewire (COOK)
- 0.018" CXI Supportcatheter 90 cm (COOK)
PTA via the 3F sheath:
- Advance Micro 14 Ultra Low-Profile PTA Balloon-Catheter (COOK)

3. After retrograde angioplasty guidewire-passage from antegrade
- 0.014" Hydro ST 300 cm guidewire (COOK)

4. Antegrade angioplasty with DEBs
- In.Pact Deep 2.5/120 mm and 3.0/120 mm (MEDTRONIC)

Clinical data
Progressive juxtarenal aortic aneurysm
Arterial hypertension, hyperlipidemia, coronary heart disease
Atrial fibrillation with oral anticoagulation

Procedural steps
1. Placement of a Zenith Endograft (2 fenestrations, 1 scallop, COOK)

2. 3D Dyna CT run (Siemens Artis Zeego)

3. Cannulation of the renal arteries with Virtual Guidance

4. Implantation of the bridging stentgrafts
(Advanta V12, ATRIUM/Maquet Getinge Group)

5. Implantation of the distal bifurcated Endograft (COOK)

Clinical data
Screening for an abdominal aortic aneurysm
Diameter 5.4 mm
Arterial hypertension, current smoker
Renal insufficiency, GFR 55

Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)

2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)

3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)

4. Ovation Main Body (TRIVASCULAR) via right groin

5. Bilateral implantation of limb-extensions

6. Post-dilatation with Reliant-Balloon (MEDTRONIC)

Clinical data
PAOD Rutherford 5, non-healing ulcer left heel
ABI left 0.4; right 0.7
CAD, PVD
Risk factors: Diabetes mellitus type 2, art. Hypertension

Procedural steps
1. Contralateral access

2. Left pedal access by ultrasound

3. Recanalization and CSI Stealth DB atherectomy (CSI Inc.)

4. PTA with 3.0mm Chocolate balloon (TriReme)

5. Provisional stenting

Clinical data
Screening for an abdominal aortic aneurysm
Diameter 5.4 mm
Arterial hypertension, current smoker
Renal insufficiency, GFR 55

Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)

2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)

3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)

4. Ovation Main Body (TRIVASCULAR) via right groin

5. Bilateral implantation of limb-extensions

6. Post-dilatation with Reliant-Balloon (MEDTRONIC)

Clinical data
PAOD Rutherford 3,
Debiliating hip, buttock and thigh-claudication
Risk factors:
Remote smoker, hyperlipidemia,
Art. hypertension, familiy-history of CAD

Procedural steps
1. Ultrasound-guided bilateral femoral access

2. Hydrophilic wire approach

3. Low threshold for Pioneer-catheter (MEDTRONIC)

4. Balloon-expandable stent graft delivered in kissing fashion

5. Hemodynamic assessment of results

Clinical data
PAOD Rutherford 3, severe claudication left calf
ABI left 0.68
Arterial hypertension, nicotine abuse

Procedural steps
1. Right groin cross-over access
- 6F 40 cm Balkin Up & Over Contralateral Check-Flo Introducer (COOK)

2. Guidewire-passage
- 0.035" stiff angled Terumo 260cm (TERUMO)
- Supported by a Judkins Right 5F-diagnostic catheter (CORDIS)
- Exchange to 0.018" Steel Core Guidewire 300 cm (ABBOTT)

3. Predilatation
- 4.0/100 mm Mustang Balloon (BOSTON SCIENTIFIC)

4. DEB-angioplasty
- 3 x 6/100 mm Lutonix drug-coated-balloon (C.R. BARD)

5. Stenting on indication
- Spot-stenting with the Tack-IT Endovascular Stapler SystemTM (INTACT VASCULAR)

Clinical data
POD Rutherford 4 left side / right side 5, little lesion dig. 1 right
RF: current smoker, arterial hypertension, Apoplex,
DVT left side 10/2012

Angio
Occlusion of infrarenal aorta, bilateral common/external iliac arteries

Duplex
Bilateral monophasic flow CFA
ABI: left 0.5 / right not detectable

Procedural steps
1. Transbrachial approach left side
- 6F Flexor Check Flo Performer Introducer
Sheath, 90 cm (COOK)
- 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
- 0.035" Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)

2. Transbrachial recanalization bilateral with femoral wire extraction and exchange for a stiff wire
- 0.018" V-18 control wire 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus angled + straight stiff guide wire, 260 cm (TERUMO)
- 4 + 5F multipurpose guiding (custom made) Catheter, 125 cm (CORDIS)
- 0.035" Supra core guide wire, 300 cm (ABBOTT)
- Quick Cross Catheter 0.035", 135 cm (SPECTRANETICS)

3. Transfemoral approach bilateral
- Left: 7F Introducer Sheath, 23 cm (ST JUDE)
- Right: 12F Introducer Sheath, 45 cm (COOK)

4. Predilatation in kissing balloon technique
- 4.0/120 mm Admiral Xtreme OTW Dilatation Catheter, 130 cm (MEDTRONIC)

5. Stenting of the infrarenal aorta
- CP STENT 2.8 cm (NUMED)
- BIB Stent Placement Catheter 20mm/40mm (NUMED)

6. Stenting and postdilatation in kissing-stent technique of aortic bifurcation/iliac arteries
- 8.0/120 mm Complete SE Iliac 130 cm (Medtronic Invatec) or
- 8.0/78 mm Scuba Peripheral CO-CR Stent 80 cmm (Medtronic Invatec)
- Optional: ADVANTA V12 (Atrium) covered stents

Clinical data
Office BP: 184/ 100 mmHg
Ambulatory BP: 154/89 mmHg, non dipping profile
Supraaortic disease: stenting left ICA 201
Atrial fibrillation (oral anticoagulation)
Renal function: GFR 56 ml/min
LV Hypetrophy
Medication: ACE-Inhibitor, AT1-Blocker, betablocker, diuretic Vasodilator, central acting angent (Moxonodine)

Procedural steps
1. Femoral access right groin 8F

2. Placement of a 8F 55 cm EnligHTN Guide Catheter (RCD-1)

3. Multielectrode Renal Denervation
- EnligHTN Renal Denervation System (St. Jude Medical)

Clinical data
Type -B- Dissection (max diameter descending aorta 40 mm) with dissection into the left subclavian artery
Acute "Stabbing" back-pain with intermittent paraplegia (10 min) in 12/12, currently intermittent back pain
Arterial hypertension (6 antihypertensive drugs)

Procedural steps
1. Surgical cut down right common femoral artery

2. Left transbrachial approach
- 7F 55cm Flexor Check-Flo Introducer (COOK)

3. Implantation of a covered stent into the the left subclavian artery in "Chimney-technique"
- 10/38mm, Advanta V12 (ATRIUM/Maquet Getinge Group)

4. Implantation of a Thoracic Stentgraft System
- Captiva (MEDTRONIC)

Clinical data
PAOD Rutherford 3, walking capacity 100 m
Claudication right thigh, ABI right 0.85
Hypertension, current smoker (60 py)

Procedural steps
1. Left brachial access
- 6F 90 cm Flexor Check-Flo Introducer (COOK)

2. Antegrade Passage of the lesion
- 0.035" Stiff Angled Terumo guide wire, 260 cm (TERUMO)
- 5F Multipurpose, 125 cm (CORDIS)

3. Right femoral access
- 6F 25 cm destination introducer sheath (TERUMO)

4. Snaring of the antegrade wire and exchanging for a
- 0.035" SupraCore, 300 cm (ABBOTT)

5. Predilation of the lesion
- 0.035" Armada-Balloon 5/80 (ABBOTT)

6. Kissing stent implantation
- 9.0/59 mm Omnilink Elite Cobalt Chromium Stent (ABBOTT)

7. Closure device of the access sites
- Perclose Proglide (ABBOTT)

Clinical data
Rapid progressive infrarenal aortic aneurysm
Arterial hypertension, hyperlipidemia, obesity

Procedural steps
1. Placement of the distal part of the Endurant II Tube Endograft (Medtronic)

2. Placement of the proximal part of the Endurant II Tube Endograft (Medtronic)

3. Fixation of the proximal Endograft to the proximal aneurysm neck with HeliFX Endoscrews (Aptus Endosystems)

4. Fixation of the distal Endograft to the distal aneurysm neck with HeliFX Endoscrews (Aptus Endosystems)

Clinical data
Dyspnea on exertion
24h RR: mean systolic values: 182mmHg w/ peak of ~240mmHg
Medication: Bisoprolol 1x 5mg, Torasemid 1x 10mg
Candesartan 1x 32mg, Doxazosin 1x 2mg
Risk factors: Hypercholesterinemia, s/p tobacco use
Resistant hypertension for >10y

Procedural steps
1. 8F guiding catheter

2. Wire distal A. renalis

3. 3 ablation points with balloon 6mm, 2ATM

4. 30 sec/ablation

Clinical data
PAOD Rutherford 3 (walking capacity 100 m) left
ABI left 0.6
PTA left SFA 12/2010, PTA right SFA 6/2011
Coronary artery disease: stenting RCA, PLA 2010 and 2011
Hypertension, hyperlipidemia (hereditary), former smoker (20 py)

Procedural steps
1. Right crossover femoral access
- 8F Flexor Check-Flo Introducer Sheath, 45 cm (COOK)

2. Wiring the occlusion
- 0.018" V-18 Control guide wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)

3. Thrombectomy/ Atherectomy
- SpiderFX Embolic Protection Device (COVIDIEN)
- 6F Rotarex S Thrombectomy Catheter (STRAUB MEDICAL)

4. PTA with DEB
- In.Pact Pacific 6/120 DEB (MEDTRONIC)

5. Stenting on indication
- Life Stent (BARD)

Clinical data
Recurrent PAOD, Rutherford 4, right leg

Procedural steps
1. Left femoral approach 5F 10 cm sheath (TERUMO)

2. 7F 45 cm Destination x-over sheath via Advantage 0,035 wire (TERUMO)

3. Cannulation Stenosis 0.014 Choice PT2 (BOSTON SCIENTIFIC)

4. Placement 5mm Spiderfilter FX via 0,035 Trailblazer support catheter (COVIDIEN)

5. Atherectomy with large tip Turbohawk smoothcutter (COVIDIEN)

6. Post PTA with 4-5 x 120 IN.PACT Admiral balloon (MEDTRONIC)

Clinical data
Office BP: 160/ 95 mmHg
Ambulatory BP: 143/ 91 mmHg, non dipping profile
Stenting renal artery right 2000
RI left:0.72, RI right:0.74
Coronary artery disease; PAOD (Stenting SFA right)
Renal function: GFR 45 ml/min
Supraaortic disease: asymptomatic moderate ICA stenosis (60%) right

Procedural steps
1. Femoral access right groin (7F)

2. Placement of a 7F 70 cm guiding catheter HS / IMA (Mach-1, BOSTON SCIENTIFIC)

3. Buddy wire renal artery:
0.014" Hi-torque Spartacore 14 (ABBOTT)

4. Renal artery denervation with the Simplicity® RF Catheter (MEDTRONIC)

Clinical data
Progressive aneurysm of the decending thoracic aorta
CAD (CABG 2005)
TEA left CFA 2008
Arterial hypertension, hyperlipidemia

Procedural steps
1. Debranching of all supraaortal vessels

2. Implantation of a stentgraft (C-TAG, GORE)

Clinical data
PAOD Rutherford III left leg, ABI 0,5
PTA/ BES right CIA 11/2012, frustrane retrograde recanalisation attempt left CIA
Arterial hypertension, CAD; COPD

Procedural steps
1. Surgical TEA left CFA

2. Transbrachial Recanalisation left CIA
- 6F 90 cm Shuttle sheath (COOK)

3. Recanalisation
- 0.035" Quickcross (SPECTRANETICS) and
- 0.035" Glidewire stiff (TERUMO)

4. Primary stenting
- 8 mm Dynamic Balloon expandable stent (BIOTRONIK)

Clinical data
PAOD Rutherford 3 (walking capacity 50 m) both thighs and left calf
ABI left 0.43, right 0.72
Hypertension, hyperlipidemia, current smoker (50 py)

Procedural steps
1. Left brachial approach for diagnostic angiograms
- 5F Pigtail-catheter (CORDIS)
- 0.035" angled soft Terumo 180 cm (TERUMO)
- 0.035" 300 cm Supra Core (ABBOTT)
- 5F MP catheter (CORDIS)

2. Left femoral retrograde access
- 6F Radiofocus introducer, 10 cm (TERUMO)

3. Passage of the occlusion from retrograde
- 5F Multipurpose 125 cm diagnostic catheter (CORDIS)
- 0.035" Aquatrack Hydrophilic Guidewire (CORDIS)

4. Redirection with a re-entry device
- 0.014" Stabilizer Plus 300 cm Straight (CORDIS)
- Outback Re-entry Catheter (CORDIS)

5. PTA
- Powerflex Pro PTA Dilatation Catheter, 5/40 mm (CORDIS)

6. Stent implantation
- Smart Control Iliac Stent system, 7/60 mm (CORDIS)

7. Closure access site left groin
- Exoseal Vascular Closure Device

Clinical data
AAA, diameter 54mm,
Long CTO left SFA
CAD, impaired left ventricula function (EF 38%), CABG 2011
Arterial hypertension, former smoker (30py), hyperlipidemia

Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)
- 2.9F 10 cm Radiofocus Introducer II both groins (TERUMO)
- 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)

4. Implantation of an AFX Endovascular AAA System (Endologix)

Clinical data
PAOD Rutherford 3, claudication at 100 meters left calf
Antegrade PTA-attempt 10/2012 with perforation
Retrograde recanalization of the right SFA 12/2012 after perforation from during recanalization-attempt from antegrade
Hypertension, hyperlipidaemia, adipositas

Procedural steps
1. Cross-over-access from right to left
- 6F 40 cm Flexor Check-Flo Introducer (COOK)

2. Retrograde puncture of the distal SFA
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 15 cm needle (COOK) in coaxial technique through a 18 Gauge 7 cm needle
- V-18 Control 300 cm guidewire (Boston Scientific)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)

3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)

4. Antegrade angioplasty
- 5/120 Mustang Balloon (Boston Scientific)

5. Implantation of selfexpanding nitinol-stents
- Supera Interwoven Nitinol Stent (IDEV)

Clinical data
POD Rutherford 3, walking distance 50 m right calf,
Long bilateral SFA occlusion with recanalisation/2 nitinol stents left SFA 11.12
Failed recanalisation right SFA 12.12
Arterial hypertension, diabetes mellitus, former smoker (40 py)
Stroke 05/2012

Procedural steps
1. Contralateral access and placement of a cross-over sheath left groin, 5F (COOK)
- 5F Hook Catheter (COOK)

2. Bringing the patient in a prone position

3. Puncture right AP under road map control
- 6F sheath, 10 cm (St Jude Medical)

4. Passage of the lesion
- 0.035" Aquatrack angled stiff guide-wire, 180 cm (Cordis)
- 0.035" Glidecath Catheter, straight, 65 cm (TERUMO)

5. After passage of the lesion change to
- 0.018" Steel Core, 300 cm (Abbott)
- Optional: Outback Catheter - 0.014 Ironman, 300 cm (Cordis)

6. Predilation
- 0.035" Powerflex Pro 4 mm (Cordis)

7. Stentimplantation
- SMART (Cordis)

Clinical data
PAOD Rutherford 4, restpain right
Recurrent occlusions right SFA
Failure to pass the BTK-occlusions right from antegrade 12/2012
ABI right 0.46
SFA-Angioplasty right 2011 and 2012
Bypass left with recurrent reocclusion
Art. hypertension,
Chronic renal insufficiency (GFR 55ml / min)

Procedural steps
1. Antegrade Access right groin
- 6F 55 cm Flexor Check-Flo Introducer (COOK)

2. Retrograde puncture of the peroneal artery
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)

3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS)

4. Antegrade angioplasty (Predilatation)
- 3.0/80 mm Chocolate PTA Balloon (TriReme MEDICAL)

5. In.Pact Pacific 4.0/120 mm (MEDTRONIC)

Clinical data
55 y male w/ resistant hypertension for >10y
s/p renal denervation w/ Simplicity© cath. 02/2012
Systolic mean 24h RR-values remain ~148 mmHg resulting in headaches and dyspnea on exertion.
Invasive r/o of CHD 02/2012
Medikation: Metoprolol 2 x 100mg, Felodipin 2 x 5mg,
Candesartan 1 x 32 mg, Urapidil 90 mg 1 x 1, Dihydralazin 2 x 12.5mg

Procedural steps
1. Analgosedation w/ Midazolam, Fentanyl, Propofol

2. Right femoral access (8F, 7.500 IE Heparin)

3. 8F RDC Guiding catheter (CORDIS)

4. 0.014" Sion blue guidewire (ASAHI)

5. OneShot™ Ballon (COVIDIEN): left 7 mm (or 2 x 6 mm?) / right 6 mm

Clinical data
CAD, CABG 2001
Art. hypertension
Hostile abdomen after colon resection
Aneurysm diameter 55 cm
Very short neck

Procedural steps
1. Percutanous approach both groins Prostar XL (Abbott) and 14 F sheath (COOK)

2. Placement of the Endurant bifurcated endograft (Medtronic) just below the renal arteries.

3. Additional fixation of the Endograft with HeliFXTM
Aortic Securement System (Aptus)

Clinical data
PAOD Rutherford 3, claudication at 100 meters left calf
Elsewhere failed antegrade PTA attempt left SFA 12/2012
PTA/stenting left EIA 12/2012
Hyperlipidaemia, current smoker

Procedural steps
1. Cross-over-access from right to left
- 6F 40 cm Flexor Check-Flo Introducer (COOK)

2. Retrograde passage of the lesion via Profunda-branch
- 0.014" Regalia XS 1.0 Guidewire (ASAHI INTECC) or Fielder FC 300 cm (ASAHI INTECC)
- Asahi Corsair Support Catheter (ASAHI INTECC)

4. After retrograde passage of the guidewire snaring from antegrade

5. Antegrade angioplasty
- 5/120 Pacific Extreme PTA Balloon Catheter (MEDTRONIC)

6. Implantation of selfexpanding nitinol-stents
- Zilver PTX-Stent (COOK)

Clinical data
Symptomatic 70% stenosis right ICA
Amaurosis fugax and dyphasia
Risk factors: hypercholesterinemia
Medication: Clopidogrel 75 mg /die (starting 5 days prior to procedure)
Simvastation 20mg /die

Procedural steps
1. Long sheath

2. Filter protection (because of incomplete circle of Willis)

3. Stenting

4. Postdilatation

Clinical data
PAOD Rutherford 4, restpain right
Failure to pass the BTK-occlusions left from antegrade 12/2012
ABI right 0.3
Pulmonary embolism 10/2011
Recurrent swelling the lower leg both sides
Art. Hypertension

Procedural steps
1. Antegrade access left groin
- 5F 55 cm Flexor Check-Flo Introducer (COOK)

2. Retrograde puncture of the posterior and anterior tibial artery
- Quick-Access Needle Holder (SPECTRANETICS)
- 21 Gauge / 7 cm needle (COOK)
- V-18 Control 300 cm guidewire (BOSTON SCIENTIFIC)
- QuickCross Support-Catheter 0.018" 90 cm (SPECTRANETICS)

3. After retrograde passage of the guidewire snaring from antegrade
- Quick Cross Capture-Wire Connector (SPECTRANETICS) or
- Judkins Right 5F catheter (CORDIS)

4. Antegrade angioplasty
- 3.0/80 Pacific (MEDTRONIC)

5. Guidewire exchange
- 0.014" guidewire Floppy ES (ABBOTT)

6. Drug-eluting balloon angioplasty of the posterior tibial artery
- Freeway (EUROCOR)

Clinical data
PTA/Stent high grade ICA-stenosis left 11/2012
Intracerebral cross-flow von right to left
CAD, PTCA/Stent of LAD/D1, RCX/PLA2 and RCA
Arterial hypertension, diabetes mellitus, hyperlipidaemia
Renal insufficiency

Procedural steps
1. Right femoral access
- 9F sheath, Radiofocus introducer, 25 cm (TERUMO)

2. Introduction of protection device
- 9F Endovascular Clamping Device – MoMa Ultra (Medtronic)

3. Passing of the lesion
- Galeo ES 0.014" ES Guidewire, 185 cm (BIOTRONIK)

4. 3.5/20 mm MiniTrek RX PTA Balloon Catheter (ABBOTT)

5. 7-10/40 mm Xact Carotid Self-Expanding Stent-System, 135 mm(ABBOTT)

6. 5/20 mm Viatrac RX PTA Balloon Catheter (ABBOTT)

Clinical data
Arterial hypertension, atrial fibrillation with oral anticoagulation
Diabetes mellitus, impaired renal function, shrinkage of right kidney
Aneurysm diameter 64 cm
Narrow and calcified iliac arteries

Procedural steps
1. Percutanous approach left groin Prostar XL (Abbott), 14 F sheath (COOK)

2. Percutanous approach right groin 8 F sheath (COOK)

3. Cannulation of the SMA and the left renal artery (8F shuttle sheath, COOK) via left axillary a (cut down)

4. Deployment of three Endurant tube endografts (Medtronic) just below the celiac trunk

5. Placement of chimney stent-grafts (Advanta V12, Atrium) in the SMA and left renal artery

Clinical data
Asymptomatic juxtrarenal aortic aneurysm / 5.6 cm
Y-prosthesis infrarenal aorta 1/2001
Coronary artery disease: D1 90%
Atrial fibrilation
RF: Hypertension

Procedural steps
1. Transbrachial approach left side
- 7F Flexor Check Flo Performer Introducer Sheath, 90 cm (COOK)
- 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
- 0.035`` Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)

2. Bilateral femoral surgical cut-down

3. Stentgraft implantation
- Implantation of the JOTEC E-extra fenestrated graft (JOTEC)
- Implantation of 4 covered V12 Advanta Stents (ATRIUM) in Coeliac trunk, AMS and both renal arteries

Clinical data
Dilatative cardiomyopathy with impaired left ventricular function, CAD
Chronic obstructive pulmonary disease (GOLD 4)
Replacement aortic valve and ascending aorta 2003
Aortic arch replacement with elefant trunk 2008
TEVAR 2009
TIA 2004
Diabetes mellitus, arterial hypertension, obesity
Hostile abdomen

Procedural steps
1. 14 F sheath (COOK) both groins and cannulation of the true lumen

2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA

3. Implantation of a tapered thoracic endograft

4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side

5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing

6. Implantation of the iliac branched device (ZBIS – COOK) on the right side

7. Placement of the aortic bifurcated device through the left side

8. Placement of the bridging limb through the right side

Clinical data
Progression of an abdominal aneurysm,
56mm diameter.
Arterial hypertension, CAD, PTCA 2002
COPD

Procedural steps
1. Preclosing with Proglide Closure Devices both groins (ABBOTT)

2. 9F 10 cm Radiofocus Introducer II both groins (TERUMO)

3. 0.035" Archer Guide Wire, 200 cm (MEDTRONIC)

4. Ovation Main Body (TRIVASCULAR) via right groin

5. Bilateral implantation of limb-extensions

6. Post-dilatation with Reliant-Balloon (MEDTRONIC)

Clinical data
Progressive suprarenal aneurysm (max diameter 65 mm)
Aortic valve replacement with aortic arch replacement (Hemashield-prosthesis, Elephant trunk) due to Type-A-Dissection and implantation of 2 Gore-TAG-Endoprostheses in to the descending aorta (2007)
Arterial hypertension, hyperlipidemia, nicotine abuse

Procedural steps
1. Surgical cut down left subclavian artery and implantation of a 12F sheath

2. Preloading of the left common femoral artery with the Proglide system (ABBOTT)

3. Pullthrough of a Lunderquist Extra-Stiff 0.038" guide wire (COOK)

4. Implantation of a 4-Vessel T-branched Tube-graft (ATRIUM/Maquet Getinge Group, COOK)

5. Implantation of covered stents ( Advanta V12, ATRIUM) into the visceral and renal arteries via the subclavian approach

6. Reinforcemant of the Advanta-Stents by Self-expanding Nitinol Stents (Zilver-Stents, COOK)

Clinical data
Dilatative cardiomyopathy with impaired left ventricular function, CAD
Chronic obstructive pulmonary disease (GOLD 4)
Replacement aortic valve and ascending aorta 2003
Aortic arch replacement with elefant trunk 2008
TEVAR 2009
TIA 2004
Diabetes mellitus, arterial hypertension, obesity
Hostile abdomen

Procedural steps
1. 14 F sheath (COOK) both groins and cannulation of the true lumen

2. Placement of three 5F sheaths in the 14F sheath on the left side and precannulation of both renal arteries and SMA

3. Implantation of a tapered thoracic endograft

4. Deployment of a preloaded thoraco-abdominal Zenith-endograft (COOK) with four fenestrations via the right side

5. Cannulation of celiac trunk, SMA and renal arteries through the branches and implantation of the bridging stentgafts (Advanta-Atrium) and flairing

6. Implantation of the iliac branched device (ZBIS – COOK) on the right side

7. Placement of the aortic bifurcated device through the left side

8. Placement of the bridging limb through the right side

Clinical data
Subclavian steal syndrom
Vertigo and claudication left arm
Stenocardia (CABG with LIMA – bypass 2006)
RR brachial right: 160 mmHg systolic
RR brachial left: 100 mmHg systolic
Hypertension, hyperlipidemia, diabetes mellitus 2

Procedural steps
1. Right femoral access and placement of a 6F sheath
- 5F JR Catheter (CORDIS)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)
- 0.035" Supra Core guide-wire, 190 cm (ABBOTT)
- 7F Flexor Check-Flo Performer Introducer Sheath, 90 cm (COOK)

2. Left brachial access an d placement of a 6F sheath
- 6F Flexor Check-Flo Performer Introducer Sheath, 55 cm (COOK)

3. Wiring the occlusion
- 0.018" V-18 Control guide wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus Terumo angled soft guide-wire, 180 cm (TERUMO)

4. PTA and stent implantation
- 5.0/20 Admiral OTW PTA balloon Catheter (MEDTRONIC)
- 8.0/18 mm Assurant Cobalt Iliac Ballon-Expandable Stent (MEDTRONIC)