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)
5. Retrograde access via ATA, if antegrade access fails
Wednesday, January 23rd:
-
,
Main Arena 2
Case 14 – Iliofemoral venous intervention
Center:
Berne
Case 14 – BER 02: male, 60 years (Z-H)
Operators:
Nils Kucher,
Gerard O'Sullivan
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)
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)
Wednesday, January 23rd:
-
,
Main Arena 2
Case 15-1 – Iliofemoral venous intervention
Center:
Berne
Case 15 – BER 03: male, 50 years (B-F)
Operators:
Nils Kucher,
Gerard O'Sullivan
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
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)
Wednesday, January 23rd:
-
,
Main Arena 2
Case 17 – Iliofemoral venous intervention
Center:
Berne
Case 17 – BER 04: female, 73 years (A-P)
Operators:
Nils Kucher,
Gerard O'Sullivan
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)
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