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)
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
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Global Expert Exchange
Case 86 – Renal denervation in drug resistant hypertension
Center:
Leipzig
Case 86 – LEI 48: male, 63 years (H-R)
Operators:
Matthias Ulrich,
Klaus Hertting
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)
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
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
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Main Arena 1
Case 60 – Re-occlusion of the left SFA
Center:
Leipzig
Case 60 – LEI 34: male, 38 years (S-S)
Operators:
Matthias Ulrich,
Klaus Hertting
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)
4. Renal artery denervation with the Simplicity® RF Catheter (MEDTRONIC)
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Main Arena 2
Case 72 – Debranching and Stenting thoracic aortic aneurysm
Center:
Leipzig
Case 72 – LEI 41: m
Operators:
Marc van Sambeek,
Michael Piorkowski
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)
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Main Arena 1
Case 61
Center:
Hamburg
Case 61 – HAM 01: male, 74 years
Operators:
Sigrid Nikol,
Sven Bräunlich
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Technical Forum
Case 80 – Occlusion left common iliac artery, stenosis common femoral artery
Center:
Münster
Case 80 – MUE 07: male, 64 years, (H-P)
Operators:
Arne Schwindt,
Konstantinos Donas
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)
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
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Main Arena 2
Case 73 – Infrarenal abdominal aortic aneurysm
Center:
Leipzig
Case 73 – LEI 42: male, 66 years (T-W)
Operators:
Jean-Paul de Vries,
Daniela Branzan,
Bernd-Michael Harnoss
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)
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Technical Forum
Case 81 – Occlusion of the left SFA, failed antegrade recanalization-attempt
Center:
Leipzig
Case 81 – LEI 44: female, 68 years (I-T)
Operators:
Andrej Schmidt,
Michael Piorkowski
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)
Case 63 – Long occlusion right superficial femoral artery
Center:
Hamburg
Case 63 – HAM 02: female, 60 years
Operators:
Hans Krankenberg,
P. Burchardt
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)
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Technical Forum
Case 82 – 3-Vessel occlusion right BTK, CLI
Center:
Leipzig
Case 82 – LEI 45: male, 76 years (A-R)
Operators:
Andrej Schmidt,
Matthias Ulrich
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)
5. OneShot™ Ballon (COVIDIEN): left 7 mm (or 2 x 6 mm?) / right 6 mm
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Main Arena 2
Case 74 – Infrarenal abdominal aortic aneurysm
Center:
Münster
Case 74 – MUE 03: male, 78 years (W-E)
Operators:
Martin Austermann,
Bernd Gehringhoff
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)
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Technical Forum
Case 83 – Occlusion of the left SFA, failed antegrade recanalization-attempt
Center:
Leipzig
Case 83 – LEI 46: male, 45 years (E-L)
Operators:
Kazushi Urasawa,
Michael Piorkowski
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
6. Implantation of selfexpanding nitinol-stents
- Zilver PTX-Stent (COOK)
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Main Arena 1
Case 65 – Renal Denervation in resistant hypertension
Center:
Leipzig
Case 65 – LEI 36: male, 53 years (A-S)
Operators:
Klaus Hertting
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Main Arena 1
Case 66 – Carotid artery stenting with cerebral embolic protection
Center:
Hamburg
Case 66 – HAM 04: female, 73 years
Operators:
Joachim Schofer,
Klaudija Bijuklic
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
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Technical Forum
Case 84 – 3-Vessel occlusion left BTK
Center:
Leipzig
Case 84 – LEI 47: female, 78 years (W-B)
Operators:
Andrej Schmidt,
Matthias Ulrich
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)
5. Guidewire exchange
- 0.014" guidewire Floppy ES (ABBOTT)
6. Drug-eluting balloon angioplasty of the posterior tibial artery
- Freeway (EUROCOR)
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Technical Forum
Case 85 – Chronic total occlusion of right popliteal artery and trifurcation
Center:
Hamburg
Case 85 – HAM 07: female
Operators:
Sigrid Nikol,
Sven Bräunlich
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Main Arena 1
Case 67 – Asymptomatic high grade stenosis right internal carotid artery
Center:
Leipzig
Case 67 – LEI 37: male, 76 years, (W-W)
Operators:
Dierk Scheinert,
Matthias Ulrich
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)
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)
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Main Arena 2
Case 75 – Pararenal abdominal aortic aneurysm
Center:
Münster
Case 75 – MUE 04: male, 78 years (W-HH)
Operators:
Martin Austermann,
Bernd Gehringhoff
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
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
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Main Arena 1
Case 68
Center:
Leipzig
Case 68 – LEI 38: female, 86 years
Operators:
Axel Linke,
Gerhard Schuler
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