Find all Live Cases and Live Case Centers listed below.
Leipzig
33 livecase(s)
Tuesday, January 27th:
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,
Main Arena 1
Case 01 – Calcified SFA occlusion left
Center:
Leipzig
Case 01 – LEI 01: male , 60 years (U-S)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Claudication intermittens bilateral,
150 meter walking capacity, calf-pain left > right
Art. hypertension, former smoker
ABI
Left 0,52; right 0,66
DUPLEX
Severely calcified SFA bilateral
ANGIOGRAPHY
Short occlusion distal SFA left, severe calcification
PROCEDURAL STEPS 1. Right groin retrograde cross-over approach
- 6F Balkin Up&Over 40 cm sheath (COOK)
2. Passage of the occlusion
- 0.035" stiff angled Terumo guidewire, 300 cm (TERUMO)
- Armada 35 5/120 mm Balloon (ABBOTT)
- Exchange to a 0.018" SteelCore guidewire (ABBOTT)
CLINICAL DATA
Severe claudication left leg, walking capacity 150 meters
PTA of the right external iliac artery in 12/2014
Thrombendartherectomy left groin 2012
Failed recanalization-attempt lef SFA elsewhere 11/2014
Art. hypertension, hyperlipoproteinemia
ABI
Left 0.67
ANGIOGRAPHY
During PTA right iliac artery: mid SFA-occlusion left, good run-off
PROCEDURAL STEPS 1. Right groin retrograde cross-over approach with 6F sheath
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)
2. Passage of the occlusion
- 0.035" Seeker supportcatheter, 135 cm (BARD)
- 0.035" angled stiff glidewire 260 cm (TERUMO)
- I n case of failure retrograde approach via the distal SFA
3. PTA
- Vascutrak 5.0/250 mm Balloon (BARD)
- Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)
4. Stenting on indication
in case of dissection:
- INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
CLINICAL DATA
Severe claudication left leg, walking capacity 150 meters
PTA of the right external iliac artery in 12/2014
Thrombendartherectomy left groin 2012
Failed recanalization-attempt lef SFA elsewhere 11/2014
Art. hypertension, hyperlipoproteinemia
ABI
Left 0.67
ANGIOGRAPHY
During PTA right iliac artery: mid SFA-occlusion left, good run-off
PROCEDURAL STEPS 1. Right groin retrograde cross-over approach with 6F sheath
- 6F Balkin Up & Over Contralateral Flexor Check-Flo Performer 40 cm (COOK)
2. Passage of the occlusion
- 0.035" Seeker supportcatheter, 135 cm (BARD)
- 0.035" angled stiff glidewire 260 cm (TERUMO)
- I n case of failure retrograde approach via the distal SFA
3. PTA
- Vascutrak 5.0/250 mm Balloon (BARD)
- Lutonix Drug-Coated Balloon 6.0/150 mm (BARD)
4. Stenting on indication
in case of dissection:
- INTACT VASCULAR Tack Endovascular Stapler™ (INTACT VASCULAR)
Case 17 – Retrograde recanalization of an SFA occlusion after surgery left groin
Center:
Leipzig
Case 17 – LEI 08: male 60 years (HJ-S )
Operators:
Andrej Schmidt,
Matthias Ulrich,
Tomohara Dohi
CLINICAL DATA
Severe claudication left calf
Stenting left iliac arteries and patch-plastic left groin 2008
Unsuccessful recanalization attempt left SFA, failed guiewire-access
into the SFA-occlusion 11/2014
Arterial hypertension, diabetes mellitus type 2, smoker
Renal insufficiency (GFR 56ml/min)
ABI
Left 0.46
ANGIOGRAPHY
Long occlusion left SFA, ostial stenosis of the deep femoral artery patent stents left iliac arteries.
PROCEDURAL STEPS 1. Right groin retrograde cross-over approach
- 7F Balkin Up & Over 40 cm sheath (COOK)
2. Retrograde access: puncture of the occluded mid SFA left
- 18 Gauge 7 cm needle
- 0.035" stiff angled guidewire 30 cm (TERUMO)
- 6Fr 10 cm sheath (TERUMO)
- 5F Judkins Right diagnostic catheter (CORDIS)
- 0.018" Connect 250 T Guidewire 300 cm (ABBOTT)
- In case of failure exchange to 0.014" Floppy ES 300 cm guidewire (ABBOTT).
- Outback Reentry catheter (CORDIS)
3. Balloon-angioplasty and stenting
- After snaring of the retrograde guidewire PTA with Savvy 5/120mm Balloon (CORDIS)
- Smart Control Selfexpanding stent (CORDIS)
- In case of bleeding at the retrograde access-site or groin-patch: Viabahn 7/100 mm covered stentgraft (GORE)
CLINICAL DATA
Severe claudication intermittens right leg
walking-capacity 200 meters
PTA with drug-eluting balloons left SFA 11/2014
Diabetes mellitus type 2, hyperlipidaemia
ABI
Right 0.66
ANGIOGRAPHY
10 cm long occlusion mid SFA right
PROCEDURAL STEPS 1. Left groin retrograde cross-over approach
- 6F Balkin Up & Over 40 cm sheath (COOK)
2. Passage of the occlusion
- 0.035" CXI-support-catheter, straight tip, 135 cm length (COOK)
- 0.018" Connect Flex guidewire, 300 cm (ABBOTT)
3. Balloon-angioplasty and stenting
- Advance 18 5.0/120 mm balloon (COOK)
- Zilver-PTX 6.0/100 mm (COOK)
CLINICAL DATA
PAOD with claudication intermittens and restpain at night left leg
PTA right SFA with drug-eluting balloons 12/2014
Thrombendartherectomy left common femoral artery 10/2014
Arterial hypertension
Hyperlipoprotaeinemia
Smoker
ABI
Left 0.61
ANGIOGRAPHY
During PTA right leg: long SFA-occlusion, moderate calcification
PROCEDURAL STEPS 1. Right groin retrograde cross-over approach
- 6F Balkin Up & Over 40 cm sheath (COOK)
2. Guidewire passage
- 0.035" QuickCross support-catheter 135 cm (SPECTRANETICS)
- 0.035" TERUMO glidewire angled stiff, 300 cm (TERUMO)
- 0.018" Victory 30g, 300 cm (BOSTON SCIENTIFIC)
3. Predilatation and drug-eluting balloon treatment
- Pacific 5/120 mm balloon (MEDTRONIC)
- In.Pact 5.0/120 mm drug-coated balloon (MEDTRONIC)
4. Stenting on indication
- Complete 6.0/150 mm Selfexpanding Nitinol-stent (MEDTRONIC)
Case 28 – Occlusion of the right iliac arteries, aneurysm left iliac
Center:
Leipzig
Case 28 – LEI 09: male, 76 years (M-M)
Operators:
Dierk Scheinert,
Matthias Ulrich,
Tomohara Dohi
CLINICAL DATA
Restpain right leg, Rutherford class 4
History of surgical aorto-biiliac prosthesis 1972, report can not be found
Minor stroke 2011 before CEA of carotid artery stenosis right, art. hypertension
ABI
Right 0.4
CT
Severe calcification of the aortic bifurcation, 32 mm aneurysm left common iliac artery
Former aortoiliac bypass can not be seen on CT
PROCEDURAL STEPS 1. Retrograde access both common femoral arteries
- 7F-10 cm sheath (TERUMO)
Left brachial access:
- 5F diagnostic pigtail-catheter (CORDIS)
- 0.035" soft angled short glidewire (TERUMO)
- 0.035" SupraCore Guidewire 300 cm (ABBOTT)
- 6F-90 cm Check-Flow Performer Sheath (COOK)
2. Guidewire passage of the iliac occlusion right
via brachial access:
- 5F-125 cm Judkins Right diagnostic catheter (CORDIS)
- 0.035" stiff angled TERUMO glidewire, 260 cm (TERUMO)
- or 0.018" Connect 300 cm guidewire (ABBOTT)
- Snaring of the wire into the retrograde sheath and passage of the contralateral common iliac artery occlusion via the brachial access.
3. After Guidewire-passage PTA via the femoral access bilateral
- Admiral 6/40 mm-balloon, 90 cm (MEDTRONIC)
4. Stenting
- via left groin: Sinus aortic stent 24-80 mm (OPTIMED)
Implantation of covered stents into the aortic bifurcation:
- 9/59 mm Lifestream covered stents (BARD)
- 9/100 mm Fluency covered stent right external iliac artery (BARD)
Case 33 – Retrograde recanalization of a tibioperoneal trunk occlusion
Center:
Leipzig
Case 33 – LEI 10: male, 52 years (A-P)
Operators:
Andrej Schmidt,
Sven Bräunlich
CLINICAL DATA
Critical limb ischemia left with toe-ulcerations Dig 2 and 3
PTA and stenting left SFA and failed recanalization attempt
left tibioperoneal trunk 1/2015
Diabetes mellitus type 2, arterial hypertension
CAD with PTCA 11/2013
Former smoker, renal insufficiency with GFR 55ml/min
ANGIOGRAPHY
During PTA of left SFA: Occlusion of the tibioperoneal trunk the peroneal and anterior tibial artery
PROCEDURAL STEPS 1. Left antegrade access
■ 5F – 55 cm Ansel Sheath (COOK)
Retrograde access to the posterior tibial artery:
■ 7 cm 21 Gauge needle (COOK)
■ 0.018" Connect Guidewire 300 cm (ABBOTT)
■ 0.018" CXC Support-Catheter 90 cm (COOK)
2. Guidewire exchange
■ After retrograde guidewire-passage and snaring from antegarde exchange to 0.014" PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)
3. PTA and stenting
■ MiniTrek RX 4/20 mm PTCA Balloon (ABBOTT)
■ Cre8 4.0/48 mm Drug-Eluting Stent (ALVIMEDICA)
Case 08 – In-stent reocclusion left distal SFA / popliteal artery
Center:
Leipzig
Case 08 – LEI 05: male, 72 years (R-T)
Operators:
Andrej Schmidt,
Yvonne Bausback,
Tomohara Dohi
CLINICAL DATA
Severe claudication left calf, walking capacity 50 meters
PTA of a restnosis of the SFA-ostium left with drug.-coated ballon 12/2014
Stenting left SFA / popliteal artery 10/2013
Thrombendartherectomy left groin /2013
CAD and PTCA LAD 9/2013
Arterial hypertension, diabetes mellitus, type 2, former smoker
ABI
Left 0.43
ANGIOGRAPHY
In-Stent occlusion distal SFA and P1/P2 popliteal artery left
P3-segment significantly stenosed
PROCEDURAL STEPS 1. Left antegrade approach
- 7F 55 cm Ansel sheath (COOK)
2. Guidewire passage
- 0.035" QuickCross support-catheter 90 cm (SPECTRANETICS)
- 0.035" Half stiff J-angled 300 cm (TERUMO)
- exchange to 0.014" Floppy ES Guidewire 300 cm (ABBOTT)
Case 09 – Severely calcified restenosis (partially in-stent) left SFA
Center:
Leipzig
Case 09 – LEI 06: male, 72 years (L-K)
Operators:
Sven Bräunlich,
Andrej Schmidt
CLINICAL DATA
Severe claudication left calf
Stenting of the SFA left 2009 (Samba-stent)
Thrombenarthererctomy left groin 2010
PTA of the right SFA / stenting 1/2015
CAD, multiple PTCAs
Chronic heart failure (NYHA II)
Chronic renal insufficiency (GFR 70ml/min)
Art. hypertension, diabetes mellitus type 2
ABI
Left 0.64; right 0.82 (post stenting)
ANGIOGRAPHY
During PTA right SFA: in-stent reocclusion and severe calcification left SFA
PROCEDURAL STEPS 1. Right groin and cross-over access
- 7F 40 cm balkin Up & Over sheath (COOK)
2. Guidewire passage
attempt to pass the occlusion from antegrade
- QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
3. In case of failure retrograde stent-puncture
- 7 cm 18 Gauge needle and
- QuickCross 0.035" 135 cm Supportcatheter (SPECTRANETICS)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- Snaring of the guidewire from above
4. PTA
- Armada 35 5.0/120 mm Ballon (ABBOTT)
- Potentially high-pressure balloon: Conquest 6/20 mm (BARD)
CLINICAL DATA
Acute onset of severe claudication right and left calf 1-2 months ago (right > left)
Eversionatherectomy of a symptomatic internal carotid artery stenosis right 12/2014
Arterial hypertension, diabetes mellitus type 2, former smoker
ABI
Right 0.55; left 0.57
ANGIOGRAPHY
Bilateral occlusion of the SFA, non calcification
Thrombotic subtotal occlusion of the right carotid artery before surgery
PROCEDURAL STEPS 1. Right femoral retrograde and cross-over access
- 8F 40 cm Balkin Up & Over sheath (COOK)
2. Guidewire passage
- 0.018" CXI angled support-catheter 135 cm (COOK)
- 0.018" V-18 COntrol Guidewire, 300 cm (BOSTON SCIENTIFIC)
4. PTA and stenting on indication
- if residual thrombus: local thrombolysis with Actilysis
- if residual arteriosclerotic lesions: balloon-angioplasty/stenting
- Lutonix drug coated balloon 5.0/150 mm (BARD)
- Epic-Stent 6.0/150 mm (BOSTON SCIENTIFIC)
CLINICAL DATA
Severe claudicatio with worsening 3 months ago
Stenting of the SFA left 12/2013
CAD and PTCA 11/2014
Art. hypertension, diabetes mellitus type 2, former smoker
ABI
Left 0.62
ANGIOGRAPHY
During coronary angiography: In-stent reocclusion left with stent-fractures.
PROCEDURAL STEPS 1. Right femoral retrograde and cross-over access
- 8F 40 cm Balkin Up & Over sheath (COOK)
2. Guidewire passage
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- Judkins Right 5F diagnostic catheter (CORDIS)
- Exchange to 0.018" guidewire coming with the Rotarex-catheter (STRAUB MEDICAL)
Case 37 – CLI and total occlusion of all BTK arteries right
Center:
Leipzig
Case 37 – LEI 13: male, 82 years (W-K)
Operators:
Andrej Schmidt,
Matthias Ulrich,
Sabine Steiner
CLINICAL DATA
Critical ischemia with ulcerations right forefoot (Dig 3 and 4 and lateral)
PTA of a SFA-stenosis 12/2014 with drug-eluting balloon
CAD with CABG 2008
Diabetes mellitus type 2, art. hypertension
ABI
Right 0.2
ANGIOGRAPHY
5 cm occlusion of the proximal peroneal artery and long tibial occlusions (ATA and PTA).
PROCEDURAL STEPS 1. Right antegrade access
- 5F 55 cm Ansel Sheath (COOK)
2. Guidewire passage of the occlusion(s)
- 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
- Amphirion Deep Balloon 2.5/120 mm - 120 cm (MEDTRONIC)
In case of failure exchange to:
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- supported by TrailBlazer 0.018" 90 cm (COVIDIEN)
3. PTA and drug administration
- Amphirion Deep 2.5/120 mm Balloon (MEDTRONIC)
- BullFrog Micro-infusion catheter for administration of Dexamethason into the arterial wall (MERCATOR MedSystems)
Case 37 – CLI and total occlusion of all BTK arteries right
Center:
Leipzig
Case 37 – LEI 13: male, 82 years (W-K)
Operators:
Andrej Schmidt,
Matthias Ulrich,
Sabine Steiner
CLINICAL DATA
Critical ischemia with ulcerations right forefoot (Dig 3 and 4 and lateral)
PTA of a SFA-stenosis 12/2014 with drug-eluting balloon
CAD with CABG 2008
Diabetes mellitus type 2, art. hypertension
ABI
Right 0.2
ANGIOGRAPHY
5 cm occlusion of the proximal peroneal artery and long tibial occlusions (ATA and PTA).
PROCEDURAL STEPS 1. Right antegrade access
- 5F 55 cm Ansel Sheath (COOK)
2. Guidewire passage of the occlusion(s)
- 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
- Amphirion Deep Balloon 2.5/120 mm - 120 cm (MEDTRONIC)
In case of failure exchange to:
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- supported by TrailBlazer 0.018" 90 cm (COVIDIEN)
3. PTA and drug administration
- Amphirion Deep 2.5/120 mm Balloon (MEDTRONIC)
- BullFrog Micro-infusion catheter for administration of Dexamethason into the arterial wall (MERCATOR MedSystems)
CLINICAL DATA
Incidental finding of an abdominal aneurysm
Since 2 years recurrent abdominal pain
RISK FACTORS
Art. hypertension, smoker
CT
57 mm abdominal aneurysm, neck-kink of 60Æ
PROCEDURAL STEPS 1. Proglide closure-device preloading both groins
- 9F – 10 cm sheath both groins (TERUMO)
2. Implantation of the main body
- 0.035" Lunderquist 180 cm guidewire via right groin (COOK)
- Aorfix abdominal endovascular stentgraft (LOMBARD MEDICAL)
3. Cannulation of the contralateral limb
- Amplatz left I diagnostic catheter 5F (CORDIS)
- 0.035" soft angled TERUMO guidewire (TERUMO)
- 0.035" Lunderquist 180 cm guidewire via right groin (COOK)
4. Implanation of the contralateral limb (LOMBARD MEDICAL)
- PTA of the graft with a Reliant-balloon (MEDTRONIC) via 12F 12 cm sheaths (COOK)
Case 39 – Critical limb ischemia with distal SFA occlusion left /restenosis
Center:
Leipzig
Case 39 – LEI 14: female, 82 years (I-U)
Operators:
Matthias Ulrich,
Yvonne Bausback,
Tomohara Dohi
CLINICAL DATA
Criticl limb ischemia, ulceration left lower leg and Dig 2
CLI right leg with heel-ulceration
PTA right SFA 1/2015
PTA left SFA 2011 for CLI-treatment
Atrial fibrillation
CAS left ICA 4/2006
ANGIOGRAPHY
During treatment of CLI right leg: 10 cm long distal SFA-occlusion left
Below-the-knee peroneal artery patent
ABI
0.34
PROCEDURAL STEPS 1. Right groin retrograde access and cross-over sheath placement
- IMA 5F diagnostic catheter (CORDIS)
- 0.035" soft angled TERUMO glidewire (TERUMO)
- 0.035" SupraCore 190 cm (ABBOTT)
- 6F 55 cm Ansel Sheath (COOK)
2. Guidewire passage and balloon-angioplasty
- 0.018" Connect 300 cm Guidewire (ABBOTT)
- supported by CXC 0.018" Catheter, 135 cm (COOK)
In case of failure exchange to:
- 0.018" Connect 250 T Guidewire, 300 cm (ABBOTT)
3. Balloon-angioplasty and stenting
- Pacific 5.0/80 mm Balloon, 135 cm (MEDTRONIC)
- Tigris GORE Vascular Stent 6.0/100 mm stent (GORE)
CLINICAL DATA
Severe claudicatio both legs right > left, worsening 1 month ago
CAD, intermittend atrial fibrillation
Art. hypertension, diabetes mellitus type 2
CT
Occlusion right common iliac artery, partially thrombotic.
2. Passage of the occlusion from antegrade and retrograde
Left:
- SOS-catheter 5F (COOK)
- 0.035" stiff straight TERUMO 260 cm (TERUMO)
Right:
- 0.018" Connect Flex 300 cm (ABBOTT)
3. Guidewire exchange to
- 0.035" SupraCore Guidewire (ABBOTT)
4. Predilatation right
- 5.0/40 mmm Armada 35 balloon (ABBOTT)
5. Implantation of covered stents in kissing-technique
- Advanta V-12 (MAQUET GETINGE GROUP)
CLINICAL DATA
Severe claudication right calf
PTA and stenting left SFA 12/2014
Art. hypertension, diabetes mellitus type 2
Renal insufficiency (GFR 65ml/min), former smoker
CAD with PTCA 11/2013
ANGIOGRAPHY
During PTA left SFA: long SFA-occlusion right.
ABI
Right 0.56
PROCEDURAL STEPS 1. Left femoral retrograde and cross-over access
- 6F 40 cm Balkin Up & Over sheath (COOK)
2. Guidewire passage of the SFA-occlusion
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- 0.015" Seeker Support-Catheter, 135 cm (BARD)
- Exchange to a 0.018" guidewire SteelCore 300 cm (ABBOTT)
3. PTA
- Vascutrak Balloon 5.0/250 cm (BARD)
- Lutonix 5.0/150 mm drug-coated balloon (BARD)
4. Stenting on indication
- LifeStent selfexpanding Nitinol-stent (BARD)
Case 42 – Reocclusion of the right tibioperoneal trunk
Center:
Leipzig
Case 42 – LEI 17: male, 50 years (G-S)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Critical limb ischemia with ulceration dig 5 right
PAOD with stenting right SFA 11/2010 and restenosis 12/2014
PTA with drug-eluting balloons 12/2014
Failure to pass the TTF-occlusion from antegrade 12/2014
ANGIOGRAPHY
12/2014: calcified TTF-occlusion, stenosis of the proximal peroneal artery
PROCEDURAL STEPS 1. Antegrade access right groin
- 5F 55 cm Ansel Sheath (COOK)
2. Guidewire passage
retrograde access via the peroneal artery:
- 7 cm 21 Gauge puncture needle (COOK)
- 0.018" V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
- Seeker 0.018" 90 cm support-catheter (BARD)
3. Guidewire exchange
After snaring of the guidewire from antegrade PTA of the lesion:
- Exchange to a 0.014" guidewire (Floppy ES ABBOTT)
- Vascutrak 3.5/40 mm Balloon (BARD)
- Lutonix Drug-Coated Balloon 3.5/120 mm (BARD)
Case 51 – Abdominal aneurysm 5.5 cm with irregular neck
Center:
Leipzig
Case 51 – LEI 20: male, 76 years (H-D)
Operators:
Andrej Schmidt,
Daniela Branzan,
Tomohara Dohi
CLINICAL DATA
Progression of an abdominal aneurysm to 55mm
CAD with PTCA 2008
Mitral valve moderate insufficiency
Art. hypertension, diabetes mellitus type 2
CT
55 mm abdominal aneurysm with irregaular neck, thrombus
PROCEDURAL STEPS 1. Proglide closure-device preloading both groins
- 9F – 10 cm sheath both groins (TERUMO)
2. Implantation of the main body
- 0.035" Lunderquist 180cm guidewire via right groin (COOK)
- Ovation abdominal endovascular stentgraft (TRIVASCULAR)
3. Cannulation of the contralateral limb
- Amplatz left I diagnostic catheter 5F (CORDIS)
- 0.035" soft angled TERUMO guidewire (TERUMO)
- 0.035" Lunderquist 180 cm guidewire via right groin (COOK)
4. Implanation of the contralateral limb (TRIVASCULAR)
- PTA of the graft with a Reliant-balloon (MEDTRONIC) via 12F 12 cm Sheaths (COOK)
Case 80 – Distal 10 cm SFA occlusion left, retrograde recanalization through proximal anterior tibial access
Center:
Leipzig
Case 80 – LEI 28: male 78 years (L-P)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD with rest-pain left leg, Rutherford class 4, and
Claudicatio intermittens left calf, walking capacity 100 meters
Failed antegrade recanalization attempt
Diabetes mellitus type 2, former smoker
ANGIOGRAPHY
10 cm distal SFA-occlusion left, moderat calcification
PROCEDURAL STEPS 1. Right femoral retrograde and cross-over access
- 6F 40 cm Balkin Up & Over sheath (COOK)
2. Guidewire passage from antegrade
- 5F Multipurpose diagnostic catheter 100 cm (CORDIS)
- 0.035" straight stiff TERUMO glidewire, 260 cm (TERUMO)
- in case of second failure: retrograde approach via the proximal anterior tibial artery 7 cm 21 Gauge needle (COOK)
- 0.018" V-18 Conrol Guidewire 300 cm (BOSTON SCIENTIFIC)
- 0.018" QuickCross 90 cm Supportcahteher (SPECTRANETICS)
3. After snaring of the guidewire from antegrade PTA
- Ultraverse 18 Balloon (BARD) and
- Luminor Drug-coated balloon (iVASCULAR)
4. Stenting on indication
- Supera Interwoven Nitinol-Stent (ABBOTT)
Case 81 – Occlusion of the left tibioperoneal trunk, transpedal recanalization
Center:
Leipzig
Case 81 – LEI 29: male, 71 years (M-C)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD with severe claudication and restpain during night left foot
PTA / stenting of the popliteal artery left elsewhere and failure to recanalize the tibioperoneal trunk
Art. hypertension, CAD with CABG 2008, Polymyalgia rheumatica
ANGIO
During first rezanalization attempt: perforation after attempt to pass the tibioperoneal trunk occlusion.
PROCEDURAL STEPS 1. Antegrade approach left groin
- 5F 55 cm Ansel Sheath (COOK)
2. Retrograde guidewire passage
- 7 cm 21 Gauge needle to puncture the posterior tibial artery
- 0.018" V-18 control guidewire 300 cm (BOSTON SCIENTIFIC)
- 3F pedal sheath (COOK)
- 0.018" CXI-support-catheter 90 cm (COOK)
- potentially exchange to a 0.014" CTO-guidewire Winn 200 T (ABBOTT))
3. PTA
- Advance Micro 3.0/40 mm 90 cm Balloon (COOK) from retrograde
4. Stenting
- After guidewire-passage from antegrade after predilatation from retrogarde implanatation of a Xience Prime 3.5/38 mm drug-eluting stent (ABBOTT)
CLINICAL DATA
Acute type-B-dissection 12/2014
Art. hypertension
Smoker
CT
Enlargement of the descending thoracic aorta of 1.1 cm within 1 month.
PROCEDURAL STEPS 1. Percutaneous access right groin
- Preclosing with Proglide both sides (ABBOTT)
- 0.035" Lunderquist guidewire 260 cm (COOK)
- Calibration-pigtail catheter left groin
- Temporary pacemaker via right groin for rapid pacing
- IVUS (VOLCANO)
2. Implantation of a TAG thoracic stentgraft (GORE)
CLINICAL DATA
Severe claudication left calf, walking capacity 50 meters
Bilateral iliac artery PTA 2014
CAD with MI and PTCA 2000
Art. hypertension, diabetes mellitus type 2
ABI
Left: 0.62
ANGIOGRAPHY
During PTA right iliac arteries: severe calcification left SFA, short distal occlusion.
PROCEDURAL STEPS 1. Left antegrade approach
- 6F 10 cm sheath (TERUMO)
2. Guidewire passage
- 0.018" Victory 18g guidewire 300 cm (BOSTON SCIENTIFIC)
- QuickCross 0.018" 90 cm support-catheter (SPECTRANETICS)
3. In case of failure to pass the guidewire from antegrade
- Retrograde approach via the dorsalis pedis artery: 7 cm 21 Gauge needle
- 0.018 Connect Guidewire 300 cm (ABBOTT)
- 3F pedal sheath (COOK)
4. Guidewire passage from retrograde
- 0.018" CXI angled support-catheter 90 cm (COOK) potentially exchange to
- 0.014 Hydro-ST Guidewire 300 cm (COOK) and
- Advance Micro Balloon 3.0/120 mm (COOK)
- LegFLow Drug-Coated Balloon (CARDIONOVUM)
Case 69 – TAVR with cerebral protection – patient characteristics
Center:
Leipzig
Case 69 – LEI 24: male, 79 years old
Thursday, January 29th:
-
,
Main Arena 1
Case 72 – Stenosis left common and profunda, occlusion of the superficial femoral artery
Center:
Leipzig
Case 72 – LEI 25: male, 67 years (D-M)
Operators:
Andrej Schmidt,
Tomohara Dohi
CLINICAL DATA
Critical limb ischemia with ulceration of the lower calf and forefoot
Chronic heart failure with NYHA II-III
Art. hypertension, diabetes mellitus type 2, former smoker
ABI
Left 0.45
DUPLEX
CFA-stenosis and SFA-occlusion
ANGIOGRAPHY
CFA-stenosis, PFA-stenosis and SFA-occlusion
PROCEDURAL STEPS 1. Right groin access and cross-over approach to left
- 7F 40 cm Balkin Up & Over sheath (COOK)
2. Filter-protection of the deep femoral artery
- Spider Filter 7 mm (COVIDIEN)
3. Atherectomy of the CFA and PFA
- TurboHawk (LX-M) (COVIDIEN)
4. Guidewire passage of the SFA-occlusion
- 0.035" TrailBlazer 135 cm supportcatheter (COVIDIEN)
- 0.035" stiff angled glidewire 260 cm (TERUMO)
- Exchange to the Spider-Filter 7 mm (COVIDIEN)
5. Atherectomy of the SFA
- TurboHawk (COVIDIEN)
6. PTA with drug-coated balloons
- Luminor 35 (iVASCULAR)
Case 87 – Complex occlusion left popliteal artery, retrograde recanalization
Center:
Leipzig
Case 87 – LEI 31: male, 79 years (M-B)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Critical limb ischemia, ulceration left plantar forefoot
Failed antegrade recanalization attempt 1/2015
Chronic renal failure, GFR 54 ml/min
Hyperlipoproteinemia, art. hypertension
ANGIOGRAPHY
During first rezanalization attempt: occlusion of the distal SFA, poplieal artery and tibioperoneal trunk
PROCEDURAL STEPS 1. Antegrade approach left groin
- 6F 40 cm Balkin Up & Over sheath (COOK)
- retrograde access via the peroneal artery: 7 cm 21 Gauge needle
- 0.018" V-18 Control Guidewire 300 cm (BOSTON SCIENTIFIC)
- QuickCross 0.018" 90 cm (SPECTRANETICS)
2. Passage of the occlusion from antegrade and retrograde with CART-technique
- antegrade Pacific 4.0/80 mm Balloon (MEDTRONIC)
- retrograde V-18 Control Guidewire (BOSTON SCIENTIFIC)
Case 92 – Hybrid procedure for an occluded external iliac, common and superficial femoral artery occlusion
Center:
Leipzig
Case 92 – LEI 33: male, 66 years (W-T)
Operators:
Sven Bräunlich,
Holger Staab,
Daniela Branzan
CLINICAL DATA
PAOD with rest pain and severe claudicatio left
Former smoker
Art. hypertension
ABI
Left 0.2
DUPLEX
Severe PAOD with chronic occlusion externa iliac artery both sides, occlusion left common and superficial femoral artery, severely calcified.
PROCEDURAL STEPS 1. Thrombendartherectomy left common femoral artery
2. Transbrachial guidewire passage through the left external iliac artery
- 6F-90 cm Check-Flow Performer Sheath (COOK)
- 5F Judkins Right diagnostic catheter 125 cm (CORDIS)
- 0.035" stiff angled glidewire 260 cm (TERUMO)
3. PTA of the iliac occlusion left after snaring of the guidewire into the left groin sheath
- Admiral 6.0/80 mm-Balloon (MEDTRONIC)
- 7.0/10 mm Complete stent (MEDTRONIC)
4. Guidewire passage of the SFA occlusion from left antegrade through the CFA-patch and potentially retrograde via the distal SFA
5. PTA and stenting of the SFA
- Armada 5.0/120 mm Balloon (ABBOTT)
- Supera 5.0/200 mm Interwoven Nitinol-stent (ABBOTT)
CLINICAL DATA
Subclavian steal with right arm exercise induced dizziness
Failed recanalization attempt due to severe iliac artery kinking
Art. hypertension, diabetes mellitus
RISK FACTORS
RR-difference right to left arm: > 30 %
ANGIOGRAPHY
During first recanalization attempt: right vertebral retrograde flow, occlusion of the right subclavian artery.
PROCEDURAL STEPS 1. Access via right brachial artery and right femoral artery
- brachial: 6F 55 cm Ansel Sheath (COOK)
- femoral: 8F Judkins Right Guiding-Catheter (CORDIS)
- Potentially stabilization of the guiding-catheter with a Filterwire EZ in the internal carotid artery right (BOSTON SCIENTIFIC).
2. Bidirectional attempt to pass the occlusion
- Judkins Right 5F diagnostic catheter 100 and 125 cm(CORDIS)
- 0.018" Connect Flex 300 cm or Connect 250 T 300 cm guidewire (ABBOTT)
3. PTA
- Predilatation with Sterling 5/40 mm Balloon (BOSTON SCIENTIFIC)
4. Stenting
- Omnilink 8/29 mm balloon-expandable stent (ABBOTT)
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