LINC 2015 live case guide

Conference day 4

• 9:00 - 9:25, Main Arena 1

  Case 89 – Thoracoabdominal aortic aneurysm type IV

  Center:

  Münster

  Case 89 – MUN 11: male, 75 years (S-H)

  Operators:

  • Martin Austermann,
  • Bernd Gehringhoff

  CLINICAL DATA
  CAD 3VD
  Art. Hypertension
  Impaired renal function
  DM 2
  
  DUPLEX
  Thoraco-abdominal aortic aneurysm 62mm
  - Crawford Type IV with aneurysms of both common iliac arteries
  - occlusion of the left hypogastric artery
  - replaced infrarenal aorta
  
  PROCEDURAL STEPS
  1. Percutaneous approach both groins
  - Prostar XL (ABBOTT)
  - 14F (COOK) both groins
  
  2. Left axillary access
  - 5F TERUMO sheath,later 12/8F sheath
  
  3. Placement of a CMD
  - Zenith-endograft (COOK) with three branches
  
  4. Implantation of the distal bifurcated endograft and a IBD on the right side
  
  5. Closure of the groins
  
  6. Cannulation of the SMA, renal arteries and the right hypogastric artery through the branches and implantation of the bridging stentgafts

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• 9:00 - 12:00, Technical Forum

  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)
  
  3. PTA
  - GPS Arrow catheter
  - Dorado balloon 5/120mm (BARD)
  - Drug-coated balloon treatment: Luminor (iVASCULAR)
  
  4. Stenting on indication
  - Supera Interwoven Nitinol-Stent 5/150 mm (ABBOTT)

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• 9:00 - 12:00, Technical Forum

  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)

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• 9:00 - 12:00, Technical Forum

  Case 94 – Right subclavian artery occlusion

  Center:

  Leipzig

  Case 94 – LEI 35: male 68 years (G-S)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  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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