Find all live cases and live case centers listed below.
Conference day 1
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Room 2 - Main Arena 2
Case 10 – BER 01:
Iliofemoral venous intervention
Center:
Berne
Case 10 – BER 01: male, 52 years (T-H)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Iliac vein thrombosis left side in 2013 treated with anticoagulation
Iliac vein thrombosis left side 06/2015
Mechanical compression of the left iliac vein (ostheosynthesis L4/5)
PRESENT STATE
Venous claudication (painfree walking distance 500 m)
Swelling (2 cm plus in thigh circumference) despite compression therapy
No skin changes
No varicose veins
DUPLEX
Postthrombotic changes in iliac and femoral veins
CT
Mechanical compression of the left iliac vein through ostheosynthetic material
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal
- 10F sheath
2. Wire crossage
- Terumo 0.035 stiff angled
3. Phlebography, IVUS
4. Predilatation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
Case 01 – LEI 01:
Highly calcified distal SFA / A. popliteal occlusion left – Part 1
Center:
Leipzig, Dept of Angiology
Case 01 – LEI 01: male, 72 years (H-L)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Rest pain left foot, Rutherford class 4
Severe claudication left, walking capacity 100 meters
Angiography during PTA right iliac arteries after coronary angiography 12/2015
ABI
Left 0.42
RISK FACTORS
CAD with PTCA 12/2015
Carotid TEA bilateral (1999 and 2000)
Permanent atrial fibrillation
Chronic renal insufficiency GFR 62 ml/min
Former smoker, art. hypertension, hyperlipidaemia
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- 0.035" SupraCore Guidewire 190 cm (ABBOTT)
- 7F-40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire-passage and PTA of the occlusion left SFA/Apop
- 4.0/80 mm Armada 35 Balloon (ABBOTT)
- 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
- 6.0/40 mm Armada 35 Balloon (ABBOTT)
- Conquest High Pressure Balloon (C.R.BARD)
In case of antegrade failure: 3. Retrograde approach via the proximal anterior tibial artery
- 21 Gauge 7 cm Micropuncture needle (COOK)
- 0.018" Connect Guidewire 300 cm (ABBOTT)
- 0.018" QuickCross Support-Catheter 90 cm (SPECTRANETICS)
4. Stenting
- 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinolstent (ABBOTT)
Case 01 – LEI 01:
Highly calcified distal SFA / A. popliteal occlusion left – Part 2
Center:
Leipzig, Dept of Angiology
Case 01 – LEI 01: male, 72 years (H-L)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Rest pain left foot, Rutherford class 4
Severe claudication left, walking capacity 100 meters
Angiography during PTA right iliac arteries after coronary angiography 12/2015
ABI
Left 0.42
RISK FACTORS
CAD with PTCA 12/2015
Carotid TEA bilateral (1999 and 2000)
Permanent atrial fibrillation
Chronic renal insufficiency GFR 62 ml/min
Former smoker, art. hypertension, hyperlipidaemia
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- 0.035" SupraCore Guidewire 190 cm (ABBOTT)
- 7F-40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire-passage and PTA of the occlusion left SFA/Apop
- 4.0/80 mm Armada 35 Balloon (ABBOTT)
- 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
- 6.0/40 mm Armada 35 Balloon (ABBOTT)
- Conquest High Pressure Balloon (C.R.BARD)
In case of antegrade failure: 3. Retrograde approach via the proximal anterior tibial artery
- 21 Gauge 7 cm Micropuncture needle (COOK)
- 0.018" Connect Guidewire 300 cm (ABBOTT)
- 0.018" QuickCross Support-Catheter 90 cm (SPECTRANETICS)
4. Stenting
- 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinolstent (ABBOTT)
Case 11 – GAL 01:
Chronic left iliac reconstruction
Center:
Galway
Case 11 – GAL 01: female, 41 years (N-W)
Operators:
Ian Davidson,
Gerard O'Sullivan
PRESENT STATE
First DVT in 2009 – just post partum – see CT
Waited 9 months, attempted endovascular reconstruction – failed.
Has had 2 more children.
Symptoms: weight gain, 50 m claudication up hill, heavy dead tired leg.
RISK FACTORS
Underlying May Thurner
PROCEDURAL STEPS 1. Prep
- R IJV; left groin and thigh; right groin
2. UltraSound (SIEMENS) guided access to left profunda and RIJV (COOK Micropuncture set)
- 10F sheath (COOK) to neck; 5F sheath BRITE TIP (CORDIS) left PFV
- 5000u IV Heparin
- Triforce (COOK MEDICAL) to gain access to and attempt to cross left iliac venous occlusion
3. Wires
- Hydrophilic 0.035" wire (MERIT MEDICAL)/stiff
hydrophilic 0.035" wire (MERIT MEDICAL)/
Roadrunner 0.035" wire (COOK MEDICAL)
- Asahi Astante 0.014" 30g tip CTO wire with back up 2.5 mm balloon
- Possibly snare (AndraSnare, ANDRAMED) if needed/
Lunderquist 0.035" wire 260 cm (COOK MEDICAL) once across
4. Balloon predilatation
- BARD Atlas 16/14 mm
to minimum 16 atm x 30s each zone
5. Stenting
- BARD Venovo 16/14/12 from low IVC down
to either low CFV or else into PFV
6. Postdilatation
- BARD Atlas again to same pressures and diameters
- IVUS (VOLCANO / PHILIPS) to confirm stent apposition and identify any intra-luminal debris
- Cone Beam CTV (SIEMENS) to confirm stent apposition
7. Aftercare
- Thigh high class 2 compression stockings (JOBST)
- Pneumatic compression boots (COVIDIEN / MEDTRONIC) x 24h until US performed
- Colour doppler US day 1 post op CTV direct at 6/52
PROCEDURAL STEPS 1. Transfemoral retrograde approach
- 8F short sheath (TERUMO)
- Diagnostic 5F catheter Weinberg shape (COOK)
- TERUMO stiff angled 0.035" wire into left ECA
2. Exchange to
- Vista Brite Tip IG guiding catheter MPA1 shape into left CCA (CORDIS)
3. Distal protection
- Filter Wire EZ (BOSTON SCIENTIFIC) into distal ICA left
4. Stenting
- Roadsaver Carotid Micromesh stent (TERUMO) 8 x 25 mm
5. Carotid postdilatation
- 5 x 20 mm Paladin balloon with integrated embolic protection (40 micron pore size) (CONTEGO-MEDICAL)
6. Paladin filter closure and combined filter/balloon-system removal
- Removal of the distal EPD-Filter Wire EZ
- Removal of guiding catheter (wire controlled)
7. Closure of puncture site
- Angioseal 8F
Transfer patient ICU
Case 12 – LEI 07:
Acute early reocclusion left SFA after PTA/Stent
Center:
Leipzig, Dept of Angiology
Case 12 – LEI 07: male, 62 years (PMC-L)
Operators:
Sven Bräunlich,
Yvonne Bausback
CLINICAL DATA
Severe claudication left calf, walking capacity 120-150 meters
ABI left 0.63
PTA and stenting of a short distal SFA-stenosis left 11/2015 elsewhere
Acute thrombosis of the SFA
RISK FACTORS
CAD, MI 2003
Art. hypertension, diabetes mellitus type 2, former smoker
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- IMA-diagnostic 5F-catheter (CORDIS/CARDINAL HEALTH)
- 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
- 0.035" SupraCore guidewire, 190 cm (ABBOTT)
- 8F Balkin Up&Over Sheath, 40 cm (COOK)
2. Passage of the occlusion and percutaneous thrombectomy
- 0.018" Connect Guidewire 300cm (ABBOTT)
- 0.018" QuickCross Support-Catheter 135 cm (SPECTRANETICS)
- Exchange to Rotarex guidewire (STRAUB MEDICAL)
- 8F Rotarex Thrombectomy Catheter (STRAUB MEDICAL)
3. PTA with DCBs
- In.Pact Pacific 5.0/120 mm (MEDTRONIC)
4. Stenting on indication
- Epic Selfexpanding Nitinol-Stent (BOSTON SCIENTIFIC)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 13 – LEI 08:
In-stent reocclusion left SFA
Center:
Leipzig, Dept of Angiology
Case 13 – LEI 08: male, 70 years (D-K)
Operators:
Matthias Ulrich,
Michael Moche
CLINICAL DATA
Severe claudication left calf, walking-capacity 150-200 meters since 9/2015
ABI left 0,67
Stenting left SFA 08/2014
Stenting iliac arteries left 2003 and right 12/2015
CAD with PTCA 2003
RISK FACTORS
Art. hypertension, current smoker
ANGIOGRAPHY
During PTA right iliac 12/2015: In-stent reocclusion left SFA
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- IMA diagnostic catheter, 5F (CORDIS / CARDINAL HEALTH)
- 0.035" SupraCore 190 cm Guidewire (ABBOTT)
- 8F-40 cm Balkin Up&Over Sheath (COOK)
2. Passage of the in-stent occlusion left SFA
- Judkins Right 5F-catheter (CORDIS/CARDINAL HEALTH)
- 0.035" Radiofocus angled stiff glidewire, 260 cm (TERUMO)
- Exchange to 0.018" Guidewire (STRAUB MEDICAL)
Case 23 – COT 04:
Asymptomatic rapid progression of right ICA stenosis
Center:
Cotignola
Case 23 – COT 04: male 78 years (M-T)
Operators:
Antonio Micari,
Fausto Castriota
CLINICAL DATA
Asymptomatic for cerebrovascular events. Recent successful PTA to left ICA
(December 2015), angiography showed rapid progression of right ICA disease.
RISK FACTORS
Diabetes, smoking, hypertension
Severe asymptomatic right ICA stenosis
ANGIOGRAPHY
80% right ICA stenosis (progressed from 50% one year ago)
PROCEDURAL STEPS 1. Right femoral approach
2. MOMA positioning for proximal cerebral protection (MEDTRONIC)
3. Wire crossing during endovascular clamping
4. Direct stenting with an Xact-Stent (ABBOTT)
5. Postdilation with Maverick XI Balloon (BOSTON SCIENTIFIC)
Case 14 – BER 02:
Iliofemoral venous intervention – Part 1
Center:
Berne
Case 14 – BER 02: male, 48 years (J-Z)
Operators:
Nils Kucher,
Torsten Fuß
MEDICAL HISTORY
Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
Permanent neurocognitive deficits
Ongoing anticoagulation therapy
RISK FACTORS
Chronic venous insufficiency left leg with: venous claudication, varicose veins,
hyperpigmentation, leg swelling
Villalta-Score: 6 points
CT
May Thurner compression of the left common iliac vein
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
Case 14 – BER 02:
Iliofemoral venous intervention – Part 2
Center:
Berne
Case 14 – BER 02: male, 48 years (J-Z)
Operators:
Nils Kucher,
Torsten Fuß
MEDICAL HISTORY
Ilio-femoro-popliteal thrombosis 1986 after severe car accident with polytrauma
Permanent neurocognitive deficits
Ongoing anticoagulation therapy
RISK FACTORS
Chronic venous insufficiency left leg with: venous claudication, varicose veins,
hyperpigmentation, leg swelling
Villalta-Score: 6 points
CT
May Thurner compression of the left common iliac vein
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated Iliac vein stents
- Sinus-Obliquus 14–16 mm (OPTIMED),
- Sinus-XL Flex 14–16 mm (OPTIMED), or
- Vici 14–16 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 16 – BER 03:
Iliofemoral venous intervention
Center:
Berne
Case 16 – BER 03: female, 38 years (A-M)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Past medical history: No personal or familiy history of DVT
Previously healthy
Chronic venous insufficiency left leg with:
Venous claudication (walking distance 600 m)
Leg swelling (thigh 7 cm plus)
No varicose veins or skin changes
DUPLEX/CT
Stenosis of the external iliac vein left side
PROCEDURAL STEPS 1. Venous access with ultrasound guidance in left popliteal (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14 mm (BARD)
5. Implantation of dedicated iliac vein stents
- Sinus-XL Flex 14 mm (OPTIMED), or
- Vici 14 mm (VENITI)
6. High-pressure postdilation of stents
- Atlas Balloon 14 mm (BARD)
Case 17 – GAL 03:
Failed varicose vein treatment; pelvic vein source
Center:
Galway
Case 17 – GAL 03: female, 40 years (E-S)
Operators:
Gerard O'Sullivan,
Ian Davidson
CLINICAL DATA
Three children, haemorrhoids and vulval varicosities
during pregnancy
Varicose veins left posterior thigh and calf
treated by foam and RFA in June 2015
At clinical follow-up 6 weeks satisfactory
At 6 months ALL recurred
IMAGING
Mildly enlarged L ovarian vein
Tight left common iliac vein compression on MRV
CDUS – large varicose veins posterior thigh and
upper calf - extend close to introitus
PROCEDURAL STEPS 1. GA
- R I JV access
- Selective catheterisation of L ovarian vein: both internal iliac veins;
possibly right ovarian V
- Coils (COOK MEDICAL) +/– EMBA medical "hourglass"
- Foam (Sclerovein 3% diluted 3:1 with air)
2. IVUS to examine is iliac vein compression syndrome real
3. I f IVCS suggests it is real the predilate to 16 mm BARD Atlas
4. Stenting if IVCS is real
- COOK Zilver Vena 16 mm/VENITI Vici 16 mm/Wallstent 16 mm
- OPTIMED Sinus Venous/Obliquus 16 mm
5. Postdilate to 16 mm
6. Foam sclerotherapy and RFA to thigh veins
7. Transvaginal US to confirm ablationof all veins at 6/52
Case 25 – NYC 02:
In-stent occlusion with stent fractures RSFA
Center:
New York
Case 25 – NYC 02: female, 65 years, (D-J)
Operators:
Prakash Krishnan,
Karthik Gujja,
Vishal Kapur
CLINICAL DATA
Subacute onset R leg pain 2 to 3 months, Rutherford Class II, Category III
US Duplex showed instent occlusion of RSFA
Failed R Fem pop bypass, multiple PTA and stenting of RSFA
at outside hospital, failed revascularization of RSFA due to stent fracture
RISK FACTORS
Hypertension, dyslipidemia, coronary artery disease,
polycythemia vera (ongoing work up)
PROCEDURAL STEPS 1. Left Common femoral access and up and over
- 7F Pinnacle destination sheath 45 cm, up and over (TERUMO)
- If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) and direct stent access
2. Intra-luminal approach
- 0.014" 4 Fr Viance catheter, 150 cm (MEDTRONIC)
- 0.038" Vertip catheter, 125 cm (CORDIS / CARDINAL HEALTH)
- 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
Case 31 – BRL 04:
DES in a CLI patient with BTK Revascularisation
Center:
Berlin
Case 31 – BRL 04: male, 74 years, (M-S)
Operators:
Ralf Langhoff,
Normund Jabs
CLINICAL DATA
Bilateral severe claudication left > right since years,
recently deterioration of walking distance and lesion
at the the dorsal side of the 2nd toe
RISK FACTORS
Hyperlipidemia, former smoker, controlled hypertension,
MRA with BTK vessel occlusions
ABI at rest: 0.5 left, 0.64 right
ABI at rest
Left 0.5, right 0.64
PROCEDURAL STEPS 1. Antegrade access left CFA
- 4F Fortress sheath (BIOTRONIK)
2. Approaching the lesion
- 0.014" wire approach, Advantage wire (TERUMO)
- Backup with CXI support catheter (COOK)
3. PTA and stenting of the occluded tibioperoneal trunc
- 3.0 x 38 mm Cr8 BTK Stent (ALVIMEDICA)
4. Recanalisation of the anterior tibial artery
- Primary PTA 2.5 x 200 mm Coyote balloon (BOSTON SCIENTIFIC)
Case 06 – LEI 04:
Occlusion right popliteal artery
Center:
Leipzig, Dept of Angiology
Case 06 – LEI 04: female, 66 years (I-B)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication right calf and restpain during night, Rutherford class 3-4
ABI
Right 0.55
PTA
Right A.poplitea 3/2013
DUPLEX
Moderate stenosis right iliac artery and reocclusion right popliteal artery
RISK FACTORS
Art. hypertension, diabetes mellitus type II, former smoker
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 7F-55 cm Check-Flow-Performer Sheath (COOK)
2. Passage of the popliteal occlusion right
- 0.018" Victory 18 30 gr 300 cm guidewire (BOSTON SCIENTIFIC)
- 0.018" QuickCross Support-Catheter 135 cm (SPECTRANETICS)
3. Filter-protection placement
- 4F-90 cm Check-Flo Performer sheath (COOK)
- Wirion-Protection system (ALLIUM MEDICAL)
4. Atherectomy
- HawkOne directional atherectomy system, 6 cm tip (MEDTRONIC)
5. PTA with Drug-coated balloons
- In.Pact Pacific 6.0/120 mm (MEDTRONIC)
6. Stenting on indication
- Complete SE-Stent (MEDTRONIC)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 5 - Global Expert Exchange
Case 32 – LEI 10
Center:
Leipzig, Dept of Angiology
Case 32 – LEI 10
Operators:
Andrej Schmidt,
Yvonne Bausback
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 07 – LEI 05:
BTK-occlusion right with critical limb ischemia
Center:
Leipzig, Dept of Angiology
Case 07 – LEI 05: male, 81 years (G-P)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Restpain right forefoot and minor gangrene Dig I, Rutherford 5
Recurrent infrainguinal disease right with
PTA right SFA and BTK-arteries 4/2014 and 2/2015
Ischaemic cardiomyopathy, NYHA II-III
CAD with PTCA left main 2/2015
TAVI 2/2015
Permanent atrial fibrillation
PTA right vertebral artery 12/2015
ABI
Right: 0.37
ANGIOGRAPHY
During vertebral artery PTA 12/2015: occlusion of all 3 BTK-arteries right
RISK FACTORS
Arterial hypertension, former smoker, hyperlipidaemia
PROCEDURAL STEPS 1. Right antegrade approach
- 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)
2. Passage of the anterior tibial artery occlusion
- CXC 0.018” 90 cm Support-Catheter (COOK)
- 0.018” V-18 Control Guidewire, 300 cm (BOSTON SCIENTIFIC)
Exchange to:
- 0.014" Floppy ES 300 cm guidewire (ABBOTT)
3. PTA and arterial wall-injection of dexamethason
- Armada 14 3.0/120 mm balloon (ABBOTT)
- BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
CLINICAL DATA
History: 2007 CAS Right
Since 3 months bilateral claudication left > right after <100 m (Rutherford 3)
Good CFA pulses
No popliteal/distal pulses
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 20 – BER 04:
Pelvic congestion syndrome
Center:
Berne
Case 20 – BER 04: female, 52 years (M-B)
Operators:
Nils Kucher,
Torsten Fuß
MEDICAL HISTORY
Appendectomy and removal of ovarian cyst 1996
Laparoscopic adhesiolysis and tubal sterilisation 2005
Last menstrual cycle 03/2015
Recent gynecologic exam unremarkable
PRESENT STATE
Left sided abdominal dull pain, lower quadrant since 6 months
The pain is worse during defecation
No pain during or after sexual intercourse or during voiding
Pain dependence on position (no pain during bed rest, worse while standing and sitting)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 3 - Technical Forum
Case 30 – LEI 09:
Recurrent stenosis left common carotid artery
Center:
Leipzig, Dept of Angiology
Case 30 – LEI 09: male, 56 years (L-F)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Recurrent stenosis left common carotid artery at the proximal anastomosis
of a prosthesis-interposition left CCA after radical neck dissection
of a parotid cancer left with infiltration of the CCA and radiation therapy 2010
Fogarty-thrombectomy left CCA and stenting left CCA/ICA 2015
Minor stroke 2015
RISK FACTORS
Facial nerve paresis left since 2015
Minor paresis right arm since 2015
Dysarthria
Former smoker, arterial hypertention, diabetes mellitus type II
DUPLEX
High grade recurrent stenosis left proximal common carotid artery
ANGIOGRAPHY
90% proximal CCA-stenosis and 70% recurrent stenosis distal to the ICA-stent
2. Placement of a filter
- Wirion protection device (ALLIUM MEDICAL)
3. Predilatation, stenting and postdilatation
- 3.5/20 mm AngioSculpt RX scoring-balloon (SPECTRANETICS)
- 9.0 or 10/30 mm CGuard carotid embolic prevention system (InspireMD/PENUMBRA)
- 7.0/20 mm Sterling RX-balloon (BOSTON SCIENTIFIC)
Case 08 – NYC 01:
Severely calcified severe stenosis of LSFA
Center:
New York
Case 08 – NYC 01: female, 83 years, (P-M)
Operators:
Prakash Krishnan,
Karthik Gujja,
Vishal Kapur
CLINICAL DATA
PAD, Rutherford Class II, category III, claudication of L calf at 1 to 2 blocks,
ABI R LE - 0.5 and L LE - 0.6
Jet stream athrectomy, PTA and stenting of RSFA in 09/2015
RISK FACTORS
Hypertension, diabetes mellitus type II,
dyslipidemia, moderate aortic regurgitation
PROCEDURAL STEPS 1. Right common femoral access and cross over approach
- 7F Pinnacle destination sheath 45 cm up and over sheath (TERUMO)
2. Guidewire passage
- 0.014" Spartacore wire, 300 cm (ABBOTT VASCULAR)
- 0.038" Vertebral 135" Tempa Aqua catheter, 125 cm (CORDIS)
3. Filter placement
- exchanged with 0.014" Bare wire, 315 cm (ABBOTT VASCULAR)
- Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)
Case 09 – LEI 06:
Calcified popliteal artery occlusion
Center:
Leipzig, Dept of Angiology
Case 09 – LEI 06: male, 73 years, (S-W)
Operators:
Sven Bräunlich,
Yvonne Bausback
CLINICAL DATA
Critical limb ischemia with ulceration lateral foot right
Severe claudication right since years
ABI right 0.34, Rutherford class 5
Thrombendartherectomy right groin 2013
RISK FACTORS
Diabetes mellitus type 2, art. hypertension, former smoker
ANGIOGRAPHY
Severely calcified distal SFA and Apop – occlusion right
PROCEDURAL STEPS 1. Right antegrade approach
- 6F 55 cm sheath (COOK)
2. Passage of the occlusion
- Stiff angled Radiofocus guidewire 0.035”, 260cm (TERUMO)
- Armada 35 balloon 4.0/120mm (ABBOTT)
In case of failure form antegrade:
- Retrograde approach vie peroneal or posterior tibial artery
3. PTA
- Armada 5/40 and 6/40 mm balloon (ABBOTT)
- Conquest High Pressure Balloon (C.R.BARD)
CLINICAL DATA
Juxtarenal aneurysm 59 mm max. below a left acc. RA
RISK FACTORS
CAD, art. hypertension, hypertensive heart disease, LE 12/15
PROCEDURAL STEPS
- Percutanous approach both groins Prostar XL (ABBOTT).
- Placement of 14F sheaths (COOK).
- Placement of Endurant bifurcated endograft (MEDTRONIC) just below the LRA.
- Cannulation of the lower left renal artery and placement of the sandwich graft (GORE-Viabahn).
- Extension of the the aortic endograft with an Endurant-tubegraft (MEDTRONIC) in order to complete the sandwich-repair.
- Closure of the groins.
CLINICAL DATA
History: 2008 CAS right, 2010 PTAS popliteal right, 2010 CEA left, 2011
PTCA + CABG, 2015 PTRA bilateral
Present State: non-healing ulcer left leg since 1 month
5. Postdilatation
- Armada 0.018", 5 or 6 mm (ABBOTT VASCULAR)
6. Assistance GE Healthcare
- Vessel assist - "Center Line Tracking"
7. Plan B
- Distal puncture + retrograde / bidirectional recanalization
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Room 2 - Main Arena 2
Case 44 – LEI 15:
Abdominal aortic aneurysm – Part 1
Center:
Leipzig, Dept of Angiology
Case 44 – LEI 15: male, (R-E)
Operators:
Andrej Schmidt,
Daniela Branzan
CLINICAL DATA
Incidental finding of an eccentric AAA, 5.3 cm diameter
RISK FACTORS
CAD with NSTEMI 10/2015, PTCA LAD
Chronic renal insufficiency (GFR 72 ml/min)
Art. hypertention, former smoker
PROCEDURAL STEPS 1. Percutaneous access both groins in local anaesthesia
- 5F-10 cm Radifocus-sheaths (TERUMO)
- 0.035" SupraCore guidewire 190 m (ABBOTT)
- Preloading of 2 Proglide-systems per groin (ABBOTT)
- 0.035" Lunderquist 260 cm guidewires bilateral (COOK)
2. Graft implantation
- Implantation of the Altura Stentgraft system and extension to the hypogastric artery bilateral (LOMBARD MEDICAL)
3. Postdilatation of the whole graft
- Exchange to 12F-12 cm sheath bilateral (COOK)
- Reliant balloons both sides (MEDTRONIC)
Case 51 – MUN 03:
Persisting Type II Endoleak via AMI with aneurysm enlargement
Center:
Münster
Case 51 – MUN 03: male, 83 years (H-K)
Operators:
Arne Schwindt,
N. Varcoe
Varcoe
CLINICAL DATA
EVAR for AAA 2013 with bifurkated stentgraft, initial diameter of AAA 56 mm, in follow-up
CT-angiograms persisting Type II Endoleak via lumbar arteries and inferior mesenteric
artery (IMA). In 2015 enlargement of AAA to 70 mm in maximum axial diameter.
RISK FACTORS
Art. hypertension, former smoker, CHD
PROCEDURAL STEPS 1. Left transbrachial approach
- 6F 70 cm Raabe sheath (COOK) insertion into ostium of superior mesenteric artery
2. Cannulation of middle colic artery
- 0,035" Glidewire and 4F 120 cm Glidecath (TERUMO)
3. Cannulation of IMA and Endoleak
- 0,014" Choice PT II wire (BOSTON SCIENTIFIC)
4. Catheter insertion
- 0,014" Echelon or 0,010" Marathon microcatheter into Endoleak and following angiogram
5. Embolisation of Endoleak with alcohol-colymer
- Onyx 34/34L (MEDTRONIC)
6. After microcatheter removal final angiogram via IMA and hypogastric artery to confirm complete Endoleak embolisation
Case 34 – BER 05:
Complex intervention of IVC and iliac veins
Center:
Berne
Case 34 – BER 05: male, 34 years (R-V)
Operators:
Nils Kucher,
Torsten Fuß
CLINICAL DATA
Past medical history:
Thrombosis of IVC and bilateral Iliac veins 08/2013 treated with anticoagulation
Varicocele, hemorrhoids
Thrombophilia testing negative
Failed endovascular recanalisation attempts in 2015 in two tertiary care hospital
PRESENT STATE
Bilateral venous claudication
Lumbar pain, bilateral swelling despite compression therapy, varicose veins
Currently no anticoagulation therapy
CT: postthrombotic IVC, large hemiazygos vein,
Failed endovascular treatment
PROCEDURAL STEPS 1. Bilateral common femoral vein access, right jugular vein access with ultrasound guidance (10F sheath)
2. Wire crossage
- TERUMO 0.035 stiff angled
3. Phlebography, IVUS
4. Predilation
- Atlas Balloon 14–18 mm (BARD)
5. Implantation of dedicated Iliac vein stents
over TERUMO stiff angled wire 0.035":
- IVC stents: Sinus XL 22 mm (OPTIMED),
- Kissing Iliac vein stents: Sinus-XL Flex 14–16 mm (OPTIMED)
6. High-pressure post-dilation of stents
- Atlas balloon 14–18 mm (BARD)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 44 – LEI 15:
Abdominal aortic aneurysm – Part 2
Center:
Leipzig, Dept of Angiology
Case 44 – LEI 15: male, (R-E)
Operators:
Andrej Schmidt,
Daniela Branzan
CLINICAL DATA
Incidental finding of an eccentric AAA, 5.3 cm diameter
RISK FACTORS
CAD with NSTEMI 10/2015, PTCA LAD
Chronic renal insufficiency (GFR 72 ml/min)
Art. hypertention, former smoker
PROCEDURAL STEPS 1. Percutaneous access both groins in local anaesthesia
- 5F-10 cm Radifocus-sheaths (TERUMO)
- 0.035" SupraCore guidewire 190 m (ABBOTT)
- Preloading of 2 Proglide-systems per groin (ABBOTT)
- 0.035" Lunderquist 260 cm guidewires bilateral (COOK)
2. Graft implantation
- Implantation of the Altura Stentgraft system and extension to the hypogastric artery bilateral (LOMBARD MEDICAL)
3. Postdilatation of the whole graft
- Exchange to 12F-12 cm sheath bilateral (COOK)
- Reliant balloons both sides (MEDTRONIC)
Case 52 – MUN 04:
Endoleak embolisation of iliac artery aneurysm after iliac-sidebranch endograft
Center:
Münster
Case 52 – MUN 04: male, 63 years (F-D. P.)
Operators:
Arne Schwindt,
N. Varcoe
Varcoe
CLINICAL DATA
2013 Complex EVAR for aorto-biiliac AAA with Zentih bifurcated endograft and bilateral Zenith iliac-sidebranch endografts, 2013 embolisation of Type II Endoleak via AMI. In CT-angiogram aneurysm enlargement of left iliac aneurysm from initially 55mm to 65 mm and persisting type II EL via left deep circumflex iliac artery.
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 35 – LEI 11:
Reocclusion right SFA
Center:
Leipzig, Dept of Angiology
Case 35 – LEI 11: male, 50 years (R-D)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication right calf, painfree walking capacity 50 meters
Rutherford class 3
ABI right 0.63
PTA left SFA 12/2015, PTA right SFA with DCBs 12/2012
RISK FACTORS
Art. hypertension, current smoker
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 7F–40 cm Balkin Up&Over Sheath
2. Guidewire passage
- 0.035" stiff angled Radiofocus guidewire, 260 cm (TERUMO)
- 0.035" Seeker Support-catheter, 135 cm (BARD)
In case of failure to redirect the guidewire back into the true lumen retrograde approach via the distal SFA:
- 21 Gauge 9 cm puncture needle (COOK)
- 0.018" V-18 Control guidewire 90 cm (BOSTON SCIENTIFIC)
3. PTA and stenting
- Armada 35 5.0/120mm (ABBOTT)
- 6.0/250 mm Viabahn (W.L.GORE)
- 7.0/80 mm GORE Tigris Stent across the collateral distal to the occlusion (W.L.GORE)
- Placement of a pigtail catheter via the left groin
- Lunderquist wire right side
- Placement of the main body through the right side directly below the renals - Treovance-Endograft (BOLTON-MEDICAL)
- Probing and positioning of the iliac limb extension contralateral
- Ipsilateral positioning of the iliac endograft
- Postballooning
- Final angiography
- Closing access with Prostar (preclose technique)
Case 54 – LEI 19:
Selective Internal Radiation Therapy (SIRT) for colorectal liver metastases
Center:
Leipzig, Dept of Radiology
Case 54 – LEI 19: male, 57 years
Operators:
Tim Ole Petersen,
Michael Moche,
T. Lincke
CLINICAL DATA
Liver metastases following rectal cancer (T3 N2b M1 G2 KRAS wild type)
Rectum resection 11 month ago, followed by nine cycles of FOLFIRI-Cetuximab
chemotherapy. After initial regressive disease now persisting metastases in the liver.
Hepatic function not impaired.
RISK FACTORS
Art. hypertension
Slight focal cholestasis from tumor mass in liver segment VII
PROCEDURAL STEPS 1. Right femoral approach
- 4F 10 cm sheath (TERUMO)
2. Catheterization of the hepatic artery
- 4F-SIM2 100 cm diagnostic catheter (CORDIS)
3. Placement of the microcatheter precisely in the same position 1 and 2 for the injection of the therapeutic agent
- Microcatheter System 2.7F 130 cm (TERUMO PROGREAT)
4. Selective application of the Yttrium-90 glass microspheres with a dedicated injection system (TheraSphere, BTG)
PROCEDURAL STEPS 1. Left CFA Access
- 0.035" Glide wire (TERUMO)
- RIM Catheter (COOK MEDICAL)
- Destination 6F, 45 cm (TERUMO)
2. Recanalization
- 0.018", 260 cm Advantage (TERUMO)
- CXI Catheter 0.018", 150 cm (COOK MEDICAL)
3. Predilatation
- Armada 0.018", 5 or 6 mm (ABBOTT VASCULAR)
4. Stenting
- Viabahn 5 or 6 mm, 250 mm (GORE)
5. Postdilatation
- Armada 0.018", 5 or 6 mm (ABBOTT)
6. Plan B
Direct Stent Puncture right SFA + Retrograde / Bidirectional Recanalization
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Room 2 - Main Arena 2
Case 46 – BER 06:
Percutaneous EVAR of infrarenal AAA under local anaesthesia
Center:
Berne
Case 46 – BER 06: male, 79 years (F-L)
Operators:
Dai-Do Do,
V. Makaloski
CLINICAL DATA
Asymptomatic infrarenal AAA with progressively increasing diameter
Femorotibial bypass on the right side 2006
Lower extremity chronic venous disorders CEAP C4 on both sides
PTCA 2006
RISK FACTORS
Type 2 diabetes, arterial hypertension, hyperlipidemia,
65-pack-year cigarette smoking history
PROCEDURAL STEPS 1. Percutaneous femoral access in both groins
- Local anaesthesia, retrograde puncture of the CFA on both sides
- 0.035" Radiofocus M stiff guidewire, 180 cm (TERUMO)
- Preclosure of the access sites using ProGlide devices (ABBOTT)
2. Implantation of the INCRAFT®AAA Stent Graft System (CORDIS, CARDINAL HEALTH)
- the delivery system (14-F OD) with the main body inside up to the lower accessory right renal artery, deployment of the main body
- Implantation of the contralateral and then the ipsilateral iliac stentgraft (12-F OD)
3. Sealing ot the percutaneous access sites in both groins
- ballon dilatation of the main body and the iliac limbs: Reliant balloon (MEDTRONIC)
- control angiogram, then withdrawing the delivery system respectively the 12F sheath
- advancing and tying the knots using the knot pusher of the ProGlide system
CLINICAL DATA
Severe claudication right calf, Rutherford class 3
ABI right 0.62
Angiography during PTCA 11/2015:
Long SFA-occlusion right and popliteal artery stenosis right
RISK FACTORS
CAD with NSTEMI 11/2015 and PTCA RCX
Moderate aortic valve stenosis
Former smoker, art. hypertension, diabetes mellitus Type 2
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 6F-40cm Balkin Up&Over Sheath (COOK)
2. Passage of the CTO
- 0.035" Radiofocus glidewire, stiff, angled, 260 cm (TERUMO)
- 0.035" Seeker support-catheter, 135 cm (BARD)
- Exchange to a 0.018" SteelCore guidewire 300 cm (ABBOTT)
Case 57 – LEI 20:
Infrarenal aortic stenosis and bilateral iliac occlusions, Leriche-Syndrome
Center:
Leipzig, Dept of Angiology
Case 57 – LEI 20: male, 68 years (K-A)
Operators:
Andrej Schmidt,
Holger Staab,
Daniela Branzan
CLINICAL DATA
Claudication intermittens, walking capacity 50 meters
Weakness and pain buttock, thigh and calf bilateral
ABI bilateral 0.67
CAD, PTCA 2012 and 2013, cardiomyopathy, EF 45%
Adipositas
Gastric surgery due to perforation 2001
RISK FACTORS
Art. hypertension, hyperlipidemia
PROCEDURAL STEPS 1. Transbrachial approach
- 6F 90 cm Check-Flo performer sheath (COOK)
- 5F 125 cm diagnostic Judkins Right catheter (CORDIS / CARDINAL HEALTH)
- SupraCore 300 cm 0.035" guidewire (ABBOTT)
2. Passage of the occlusions
- Stiff angled 0,035" guidewire, 260 cm (TERUMO)
- Together with 5F-125 cm Judkins Right Catheter
3. Bilateral groin access
- 7F 10 cm Radiofocus sheath (TERUMO)
- Snaring of the antegrade guidewire form above into the groin-sheath or
- Into 6F-Judkins-Right guiding catheter (CORDIS), inserted form below
4. PTA via the groin access bilateral
- SupraCore 300 cm 0,035" guidewire (ABBOTT)
- Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
5. Stenting
- Aorta: Sinus XL Aortic Stent (OPTIMED)
- Common iliac arteries: 8.0/59 mm LifeStream covered Stentgrafts in Kissing technique (C.R.BARD)
- External iliac artery bilateral: 8.0/120 mm Absolute Pro Stent bilateral (ABBOTT)
Case 49 – HEI 02:
Asymptomatic aortoiliac aneurysmal disease – Part 1
Center:
Heidelberg
Case 49 – HEI 02: male, 73 years (G-K)
Operators:
Dittmar Böckler,
Alexander Hyhlik-Dürr,
Bischoff
CLINICAL DATA
Small AAA 31 mm, left common iliac artery 31 mm
and left thrombosed internal iliac artery aneurysm 38 mm
Diagnosed in 9/2105 in an external institution, asymptomatic status
RISK FACTORS
Ascending aneurysm (46 mm)
Ectatic infrarenal aorta (31 mm)
Ectatic popliteal arteries (right 13 mm: left: 14 mm)
Hx of smoking (40 py)
Hx of art. hypertension
ABI 1,0 both sides with palpable pulses
CLINICAL DATA
Severe claudication left calf, walking capacity 200-300 meters
Rutherford class 3, ABI left 0.68
PTA with plane balloon angioplasty left 7/2015
(POBA-arm of a DCB randomized controlled trial)
PTA right SFA 1/2016
CAD
Minor stroke without residual symptoms 2012
RISK FACTORS
Art. hypertension, former smoker
Angiography during PTA right SFA: diffuse restenosis left SFA
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
- IMA 5F diagnostic catheter (CORDIS / CARDINAL HEALTH)
- 0.035" soft angled Radiofocus guidewire, 190 cm (TERUMO)
- 0.035" SupraCore Guidewire 190 cm (ABBOTT)
- 6F-40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire-passage and preparation of the lesion
- 0.018" SteelCore Guidewire, 300 cm (ABBOTT)
- FLEX Plaque Modification Catheter (VENTURE MED GROUP)
3. PTA and stenting on indication
- Luminor DCB 5.0/120 mm (iVASCULAR)
- VascuFlex Multi-LOC (B.BRAUN)
Case 49 – HEI 02:
Asymptomatic aortoiliac aneurysmal disease – Part 2
Center:
Heidelberg
Case 49 – HEI 02: male, 73 years (G-K)
Operators:
Dittmar Böckler,
Alexander Hyhlik-Dürr,
Bischoff
CLINICAL DATA
Small AAA 31 mm, left common iliac artery 31 mm
and left thrombosed internal iliac artery aneurysm 38 mm
Diagnosed in 9/2105 in an external institution, asymptomatic status
RISK FACTORS
Ascending aneurysm (46 mm)
Ectatic infrarenal aorta (31 mm)
Ectatic popliteal arteries (right 13 mm: left: 14 mm)
Hx of smoking (40 py)
Hx of art. hypertension
ABI 1,0 both sides with palpable pulses
Case 49b – LEI 17:
Amplatzer Plug implantation for an Endoleak via subclavian artery
Center:
Leipzig, Dept of Angiology
Case 49b – LEI 17: female 73 years (M-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Type II Endoleak after thoracoabdominal Stentgraft via left subclavian artery
Surgical repair of an aneurysm of the ascending aorta 2015
Bypass surgery from right to left common carotid and from left common carotid to left subclavian artery to prepare a landing-zone for a thoracoabdominal stentgraft
No proximal bending / clipping to occlude the left subclavian artery
RISK FACTORS
Art. Hypertension
ANGIOGRAPHY LEFT
Via left brachial artery: large endoleak into the descending thoracic aorta
PROCEDURAL STEPS 1. Left brachial approach
- 6F 55 cm sheath (COOK)
2. Implantation of an Amplatzer Plug 16 mm (ST JUDE MEDICAL) into the proximal left subclavian artery
New patient! Information will follow in due time. Thank you for your understanding.
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Room 3 - Technical Forum
Case 82 – BK 05:
Recanalisation of EIA/CFA and SFA left leg
Center:
Bad Krozingen
Case 82 – BK 05: male, 61 years (G-H)
Operators:
Thomas Zeller,
Elias Noory
CLINICAL DATA
Calf & leg claudication left leg, calf claudication right leg about 200 m
with progressive deterioration since a couple of weeks
Interventional treatment of the left CFA 2007 in an external hospital
Coronary 2-vessel disease
PCI / DES 2009, 3/2010, 6/2010
AMI (posterior wall) 2009
Moderate reduction of LV function
ABI at rest: 0.4 / 0.3, ABI after exercise: 0.2 / 0.1
Oscillometry: reduced amplitudes right calf & ankle
Reduced amplitudes left tigh, calf & ankle
Duplex left leg: Occlusion of EIA & CFA (vessel diameter 11 mm!)
Moderate to high grade stenosis of DFA
Proximal occlusion of SFA (reperfusion distally)
Crea/eGFR: 1.3 mg/dl / 76.3 ml/min
DUPLEX
Duplex-sonographic surveillance for a few years
Progression from < 5.0 cm to 5.5 cm within a year
PROCEDURAL STEPS 1. Percutaneous approach with local anaesthesia both groins
- Preloading of 2 Proglide-Systems per groin (ABBOTT)
- 0.035" LunderQuist 200 cm guidwires via both groins (COOK)
- Calibration angiography to estimate the graft-length
2. Bilateral insertion of the Nellix-systems (ENDOLOGIX)
- Implantation of the 10 mm-diameter stentgrafts with integrated balloons
- Pre-filling of Nellix Endobags with pressure-monitoring (ENDOLOGIX)
- After aspiration of the pre-fill injection of the Polymer-filling
- Postdilatation with integrated 10 mm balloons
DUPLEX
Duplex-sonographic surveillance for a few years
Progression from < 5.0 cm to 5.5 cm within a year
PROCEDURAL STEPS 1. Percutaneous approach with local anaesthesia both groins
- Preloading of 2 Proglide-Systems per groin (ABBOTT)
- 0.035" LunderQuist 200 cm guidwires via both groins (COOK)
- Calibration angiography to estimate the graft-length
2. Bilateral insertion of the Nellix-systems (ENDOLOGIX)
- Implantation of the 10 mm-diameter stentgrafts with integrated balloons
- Pre-filling of Nellix Endobags with pressure-monitoring (ENDOLOGIX)
- After aspiration of the pre-fill injection of the Polymer-filling
- Postdilatation with integrated 10 mm balloons
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 66 – MUN 05
Center:
Münster
Case 66 – MUN 05
Operators:
Arne Schwindt,
S. Stahlhoff
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 67 – MUN 06
Center:
Münster
Case 67 – MUN 06
Operators:
Arne Schwindt,
S. Stahlhoff
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 68 – LEI 24:
Retrograde approach using a 2.9F pedal sheath in CLI
Center:
Leipzig, Dept of Angiology
Case 68 – LEI 24: male 76 years (H-H)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Critical limb ischemia with forefoot gangrene left
Rutherford class 5, ABI > 1.3
Failed recanalization attempt 01/2016 of an occluded anterior tibal artery
RISK FACTORS
Diabetes mellitus type 2, art. Hypertension
ANGIOGRAPHY
During recanalization attempt:
Left: SFA, Apop and peroneal artery patent, posterior and anterior tibial artery occluded
Guidewire-perforation in the mid segment of the anterio tibial artery
PROCEDURAL STEPS 1. Antegrade left access
- 5F-55 cm sheath (COOK)
2. Retrograde approach via the dorsalis pedis artery
- Pedal puncture kit (COOK)
- 21 Gauge 4 cm needle (COOK)
- 2.9F ID pedal sheath (COOK)
3. Retrograde passage of the ATA-occlusion left
- 0.018" straight CXI support-catheter, 90 cm (COOK)
- 0.014" Hydro-ST guidewire, 300 cm (COOK)
- 0.014" CTO-Approach 25 gramm 300 cm guidewire (COOK)
4. PTA from retrograde
- Advance Micro balloon 2.5/120 mm (COOK)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 70 – BK 02: male, 64 years (P-W)
Center:
Bad Krozingen
Case 70 – BK 02: male, 64 years (P-W)
Operators:
Thomas Zeller,
Elias Noory
CLINICAL DATA
Claudication Rutherford 3 (50m) left calf since 1 year
Sudden onset of symptoms
Embolic nature, source: intra cardiac thrombus as a result of an anterior wall infarction
Oral anticoagulation
RISK FACTORS
CVRF: Nicotine, family history
ABI: right 1.1, left 0.6
DUPLEX
Thrombotic occlusion of distal left SFA
PROCEDURAL STEPS 1. 7F antegrade sheath left CFA
2. I ntraluminal lesion passage
- 4F vertebral diagnostic catheter (CORDIS) 0.018’’ or
- 0.014” Advantage GW (TERUMO)
Case 71 – LEI 25:
Popliteal occusion right, previous unsuccessful recanalization attempt
Center:
Leipzig, Dept of Angiology
Case 71 – LEI 25: male, 76 years (W-K)
Operators:
Andrej Schmidt,
Sven Bräunlich
CLINICAL DATA
Restpain and severe claudication right foot and calf
11/2015 unsuccessful recanalization attempt elsewhere with
inability to redirect the guidewire into the true lumen distally
ABI
Right 0.47
RISK FACTORS
Art. hypertension, former smoker, hyperlipidaemia
PROCEDURAL STEPS 1. Right antegrade approach
- 6F-55 cm Check-Flo Performer sheath (COOK)
2. Second attempt to pass the occlusion from antegrade
- 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
- Pacific balloon 3.0/80 mm (MEDTRONIC)
3. In case of failure retrograde approach via the peroneal artery
- 21 gauge 7 cm puncture needle (COOK)
- 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
- 0.018" TrailBlazer support-catheter, 90 cm (MEDTRONIC / COVIDIEN)
- Snaring of the guidewire from antegrade after passage of the CTO
4. Vessel preparation and PTA from antegrade
- FLEX Plaque-Modification catheter (VENTUREMEDGROUP)
- Lutonix DCB (C.R.BARD)
5. Stenting on indication
- Multi-LOC Multiple-Stent-Delivery-System (B.BRAUN) or
- Supera Interwoven Nitinol-Stent (ABBOTT)
CLINICAL DATA
89 yo male with ESRD on HD with dysfunctional LUE radio-cephalic fistula
at the wrist, decreased access flow rates greater than 25% drop
from 900 ml/min to 600 ml/min. Multiple prior interventions in the past
(beginning in 2009).
Most recent intervention 3 months prior.
RISK FACTORS
DM, CAD, DM
PROCEDURAL STEPS 1. US guided left radial artery access
- 4F or 6F slender sheath (TERUMO)
Case 72 – BK 03:
Stent angioplasty of renal artery stenosis right side
Center:
Bad Krozingen
Case 72 – BK 03: female, 64 years (M-F)
Operators:
Thomas Zeller,
Elias Noory
CLINICAL DATA
Since more than 15 years known history of hypertension
Sudden onset of symptoms of recurrent hypertensive crisis in September 2015
Coronary 2-vessel disease
PCI / DES LAD and Rcx 2012
Normal LV function
Negative stress echo up to 125 W 10/2015
DUPLEX
Kidney length R/L: 119 mm/118 mm
Acceleration time: > 70 ms/< 70 ms
Intrarenal RI R/L: 0,74/0,81
RA PSV- ratio R/L: 4.5/1.8
PROCEDURAL STEPS 1. 6F retrograde sheath right groin (11 cm)
2. 6F IMA guiding catheter via standard 0.038" GW
3. Non-selective angiography (DSA)
4. Selective angiography
5. Lesion crossing with a 0.014" GW (Galeo ES, BIOTRONIK)
6. Direct stenting if feasible, predilatation on indication
- Hippocampus (MEDTRONIC) or Dynamic renal (BIOTRONIK)
7. Closure device
- Femoseal (ST. JUDE)
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Room 1 - Main Arena 1
Case 73 – TEA 01
Center:
Teaneck
Case 73 – TEA 01
Operators:
John Rundback,
Kevin Herman,
Amish Patel
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 74 – BK 04:
Chronic occlusion of left SFA, popliteal and BTK arteries
Center:
Bad Krozingen
Case 74 – BK 04: male, 79 years (B-H)
Operators:
Thomas Zeller,
Elias Noory
CLINICAL DATA
Claudication Rutherford 3 (<50m) both legs for years
with progressive deterioration during a the last couple of months
ABI: right 0.3, left 0.4
RISK FACTORS
Hypertension, former smoker, hyperlipidemia
DUPLEX
Chronic bilateral SFA occlusion plus occlusion of left popliteal artery middle segment
PROCEDURAL STEPS 1. 7F cross-over Destination- sheath from the right groin (TERUMO)
2. In the unlikely case of intraluminal lesion passage: Mechanical thrombectomy
(Rotarex; STRAUB MEDICAL)
3. If subintimal: predilatation with plain balloon, if result insufficient
directional atherectomy & DCB angioplasty (TurboHawk and In.Pact DCB; MEDTRONIC)
4. Stent only on indication (provisional stenting) (Supera Interwoven Nitinol-Stent; ABBOTT)
5. In case of failed antegrade recanalization attempt retrograde access via left ATA
New patient! Information will follow in due time. Thank you for your understanding.
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Room 2 - Main Arena 2
Case 81 – LEI 28:
Fenestrated EVAR for a juxtarenal aortic aneurysm
Center:
Leipzig, Dept of Angiology
Case 81 – LEI 28: male
Operators:
Andrej Schmidt,
Daniela Branzan,
Holger Staab
CLINICAL DATA
Progressive juxtarenal aneurysm
Incidental finding during an episode of abdominal pain
CAD, PTCA 20120
RISK FACTORS
Art. hypertension, former smoker
PROCEDURAL STEPS 1. General anaesthesia
Percutaneous approach via both groins and left axillary artery
- Preloading of 2 Proglide-systems per groin and left axillary artery (ABBOTT)
- 12F-45 cm Sheath via left brachial artery (COOK)
- 0.035" Lunderquist 300 cm (COOK) pullthrough left groin to axillary artery using a
- Snare-kit 10 mm (COVIDIEN / MEDTRONIC)
2. Precannulation of the visceral arteries before stentgraft implantation
- 16F-30 cm sheath via right groin (COOK)
- SOS Omni-Selective 5F-catheter (ANGIODYNAMICS)
- Stabilization with guidewires: Galeo Pro (BIOTRONIK)
3. Stentgraft implantation
- Implantation of the 4-vessl branched CMD-stentgraft (JOTEC) via left groin
- Removal of the stentgraft delivery system and partiall closure left groin
4. Cannulation of the visveral arteries
- Puncture of the valve of the 12F-45 cm sheath axillary artery and insertion of a 7F-55 cm sheath (COOK)
- Judkins Right Diagnostic Catheter (CORDIS)
- 0.018" V-18-Control Guidewire 300 cm (BOSTON SCIENTIFIC)
5. Implantation of covered stents to the visceral arteries
- E-ventus BX stentgrafts (JOTEC)
Conference day 4
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Room 1 - Main Arena 1
Case 87 – MUN 10:
LP-branched endovascular aortic repair – Part 1
Center:
Münster
Case 87 – MUN 10: female, 61 years (W-H)
Operators:
Martin Austermann,
Bernd Gehringhoff,
M. Bosiers
CLINICAL DATA
Thoracoabdominal aortic aneurysm
Narrow iliac arteries
CLINICAL DATA
Severe claudication bilateral, right > left, restpain right foot, Rutherford 4
walking capacity 60 meters
ABI right 0.55
PTA of iliac stenosis bilateral 11/2015
Persistent symptoms
CLINICAL DATA
Art. hypertension, current smoker
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
- 7F 55 cm Check-Flow-Performer sheath (COOK)
2. Atherectomy of the profunda femoris stenosis right
- HawkOne directional atherectomy system, 9 cm tip (MEDTRONIC)
3. Passage of the SFA-occlusion and filter placement
- 0.018" Connect guidewire 300 cm (ABBOTT)
- 0,018" QuickCross Support-Catheter, 135 cm (SPECTRANETICS)
- 4F 90 cm sheath (COOK)
- Wirion-Protection system (ALLIUM-MEDICAL)
4. Atherectomy of the superficial femoral artery
- HawkOne directional atherectomy system, 9 cm tip (MEDTRONIC)
5. PTA with drug-coated balloons
- Ranger DCB 5.0/120 mm (BOSTON SCIENTIFIC)
Case 90 – LEI 31:
High grade stenosis brachiocphalic trunk
Center:
Leipzig, Dept of Angiology
Case 90 – LEI 31: male, 62 years (R-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Minor stroke right hemispheric 2011, no residual symptoms
Intermittent vertigo
Intermittent atrial fibrillation
CAD, MI 2012
COPD
RISK FACTORS
Art. hypertension, former smoker, diabetes mellitus type 2
DUPLEX
Retrograde flow right vertebral artery
MR-ANGIOGRAPHY
High grade stenosis origin of the brachiocephalic trunk
PROCEDURAL STEPS
1. Right groin access
- 5F-Judkins Right diagnostic catheter (CORDIS / CARDINAL HEALTH)
- 0.035" SupraCore guidewire 300 cm (ABBOTT)
- 7F 90 cm Check-Flo Performer sheath (COOK)
- Guidewire-position into the subclavian artery
2. Potentially cerebral protection with a filter via a right brachial access
- 6F 25 cm Radiofocus sheath (TERUMO)
- 6F IMA guiding catheter (MEDTRONIC)
- Filterwire EZ (BOSTON SCIENTIFIC) from brachial to the internal carotid artery
3. Predilatation and stenting
- 5.0/40 mm Admiral balloon, 135 cm (MEDTRONIC)
- BeGraft 10/27 mm Covered Stent (BENTLEY INNOMED)
New patient! Information will follow in due time. Thank you for your understanding.
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Room 1 - Main Arena 1
Case 92 – LEI 33
Center:
Leipzig, Dept of Angiology
Case 92 – LEI 33: male, 55 years
New case! Information will follow in due time. Thank you for your understanding.
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,
Room 1 - Main Arena 1
Case 93 – LEI 34
Center:
Leipzig, Dept of Angiology
Case 93 – LEI 34: female, 60 years
New case! Information will follow in due time. Thank you for your understanding.
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