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)
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