Leipzig, Dept. of Angiology

• Tuesday, January 24th: 8:14 - 8:49, Room 1 - Main Arena 1

  Case 01 – LEI 01: Severely calcifed SFA-occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 01 – LEI 01: male, 68 years

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 60 meters
  ABI right 0.65
  COPD, GOLD B
  Permanent atrial fibrillation
  
  RISK FACTORS
  Arterial hypertension, smoker
  
  ANGIO
  Angiography elsewhere: total occlusion right SFA, calcified
  
  PROCEDURAL STEPS
  1. Left 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 right SFA
  - 4.0/120 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 failure to pass from antegrade:
  3. Retrograde approach via the distal SFA right
  - 21 Gauge 9 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 Nitinol stent (ABBOTT)
  - Stenting of the SFA-ostium: 7.0/40 mm Absolute stent (ABBOTT)
  

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• Tuesday, January 24th: 9:45 - 10:10, Room 2 - Main Arena 2

  Case 12 – Acute on chronic ischemia right leg

  Center:

  Leipzig, Dept. of Angiology

  Case 12 – LEI 05: male, 78 years (M-M)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Very short walking capacity right since few weeks
  Persistent atrial fibrillation
  Diabetes mellitus, type 2
  Nicotin abuse
  
  IMPORTANT ITEMS
  Angiography: Thrombotic/embolic occlusion right popliteal artery
  Chronic BTK-disease
  
  1. Right antegrade femoral access
  - 6F 55 cm Check-Flo Performer, Raab Modification (COOK)
  
  2. GW-passage and thrombectomy
  - Rotarex 6F (STRAUB MEDICAL)
  
  3. PTA and stenting on indication
  - Lutonix DCB (C.R. BARD)
  

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• Tuesday, January 24th: 13:30 - 15:00, Room 3 - Technical Forum

  Case 24 – Flush-occlusion right SFA after CEA right groin

  Center:

  Leipzig, Dept. of Angiology

  Case 24 – LEI 06: male, 57 years (H-F)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 50 meters
  CEA and patch-plastic 9/2014 right groin
  Stenting right SFA 2009
  PTA left SFA (Lithoplasty)
  CAD, MI and PTCA 2009
  Art. hypertension, former smoker
  
  ANGIO
  Flush-occlusion right SFA, stent within the SFA-occlusion right
  ABI right 0,57
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F-catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 7F Balkin Up&Over Sheath, 40 cm (COOK)
  
  2. Right SFA CTO-puncture (stent-puncture)
  - 18 Gauge 7 cm needle
  - 0.035" stiff angled Glidewire, 190 cm (TERUMO)
  - 6F – 10 cm Radiofocus-Introducer (TERUMO)
  
  3. Passage of the CTO
  Retrograde passage into the right CFA:
  - Pioneer-Plus Reentry-system (VOLCANO)
  - 0.014" Floppy ES Guidewire, 300cm (ABBOTT)
  - Snaring if the retrograde guidewire into the the cross-over-sheath
  
  Final guidewire-passage into the popliteal artery from antegrade:
  - 0.035" siff angled Glidewire 260 cm (TERUMO)
  
  4. PTA/stenting
  - Armada 35 5.0/100 mm balloon (ABBOTT)
  - Supera Interwoven Nitinol stent (ABBOTT)
  - SFA-ostium: Viabahn 7.0/50 mm (GORE) or Absolute stent (ABBOTT)
  

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• Tuesday, January 24th: 13:48 - 14:08, Room 1 - Main Arena 1

  Case 05 – Chronic total occlusion right SFA, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 05 – LEI 02: male, 64 years (P-S)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  Critical limb ischemia right, ulceration dig 4, Rutherford class 5
  Severe claudication right calf, walking capacity 50 meters, PTA/stenting left SFA 12/2015 for CLI left
  Diabetes mellitus, type 2, art. hypertension, former smoker
  ABI right: 0.2
  
  ANGIO
  Angiography (during PTA left):
  long CTO right SFA, minimal calcification
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 6F Balkin Up&Over Sheath, 40 cm (COOK)
  
  2. Passage of the occlusion left SFA
  - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035" TrailBlazer supportcatheter, 135 cm (MEDTRONIC)
  - Exchange to 0.018" SteelCore guidewire (ABBOTT)
  
  3. PTA
  - 5.0/120mm Pacific Plus PTA catheter, 130 cm (MEDTRONIC)
  - 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)
  
  4. Stenting on indication
  - In case of dissections: provisional placement of nitinol Tacks (INTACT VASCULAR)
  - In case of residual stenosis: Complete-Stent (MEDTRONIC)
  

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• Tuesday, January 24th: 14:26 - 14:46, Room 5 - Global Expert Exchange

  Case 31 – Calcified SFA-CTO right

  Center:

  Leipzig, Dept. of Angiology

  Case 31 – LEI 08: male, 64 years (F-B)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  Severe claudication right calf, walking capacity 100 meters
  PTA/stent left SFA 12/2015
  Diabetes mellitus, type 2, insulin-dependent
  Art. hypertension, former smoker
  
  ANGIO
  Angiography right SFA during PTA/stent left SFA:
  short, moderately calcified SFA-CTO right
  ABI right 0.61
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)
  
  2. Guidewire passage and PTA of the occlusion right SFA
  - 4.0/40 mm Pacific Plus balloon (MEDTRONIC)
  - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
  
  3. Stenting
  - NitiDES drug-eluting stent (ALVIMEDICA)
  

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• Tuesday, January 24th: 15:27 - 16:01, Room 1 - Main Arena 1

  Case 07 – Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 07 – LEI 03: female, 72 years

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Restpain left foot, Rutherford class 4
  Severe claudication, walking capacity 50 m
  ABI left 0.42
  CAD, PTCA 10/16
  TAVI 03/16
  
  RISK FACTORS
  Arterial hypertension
  
  PROCEDURAL STEPS
  - Right croin retrograde and cross-over approach
  - Passage and predilatation of the SFA-occlusion left
  - PTA/Stenting SFA left (ELUVIA)
  

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• Tuesday, January 24th: 16:30 - 18:00, Room 3 - Technical Forum

  Case 29 – Progressive, asymptomatic internal carotid stenosis right

  Center:

  Leipzig, Dept. of Angiology

  Case 29 – LEI 07: male, 71 years (M-Z)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Progressive ICA-stenosis right, peak systolic velocity 5.8 m/sec.
  CAD with CABG 2000
  PTCA stent 12/2016
  Recurrent supraventricular arrythmia, left atrial ablations 2014/2015
  CEA left ICA 2010
  Former smoker
  
  ANGIOGRAPHY
  Angiography during PTCA 12/2016, short, high-grade stenosis right ICA
  
  PROCEDURAL STEPS
  1. Right groin access
  - 9F 25 cm Radiofocus Introducer (TERUMO)
  - 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" soft angled Glidewire, 190 cm (TERUMO)
  - 0.035" SupraCore 190 cm guidewire (ABBOTT)
  
  2. Cerebral protection
  - MoMa proximal protection system (MEDTRONIC)
  
  3. Predilatation and stenting
  - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
  - 8/30 mm CGuard stent (InspireMD)
  
  4. Postdilatation
  - Paladin® Carotid Post-Dilatation balloon with integrated embolic protection (CONTEGO MEDICAL)
  
  5. Aspiration and declamping with the Paladin-filter in place
  
  6. Retrieval of the Paladin-system
  

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• Tuesday, January 24th: 16:44 - 17:04, Room 1 - Main Arena 1

  Case 08 – Severely calcified SFA-CTO right

  Center:

  Leipzig, Dept. of Angiology

  Case 08 – LEI 04: male, 69 years (R-P)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 150 meters
  Thromendartherectomy both groins 2014
  Stenting/PTA left SFA 11/2016
  CAD, PTCA 2000, CABG 2000
  Art. hypertension, former smoker
  
  ANGIOGRAPHY
  Severely calcified distal SFA-CTO right
  ABI right 0.51
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 7F 55cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)
  
  2. Passage of the distal SFA-CTO
  - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
  - 0.018" QuickCross support catheter 135 cm (SPECTRANETICS)
  
  3. Angioplasty
  - 6.0/60 mm Lithoplasty balloon (SHOCKWAVE MEDICAL)
  
  4. Stenting only on indication
  - Supera Interwoven Nitinol stent (ABBOTT)
  

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• Wednesday, January 25th: 8:00 - 8:10, Room 1 - Main Arena 1

  Case 32 – ATA recanalization and dexamethason-injection with a Bullfrog-Device

  Center:

  Leipzig, Dept. of Angiology

  Case 32 – LEI 09: female, 75 years (R-K)

  Operators:

  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  Critical limb ischemia left forefoot, ulceration dig I left
  PTA of a tibioperoneal trunk stenosis left 12/2015, only minor healing tendency
  Diabetes mellitus, type 2
  
  ANGIOGRAPHY
  Total occlusion of the anterior tibial artery
  
  PROCEDURAL STEPS
  1. Left antegrade access
  - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)
  
  2. Guidewire passage of the ATA-CTO
  - 0.014" Command ES guidewire, 300 cm (ABBOTT)
  - 3.5/120 mm Armada 14 balloon (ABBOTT)
  
  3. Arterial wall-injection of dexamethason
  - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
  
  4. In case of dissections: placement of nitinol-Tacks (INTACT VASCULAR)
  

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• Wednesday, January 25th: 8:00 - 8:34, Room 5 - Global Expert Exchange

  Case 53 – Total occlusion of the common iliac artery

  Center:

  Leipzig, Dept. of Angiology

  Case 53 – LEI 18: male, 62 years

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - Severe claudication right leg, Rutherford class 3
  - Walking capacity 20 meters
  - Diabetes mellitus, type 2
  - ABI right 0.37
  
  RISK FACTORS
  - Arterial hypertension
  - Diabetes mellitus
  - Smoker
  
  PROCEDURAL STEPS
  1. Left brachial and bilateral femoral approach
  2. Guidewire passage
  3. Kissing stent (LIFESTREAM covered stant)

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• Wednesday, January 25th: 8:49 - 9:05, Room 1 - Main Arena 1

  Case 32 – ATA recanalization and dexamethason-injection with a Bullfrog-Device

  Center:

  Leipzig, Dept. of Angiology

  Case 32 – LEI 09: female, 75 years (R-K)

  Operators:

  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  Critical limb ischemia left forefoot, ulceration dig I left
  PTA of a tibioperoneal trunk stenosis left 12/2015, only minor healing tendency
  Diabetes mellitus, type 2
  
  ANGIOGRAPHY
  Total occlusion of the anterior tibial artery
  
  PROCEDURAL STEPS
  1. Left antegrade access
  - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)
  
  2. Guidewire passage of the ATA-CTO
  - 0.014" Command ES guidewire, 300 cm (ABBOTT)
  - 3.5/120 mm Armada 14 balloon (ABBOTT)
  
  3. Arterial wall-injection of dexamethason
  - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
  
  4. In case of dissections: placement of nitinol-Tacks (INTACT VASCULAR)
  

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• Wednesday, January 25th: 9:58 - 10:23, Room 2 - Main Arena 2

  Case 42 – Progressive abdominal aneurysm

  Center:

  Leipzig, Dept. of Angiology

  Case 42 – LEI 14: male, 65 years

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  - Progressive aneurysm of the infrarenal aortic aneurysm, now max. diameter 58 mm
  - Small caliber external iliac arteries bilateral
  - Coiling of lumbar arteries and AMI 01/16
  - Chronical pancreatitis with pseudocysts
  
  RISK FACTORS
  - Arterial hypertension
  - Current smokera
  
  PROCEDURAL STEPS
  1. Bifemoral percutaneous approch in local anaesthesia and preclosing with 2 Proglide closure devices
  2. Guidewire positioning
  3. Implantation of a bifurcational stentgraft (OVATION STENTGRAFT)
  4. Postdilatation

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• Wednesday, January 25th: 10:33 - 10:50, Room 1 - Main Arena 1

  Case 33 – SFA occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 33 – LEI 10: male, 70 years

  Operators:

  • Sven Bräunlich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 150 meters
  ABI right 0.7
  
  RISK FACTORS
  - Arterial hypertension
  - Current smoker
  - Hyperlipidemia
  
  PROCEDURAL STEPS
  - Left groin retrograde and cross-over approach
  - Guidewire passage
  - Predilation with low profile ballon
  - PTA with drug coated ballon
• Wednesday, January 25th: 11:16 - 11:37, Room 5 - Global Expert Exchange

  Case 54 – SFA-occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 54 – LEI 19: female, 71 years (E-D)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right leg, walking capacity 100 meters
  PTA/stenting left SFA 12/2016
  PTA iliac left 12/2015
  Art. hypertension, current smoker
  
  ANGIOGRAPHY
  During PTA left SFA 12/2016: Long SFA-occlusion right, moderately calcified
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 6F Balkin Up&Over Sheath, 40 cm (COOK)
  
  2. Passage of the occlusion right SFA
  - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035" TrailBlazer support catheter, 135 cm (MEDTRONIC)
  - Exchange to 0.018" SteelCore guidewire (ABBOTT)
  
  3. PTA and stenting on indication
  - Luminor DCB 5.0/120 mm (iVASCULAR)
  - VascuFlex Multi-LOC (B. BRAUN)
  

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• Wednesday, January 25th: 11:35 - 11:55, Room 1 - Main Arena 1

  Case 35 – In-Stent reocclusion right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 35 – LEI 11: male, 71 years (D-K)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 150 meters
  PTA with DCB and spotstenting right SFA 12/2014
  PTA and stenting left SFA 11/2014
  CAD with PTCA 2003
  Art. hypertension, current smoker
  
  ANGIOGRAPHY
  SFA-reocclusion right, Nitinol stent within the occlusion
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - 0.035" SupraCore guidewire 190 cm (ABBOTT)
  - 7F–40 cm Balkin Up&Over Sheath (COOK)
  
  2. Guidewire passage
  GW-passage from antegrade:
  - 0.035" stiff angled Glidewire, 260 cm (TERUMO)
  - 4.0/120 mm Admiral balloon (MEDTRONIC)
  in case of failure to pass from antegrade:
  - puncture of the occluded SFA-stent:
  - same wire and 0.035" TrailBlazer support catheter, 90 cm (MEDTRONIC)
  - snaring of the guidewire into the cross-over sheath and finalization guidewire passage of the occlusion from antegrade
  
  3. PTA and stenting
  - 6.0/80 mm Admiral balloon (MEDTRONIC)
  - 6.0/250 mm Viabahn (GORE)
  - 6.0/100 mm Tigris stent (GORE)
  

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• Wednesday, January 25th: 13:58 - 14:18, Room 1 - Main Arena 1

  Case 36 – Total occlusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 36 – LEI 12: female, 60 years

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Severe claudication left calf, walking capacity 10 meters, rest pain
  ABI left 0.31
  PTA of the right EIA 11/16
  Stroke 1995 with residual incomplere hemiparesis left
  
  RISK FACTORS
  - Arterial hypertension
  - Hyperlipidemia
  
  ANGIOGRAPHY
  Long SFA and P1-segment occlusion left, moderately calcified
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  2. Guidewire passage
  3. Angioplasty (VASCUTAK)
  4. Stenting on indication
  - In case of dissections: provisional placement of nitinol Tackts (INTACT)
  - In case of residual stenosis after DCB: LifeStent

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• Wednesday, January 25th: 16:15 - 16:30, Room 5 - Global Expert Exchange

  Case 55 – Treatment of the left GSV with ELVeS Radial slim™

  Center:

  Leipzig, Dept. of Angiology

  Case 55 – LEI 20: male, 26 years old, (N-S)

  Operators:

  • Matthias Ulrich,
  • Christina Julia Harzendorf

  CLINICAL DATA
  Chronic venous disease C2EpAs2Pr (CEAP)
  Symptoms: feeling of heaviness and dysesthesia in the left leg
  
  DUPLEX
  Complete insufficiency of the left great saphenous vein Hach 2
  Side branch varicose veins below the left knee
  Competent deep veins
  No Thrombosis
  
  PROCEDURAL STEPS
  1. Puncture of the distal GSV with 16G Introducer
  Puncture of sidebranches with 18G Introducer
  Introducing of Laser Fiber (ELVeS Radial slim™ BIOLITEC)
  Ultrasound control of the tip position at GSV junction
  
  2. Application of the tumescent anesthesia around the left great saphenous vein
  
  3. Treatment of the left GSV with 10 W/70Joul/cm
  
  4. Foam sklerotherapy of sidebranches with Aethoxysklerol
  
  5. Applying compression bandage left leg
  
  6. Injection of a LMWH for thrombosis prophylaxis
  

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• Wednesday, January 25th: 16:42 - 17:07, Room 3 - Technical Forum

  Case 51 – Restenosis right SFA after DCB-treatment

  Center:

  Leipzig, Dept. of Angiology

  Case 51 – LEI 17: female, 78 years

  Operators:

  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  - CLI with ulcer Dig 2 right and restpain
  - PTA with DCBs 3/2016 right SFA
  - PTA left SFA 2/2015
  - CAD, PTCA 2012
  
  RISK FACTORS
  - Diabetes mellitus, type 2
  - Arterial hypertension
  - Chronic renal impairment (GFR 56 ml/min)
  
  PROCEDURAL STEPS
  1. Left femoral retrograde and cross-over approach
  2. Guidewire passage of the SFA-restenosis and filter positioning (WIRION protection system)
  3. Atherectomy (JETSTREAM) and PTA with DCBs

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• Wednesday, January 25th: 16:54 - 17:14, Room 1 - Main Arena 1

  Case 39 – Total chronic occlusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 39 – LEI 13: female, 57 years (B-B)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication left SFA, walking capacity 100 meters
  PTA with stenting right SFA 1/2016
  PTA with DCBs for restenosis right SFA 12/2016
  PTA/stenting iliac arteries bilateral 2009
  Art. hypertension, smoker
  
  ANGIOGRAPHY
  During PTA right SFA: total occlusion left SFA
  ABI left 0.67
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 6F Balkin Up&Over Sheath, 40 cm (COOK)
  
  2. Passage of the occlusion left SFA
  - 0.035" Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035" CXC support catheter, 135 cm (COOK)
  - Exchange to 0.018" SteelCore guidewire (ABBOTT)
  
  3. PTA and stenting on indication
  - Luminor DCB 5.0/120 mm (iVASCULAR)
  - VascuFlex Multi-LOC (B. BRAUN)
  

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• Thursday, January 26th: 8:00 - 8:25, Room 1 - Main Arena 1

  Case 56 – Multilevel disease with CLI right

  Center:

  Leipzig, Dept. of Angiology

  Case 56 – LEI 21: male, 72 years (P-F)

  Operators:

  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  Critical limb ischemia right leg, restpain, Rutherford class 4
  PTA SFA and popliteal artery right and failed antegrade recanalization
  of a tibioperoneal trunk occlusion right elsewhere 12/2015
  Persistent atrial fibrillation
  
  ANGIOGRAPHY
  high-grade stenosis SFA and popliteal artery right,
  occlusion of the tibioperoneal trunk
  ABI 0,21
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - 0.035" SupraCore guidewire 190 cm (ABBOTT)
  - 6F-40 cm Balkin Up&Over Sheath (COOK)
  
  2. Guidewire-passage of the SFA/popliteal stenoses and PTA
  - predilatation with 0.014" NanoCross balloon (MEDTRONIC)
  
  After failed antegrade GW-passage:
  3. Retrograde passage via the peroneal artery
  - 21 Gauge 7 cm needle (COOK)
  - 0.018" V-18 Controll-GW 300 cm (BOSTON SCIENTIFIC)
  - 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)
  
  4. PTA with a drug-coated balloon
  - Chocolate Touch 6.0/120 mm (TRIREME MEDICAL)
  

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• Thursday, January 26th: 8:48 - 9:23, Room 2 - Main Arena 2

  Case 67 – TEVAR of a subacute Type B aortic dissection

  Center:

  Leipzig, Dept. of Angiology

  Case 67 – LEI 25: male, 64 years

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  Acute Type-B dissection 6 weeks ago, since then intermittend thoracic pain
  CT 4 weeks later: diameter-increase of the descending aorta of 5 mm
  Coiling of intercostal arteries to reduce the risk of spinal cord ischemia during TEVAR
  Art. hypertension, former smoker
  
  CT-SCAN
  2 focal dissections of the descending thoracic aorta,
  both have an entry without reentry,
  max. diameter of the aorta 46m
  
  PROCEDURAL STEPS
  1. Bilateral femoral access
  - Preloading of Proglide-Systems right (ABBOTT)
  
  2. Positioning of guidewire
  - LunderQuist 0.035" 260 cm (COOK)
  
  3. Implantation of 2 thoracic stentgrafts
  - Ankura thoracic graft (LIFETECH)
  - Stengraft from left subclavian artery to the celiac trunk
  

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• Thursday, January 26th: 9:30 - 11:30, Room 3 - Technical Forum

  Case 76 – CLI, popliteal artery occlusion

  Center:

  Leipzig, Dept. of Angiology

  Case 76 – LEI 26: male, 81 years (H-L)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Critical limb ischemia with gangrene dig 4/5 left, Rutherford 5
  Failed recanalization of a popliteal occlusion left
  CEA left femoral bifurcation 1/2017
  CAD, PTCA 2004
  Chronic heart failure, EF 40%
  Diabetes mellitus, type 2
  Chronic renal insufficiency with GFR 55 ml/min
  
  PRESENT STATE
  Angiography before CEA left groin
  ABI left 1.3, mediasclerosis
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
  - 6F 55 cm Check-Flow Performer, Raabe Modification (COOK)
  
  2. Guidewire passage
  second attempt from antegarde:
  - 0.018" Connect Flex guidewire, 300 cm (ABBOTT)
  - 0.018" Seeker support catheter, 135 cm (C.R. BARD)
  
  In case of failure of GW-passage from antegrade:
  3. Retrograde approach via the posterior tibial artery
  - 2.9F sheath (pedal puncture set) (COOK)
  - 0.014" CTO-Approach 25 gramm guidewire, 300 cm (COOK)
  - 0.018" CXI support catheter 90 cm (COOK)
  - Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
  
  4. PTA of the distal SFA/popliteal artery occlusion
  - AngioSculpt 4.0/100 mm Scoring balloon (SPECTRANETICS)
  - Stellarex 4.0 or 5.0/120 mm DCB (SPECTRANETICS)
  
  5. Stenting on indication
  - Supera Interwoven Nitinol stent (ABBOTT)
  

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• Thursday, January 26th: 10:18 - 10:55, Room 1 - Main Arena 1

  Case 59 – Diffuse subtotal stenosis distal SFA / popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 59 – LEI 22: male, 71 years

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Restpain and Severe claudication left leg, Rutherford class 4
  CAD, PTCA 2012, Chronic heart failure, EF 35%
  Diabetes mellitus, type 2
  Art. hypertension, former smoker
  
  DUPLEX
  Left distal SFA and popliteal artery with long subtotal stenosis,
  Moderately calcified, diffuse BTK-stenoses
  ABI left 0.32
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  - 6F 55 cm Check-Flo Performer, Raabe Modification (COOK)
  
  2. Guidewire passage
  - PT2 0.014” 300cm guidewire (BOSTON SCIENTIFIC)
  - QuickCross support catheter (SPECTRANETICS)
  
  3. PTA
  
  - AngioSculpt scoring balloon 5.0/100 mm (SPECTRANETICS)
  - Exchange to a 0.035" SupraCore guidewire (ABBOTT)
  - Stellarex DCB (SPECTRANETICS)
  
• Thursday, January 26th: 12:30 - 13:25, Room 1 - Main Arena 1

  Case 61b - Total ATA-occlusion, CLI left forefoot

  Center:

  Leipzig, Dept. of Angiology

  Case 61b - LEI22b: male, 72 years (W-J)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Critical limb ischemia left, gangrene Dig 2-4,
  CAD, PTCA 2012, chronic heart failure, NYHA II-III
  Art. Hypertension, diabetes mellitus type 2
  Previous PTA / stenting BTK for CLI 2010
  Failed recanalization-attempt 1/2017
  
  ANGIOGRAPHY
  from previous unsuccessful recanalization attempt
  
  PROCEDURAL STEPS
  1. Left antegrade access
  - 6Fr-55cm Check-Flo Sheath, Raabe Modification (COOK)
  
  2. Retrograde access via dorsalis pedis artery
  - 2.9 Pedal Introducer Access Set (COOK)
  
  3. Passage of the occlusion (retrograde)
  - CXI support-catheter, 0.018”, 90 cm (COOK)
  - Hydro-ST 0.014” Guidewire, 300cm (COOK)
  - Approach CTO 25gramm Guidewire, 300cm (COOK)
  
  4. PTA (BTK-bifurcation in kissing technique)
  - retrograde: Advance Micro Balloon 3.0/120mm, 90cm (COOK)
  - antegrade: Advance LP 3.0/40mm Balloon (COOK)

  View image
• Thursday, January 26th: 12:30 - 13:30, Room 1 - Main Arena 1

  Case 61c – Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 61c – LEI 22c: male, 66 years

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  - CLI, Ulceration D5 right
  - ABI right 0.4
  
  RISK FACTORS
  - Arterial hypertension
  - Former smoker
  - Diabetes mellitus, type 2
  
  PROCEDURAL STEPS
  1. Right groin antegrade access
  3. Recanalization of the anterior tibial artery
  3. Retrograde access 3F: dorsalis pedis artery
• Thursday, January 26th: 13:30 - 13:55, Room 1 - Main Arena 1

  Case 62 – Total occlusion of the common iliac artery left

  Center:

  Leipzig, Dept. of Angiology

  Case 62 – LEI 23: female, 70 years (C-L)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Severe claudication left, walking capacity 50-100 meters
  Art. hypertension, nicotine-abuse
  CAD, PTCA 11/2015
  
  ANGIOGRAPHY ELSEWHERE
  Common iliac artery occlusion left moderately calcified
  
  PROCEDURAL STEPS
  1. Left femoral access
  - 7F 25 cm Radiofocus Introducer (TERUMO)
  - 0.035" SupraCore guidewire 300 cm (ABBOTT)
  Left brachial approach:
  - 7F 90 cm Check-Flo Performer (COOK)
  
  2. Antegrade and retrograde guidewire passage
  brachial:
  - 5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
  from femoral:
  - 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
  - 0.035" stiff angled glidewire, 260 cm (TERUMO)
  
  3. Predilatation and stenting of the aorto-iliac bifurcation
  - Armada 35 6/40 mm ballon (ABBOTT)
  - LifeStream covered stent 7/58 bilateral in kissing-technique (C.R. BARD)
  

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• Thursday, January 26th: 13:30 - 17:00, Room 3 - Technical Forum

  Case 77 – Extremely calcified SFA CTO left, "pave and crack"-technique

  Center:

  Leipzig, Dept. of Angiology

  Case 77 – LEI 27: male, 69 years (S-F)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Restpain during night and severe calcification left, Rutherford 4
  Failed recanalization attempt left leg 11/2015
  PTA/stenting right SFA-CTO 12/2016
  Art. hypertension, diabetes mellitus, type 2
  Former smoker
  
  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)
  - 7F 55 Check-Flo Performer Sheath, Raabe Modification (COOK)
  
  2. Antegrade guidewire passage
  - 0.035" Stiff angled Glidewire, 260 cm (TERUMO)
  - CXC 0.035" support catheter, 135 cm (COOK)
  
  3. Retrograde guidewire passage:
  Access via the proximal anterior tibial artery:
  - 7 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4Fr-10cm Radiofocus Introducer (TERUMO)
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  
  4. PTA and stenting
  - 6.0/20mm Admiral Xtreme Balloon (MEDTRONIC)
  - 7.0/20 Conquest non-compliant high-pressure balloon (C.R. BARD)
  - In case of inability to open the balloons fully implantation of a Viabahn 7.0/100 mm (GORE)
  - Relining with Supera Interwoven Nitinol stent (ABBOTT)
  

  View image
• Thursday, January 26th: 17:22 - 17:46, Room 1 - Main Arena 1

  Case 66 – Popliteal occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 66 – LEI 24: female, 79 years (A-M)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Restpain left foot, Rutherford class 4
  PTA/stenting aortic bifurcation 11/2016
  D iabetes mellitus, type 2
  Art. Hypertension
  
  ANGIOGRAPHY
  During PTA of the aortic bifurcation:
  moderately calcified distal SFA/P1-occlusion left
  
  PROCEDURAL STEPS
  1. Antegrade approach left
  - 7F 55 cm Check-Flo Sheath, Raabe Modification (COOK)
  
  2. Guidewire passage
  - 5.0/40 mm Pacific Plus balloon, 90 cm (MEDTRONIC)
  - 0.018" Victory guidewire, 18 gramm, 30 cm (BOSTON SCIENTIFIC)
  
  3. PTA and stenting
  - 6.0/40mm Pacific Plus balloon, 90 cm (MEDTRONIC)
  - Supera Interwoven Nitinol stent (ABBOTT)
  

  View image
• Friday, January 27th: 9:05 - 9:45, Room 3 - Technical Forum

  Case 83 – Severely calcified SFA occlusion, "pave and crack"-technique

  Center:

  Leipzig, Dept. of Angiology

  Case 83 – LEI 29: female, 65 years (H-T)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Critical limb ischemia right, ulcerations dig 2 / 3, Rutherford 5
  Endstage renal failure, chronic hemodialysis until 1997
  Renal transplantation 1997
  Art. Hypertension
  
  PRESENT STATE
  CO2-angiography
  ABI right: mediasclerosis
  
  PROCEDURAL STEPS
  1. Left 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-55 cm Check-Flo Sheath, Raabe Configuration (COOK)
  
  2. Antegrade guidewire passage
  - 0.035" Stiff angled Glidewire, 260 cm (TERUMO)
  - CXC 0.035" support catheter, 135 cm (COOK)
  
  In case of guidewire passage failure:
  3. Retrograde approach via the distal SFA
  - 9 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTIN SCIENTIFIC)
  
  4. PTA and stenting
  - 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
  - 7.0/20 Conquest non-compliant high-pressure balloon (C.R. BARD)
  - In case of inability to open the balloons fully implantation of a Viabahn 7.0/100 mm (GORE)
  - Relining with Supera Interwoven Nitinol stent (ABBOTT)
  

  View image
• Friday, January 27th: 10:08 - 10:45, Room 1 - Main Arena 1

  Case 81 – FEVAR of a juxtarenal aneurysm

  Center:

  Leipzig, Dept. of Angiology

  Case 81 – LEI 28: male, 67 years

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  Incidental finding of a juxtarenal aortic aneurysm
  with progression to 61 mm max. diameter
  Accessory renal arteris on both sides
  Coiling of intercostal and lumbar arteries before FEVAR
  to reduce the risk of spinal ischemia
  Coiling of the accessory right renal artery
  CAD, PTCA 2012 heart failure, EF 40%
  Thyreoidectomy 1/2017
  
  IMPORTANT ITEMS
  CT-scans and Stentgraft-plan
  
  PROCEDURAL STEPS
  1. Bilateral femoral access and left axillar percutaneous access
  - Preloading of Proglide-Systems (ABBOTT) for all 3 access-sites
  
  2. Implantation of the CMD thoracoabdominal stentgraft (JOTEC)
  
  3. Implantation of E-ventus covered stents into the visveral arteries (JOTEC)
  
  4. Implantation of the bifurcated component with extension into the common iliac arteries

  View image
• Friday, January 27th: 11:21 - 12:30, Room 3 - Technical Forum

  Case 85 – Leipzig

  Center:

  Leipzig, Dept. of Angiology

  Case 85 – LEI 31: female, 60 years

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - Asymptomatic highgrade stenosis of the ostium of the common carotid artery left
  - Duplex-sonography because of recurrent dizziness: severe flow-disturbance of the proximal common carotid artery and slow flow
  
  RISK FACTORS
  - Arterial hypertension
  - Diabetes mellitus, type 2
  - Former smoker