Bern

• Tuesday, January 24th: 8:10 - 8:30, Room 2 - Main Arena 2

  Case 10 – Complex venous intervention of IVC and iliac vein

  Center:

  Bern

  Case 10 – BER 01: male, 37 years, (D-P)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Iliofemoral DVT right side in 2014
  Currently no anticoagulation therapy
  Moderate renal insufficiency (atrophic left kidney)
  
  RISK FACTORS
  Venous claudication while standing and walking (works as a chef de cuisine)
  Leg swelling right > left
  Hyperpigmentation right lower leg
  
  PROCEDURAL STEPS
  1. Venous access with ultrasound guidance in both femoral and right IJ veins
  - 10F sheath
  
  2. Wire crossage
  - TERUMO 0.035" stiff angled
  
  3. Phlebography, IVUS
  
  4. Predilation
  - Atlas Balloon 14–20 mm (C.R. BARD)
  
  5. Implantation of dedicated Iliac vein stents
  - IVC: Sinus XL 22–24 mm (OPTIMED)
  - Sinus-XL Flex 14 mm (OPTIMED)
  
  6. High-pressure postdilatation of stents
  - Atlas balloon 14–20 mm (C.R. BARD)
  
• Tuesday, January 24th: 11:00 - 11:15, Room 2 - Main Arena 2

  Case 14 – Iliofemoral venous intervention

  Center:

  Bern

  Case 14 – BER 02: female, 37 years (E-B)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Acute left-sided iliofemoral deep vein thrombosis in 04/2008
  
  RISK FACTORS
  Long distance flight, estrogen-containing contraceptives, no known thrombophilia (negative testing)
  Chronic venous insufficiency leg with Villalta Score: 9 points
  
  PROCEDURAL STEPS
  1. Venous access with ultrasound guidance in left popliteal vein
  - 10F sheath
  
  2. Reconstruction of iliac veins
  
  3. Predilation
  - Atlas balloon 12–14 mm (C.R. BARD)
  
  4. Implantation of dedicated iliac vein stents
  - MT stent: Sinus obliquus 14 mm (OPTIMED)
  - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)
  
  5. High-pressure post-dilation of stents
  - Atlas balloon 14 mm (C.R. BARD)
  
• Tuesday, January 24th: 12:00 - 12:15, Room 2 - Main Arena 2

  Case 14 – Iliofemoral venous intervention

  Center:

  Bern

  Case 14 – BER 02: female, 37 years (E-B)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Acute left-sided iliofemoral deep vein thrombosis in 04/2008
  
  RISK FACTORS
  Long distance flight, estrogen-containing contraceptives, no known thrombophilia (negative testing)
  Chronic venous insufficiency leg with Villalta Score: 9 points
  
  1. Venous access with ultrasound guidance in left popliteal vein
  - 10F sheath
  
  2. Reconstruction of iliac veins
  
  3. Predilation
  - Atlas balloon 12–14 mm (C.R. BARD)
  
  4. Implantation of dedicated iliac vein stents
  - MT stent: Sinus obliquus 14 mm (OPTIMED)
  - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)
  
  5. High-pressure post-dilation of stents
  - Atlas balloon 14 mm (C.R. BARD)
  
• Tuesday, January 24th: 13:30 - 15:00, Room 2 - Main Arena 2

  Case 16 – Removal of tilted IVC filter (aortic penetration) and reconstruction of the IVC and iliac veins

  Center:

  Bern

  Case 16 – BER 03: female, 48 years (T-B)

  Operators:

  • Nils Kucher,
  • T. Gregory Walker

  CLINICAL DATA
  Protein S deficiency and factor V Leiden mutation
  Ongoing anticoagulation therapy
  Recurrent ilio-femoral thrombosis despite medical therapy
  Implantation of permanent Simon™ filter (2004/USA)
  
  RISK FACTORS
  Chronic venous insufficiency both legs with:
  venous claudication, varicose veins, hyperpigmentation, leg swelling
  Villalta-score: 6 points
  
  PROCEDURAL STEPS
  1. Venous access
  - Venous access with ultrasound guidance in both femoral veins (10F sheath)
  - Venous access IJ (18F sheath)
  
  2. Filter extraction with endobronchial forceps from IJ access
  - Forceps Alligator 2.5 mm x 55 cm hard foreign body double action (KARL STORZ)
  
  3. Reconstruction of IVC and iliac veins
  
  4. Predilatation
  - Atlas balloon 14–20 mm (C.R. BARD)
  
  5. Implantation of dedicated IVC and Iliac vein stents
  - IVC: Sinus XL 22 mm (OPTIMED)
  - Iliac veins: Sinus-XL Flex 14 mm (OPTIMED)
  
  6. High-pressure postdilatation of stents
  - Atlas balloon 14–20 mm (C.R. BARD)
  

  View image
• Tuesday, January 24th: 16:30 - 18:00, Room 2 - Main Arena 2

  Case 20 – Thoracic inlet syndrome with instent thrombosis

  Center:

  Bern

  Case 20 – BER 04: female, 46 years (D-C)

  Operators:

  • Nils Kucher,
  • Torsten Fuß

  CLINICAL DATA
  Primary (spontaneous) upper extremity deep vein thrombosis 06/15
  (Paget-Schroetter syndrome) --> lysis and anticoagulant therapy
  Known bony exostosis of the first rib and the clavicula --> resection the the first rib and stenting of the subclavian vein in 12/15
  Recurrent swelling of the right arm --> thrombus aspiration in a tertiary care hospital (11/16)
  
  PRESENT STATE
  Swelling of the right arm since several weeks
  
  PROCEDURAL STEPS
  1. Venous access with ultrasound guidance in right femoral vein
  - 10F sheath
  
  2. Wire crossage
  - Terumo 0.035" stiff angled
  
  3. Phlebography
  
  4. Predilatation
  - Dorado balloon 10 mm (C.R. BARD)
  
  5. Implantation of dedicated vein stent (stent-in-stent)
  
  6. High pressure postdilatation of stent
  - Atlas balloon 12 mm (C.R. BARD)
  

  View image