Conference day 4

• 9:00 - 9:40, Room 1 - Main Arena 1

  Case 80 – 4-fenestrated endovascular repair of a 7 cm post-dissection TAAA

  Center:

  Münster

  Case 80 – MUN 14: male, 76 years, (W-H)

  Operators:

  • Martin Austermann,
  • Theodosios Bisdas,
  • Stefan Stahlhoff

  CLINICAL DATA
  Post-dissection thorakoabdominal aneurysm with a diameter of 7 cm
  Aszendens and aortic arch repair by frozen elefant trunk in the acute phase and endovascular extension to open the true lumen but still increase of the still perfused false lumen.
  
  RISK FACTORS
  Art. hypertension, CAD
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins (Prostar XL, ABBOTT) 14F (COOK) both groins
  Careful cannulation of the true lumen
  
  2. Angiogaphy to locate CT, SMA and RRA coming out of the true lumen and use of fusion technology
  
  3. Changing the left 14F sheath for a 22F sheath
  Placement of three 5F sheaths into the 22F sheath and pre-cannulation of the right renal artery and SMA by using fusion technology.
  
  4. Placement of the 4-fenestrated Zenith-endograft (tube) (COOK) via the right groin
  Cannulation of the SMA and RRA through the fenestrations
  
  5. Advancement of 7 and 8F sheaths into the target vessels
  Complete release of the endograft and stenting of the fenestrations for the SMA and RRA with covered stents (Advanta V12-MAQUET) and flairing
  Cannulation of the CT and stenting
  
  6. Cannulation of the fenestration for the LRA, perforation of dissectionmembrane and cannulation of the LRA coming out of the false lumen and implantation of another bridging stentgraft (Advanta V12)
  
  7. Placement of the distal bifurcated graft and the iliac extensions
  Closure of the accesses
  

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• 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)
  

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• 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

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• 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