LINC 2018 live case guide

Leipzig, Dept. of Angiology

• Tuesday, January 30th: 8:14 - 8:45, Room 1 - Main Arena 1

  Case 01 – Severely calcified CTO of the SFA left

  Center:

  Leipzig, Dept. of Angiology

  Case 01 – LEI 01: male, 56 years (G-Q)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Severe claudication left calf, walking capacity 50 meters
  - ABI left 0.62
  - Thrombendatherectomy right groin 7/2016
  - Minor stroke 2014
  
  RISK FACTORS
  - Art. hypertension, diabetes mellitus type 2, nicotine abuse
  
  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
  - Command 18 and Armada 18 balloon (ABBOTT) or
  - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO) and 4.0/120 mm Armada 35 balloon (ABBOTT)
  - 6.0/40 mm Armada 35 balloon (ABBOTT)
  - Conquest high pressure balloon on indicaiton (BARD)
  3. Stenting
  - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
  

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• Tuesday, January 30th: 8:59 - 9:30, Room 1 - Main Arena 1

  Case 02 – Re-occlusion left popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 02 – LEI 02: male, 78 years (G-A)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - Restpain left foot, Rutherford class 4, ABI left 0.40
  - PTA/ stenting left SFA 11/2016 and PTA left popliteal artery
  - PTA/ stent right SFA 11/2015
  
  RISK FACTORS
  - Chronic renal failure, GFR 65 ml/min
  - Nephrectomy left due to renal cell carcinoma 1994
  - Art. hypertension, former smoker
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 0.035" SupraCore guidewire 190 cm (ABBOTT)
  - 6F–55 cm sheath (COOK)
  2. Guidewire passage
  - Command 18, 300 cm guidewire (ABBOTT)
  - Armada 18 4.0/80 mm balloon (ABBOTT)
  In case of failure to pass the CT from antegrade:
  3. Retrograde approach via proximal anterior tibial artery
  - 7 cm 21 Gauge needle (COOK)
  - Command 18, 300 cm guidewire (ABBOTT)
  - 0.018" 3.0/40 mm Armada 18 balloon (ABBOTT)
  4. P TA and stenting
  - Armada 18 5.0/50 mm balloon (ABBOTT)
  - Supera Interwoven Nitinol Stent 5.0/80 mm (ABBOTT)
  

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• Tuesday, January 30th: 10:26 - 10:54, Room 2 - Main Arena 2

  Case 13 – TASC D iliac occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 13 – LEI 06: male, 59 years (A-W)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Severe claudication left, walking-capacity 120 meters
  - Rutherford class 3, ABI left 0.53
  
  RISK FACTORS
  Minor stroke 2009, art. hypertension, former smoker, diabetes mellitus type 2
  
  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
  - Ultraverse or Dorado balloon (BARD)
  - LifeStream covered stent 7/58 bilateral common iliac arteries in kissing-technique (BARD)
  - Covera Plus vascular covered stent for the external iliac artery (BARD)
  
  

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• Tuesday, January 30th: 11:21 - 11:41, Room 1 - Main Arena 1

  Case 03 – Chronic total occlusion right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 03 – LEI 03: male, 62 years (F-L)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  - Severe claudication right calf, walking capacity 10 meters
  - ABI right 0.35
  - Rutherford class 3
  
  RISK FACTORS
  - Congesitve heart failure, EF 40%
  - Chronic renal failure, GFR 50 ml/min
  - Art. hypertension, diabetes mellitus type 2, former smoker
  
  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
  - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
  - CXI support catheter, 0.035" 135 cm (COOK)
  In case of failure to pass the CT from antegrade:
  3. Retrograde approach via distal SFA
  - 9 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 0.018" CXI support catheter 90cm (COOK)
  4. Angioplasty
  - Advance balloon 5.0/100 mm (COOK)
  - Advance Enforcer 6.0/40 mm in case of focal residual stenosis (COOK)
  5. Stenting
  - Zilver PTX stent 6.0/140 mm (COOK)
  

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• Tuesday, January 30th: 13:30 - 14:15, Room 3 - Technical Forum

  Case 23 – Chronic total occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 23 – LEI 07: male, 72 years (U-R)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - Severe claudication left calf, walking capacity 150 meters
  - ABI left 0.67, Rutherford class 3
  - Failed recanalization-attempt left SFA 11/2017
  
  RISK FACTORS
  Art. hypertension, former smoker, diabetes mellitus type 2
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 0.035" SupraCore guidewire 190 cm (ABBOTT)
  - 6F–40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO) and
  - QuickCross support catheter, 0.035" 135 cm (SPECTRANETICS - PHILIPS)
  3. PTA and stenting on indication
  - SeQuent Please DCB 5.0/150 mm (B.BRAUN)
  - VascuFlex Multi-LOC (B.BRAUN)
  

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• Tuesday, January 30th: 14:15 - 15:00, Room 3 - Technical Forum

  Case 24 – Critical limb ischemia with restpain right, severely calcified right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 24 – LEI 08: male, 64 years (F-B)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Restpain right foot, livedo forefoot right, ABI 0.0, Rutherford class 4,
  - PTA/ stenting right iliac and left SFA 3/2016, CAD, PTCA 2/2015,
  - Hypertensive and ischemic cardiomyopathy, NYHA II
  
  RISK FACTORS
  Art. hypertension
  
  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)
  - Command 18 guidewire, 300 cm (ABBOTT)
  - 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 (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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• Tuesday, January 30th: 15:17 - 15:47, Room 1 - Main Arena 1

  Case 07 – CLI with multilevel disease right

  Center:

  Leipzig, Dept. of Angiology

  Case 07 – LEI 04: male, 65 years (J-G)

  Operators:

  • Matthias Ulrich,
  • Andrej Schmidt

  CLINICAL DATA
  - Critical limb ischemia with chronic ulceration right heel, Rutherford class 5
  - Restpain during night
  - ABI right 0.33
  - Failed recanalization-attempt of the posterior tibial artery elsewhere 1/2018
  - PTA of the popliteal artery right 7/2017
  
  RISK FACTORS
  - Diabetes mellitus type 2, CAD, PTCA 7/2017
  - Hypertensive cardiomyopathy, chronic renal failure, GFR 55ml/min
  - Art. hypertension
  
  PROCEDURAL STEPS
  1. Antegrade approach right groin
  - 6F-55 cm Flecor Shetah (COOK)
  2. Guidewire passage into the anterior tibial artery and placement
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4m Spider filter (MEDTRONIC)
  3. Atherectomy of the popliteal artery
  - JetStream atherectomy device (BOSTON SCIENTIFIC)
  4. Guidewire passage of the posterior tibial artery
  - 0.014" PT2 guidewire, 30 cm (BOSTON SCIENTIFIC)
  - 0.014" Coyote balloon (BOSTON SCIENTIFIC)
  5. PTA with DCBs of the popliteal and posterior tibial artery
  - Ranger DCB balloon 2.0 – 4.0 mm diameter (BOSTON SCIENTIFIC)
  
  

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• Tuesday, January 30th: 15:55 - 16:15, Room 3 - Technical Forum

  Case 26 – Chronic CTO left SFA, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 26 – LEI 09: female, 78 years (E-B)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - Critical limb ischemia, small interdigital ulceration
  - Rutherford class 5, ABI left 0.56
  - CAD, MI and PTCA 2007
  - Spinal surgery 2006
  
  RISK FACTORS
  Art. hypertension
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
  2. Recanalisation left SFA
  - 0.018" Advantage glidewire (TERUMO)
  - 0.018" CXI support catheter (COOK)
  Back-up material:
  - Connect 250T CTO-wire (ABBOTT)
  - Outback reentry system (CORDIS/ CARDINAL HEALTH)
  3. PTA
  - Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
  - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
  4. Stenting on indication, spot-stenting
  - Pulsar 18 stent (BIOTRONIK)
  

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

  Case 27 – Restenosis after TEA left internal carotid artery

  Center:

  Leipzig, Dept. of Angiology

  Case 27 – LEI 10: male, 70 years (KH-J)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Restenosis left ICA, TEA left 2013, asymptomatic
  - TEA right 3/2015, minor stroke 5/2006 right hemispheric
  - Congestive heartfailure, EF 45%, NYHA II
  - Chronic renal insufficiency, GFR 67ml/min
  - COPD
  
  RISK FACTORS
  Art. hypertension, nicotin abuse
  
  PROCEDURAL STEPS
  1. Right groin acces
  - 8F 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, Mono-Balloon (MEDTRONIC)
  3. Predilatation and stenting
  - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
  - 8/30 mm CGuard stent (INSPIRE-MD)
  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 30th: 17:30 - 17:50, Room 1 - Main Arena 1

  Case 09 – Severely calcified SFA-stenosis right

  Center:

  Leipzig, Dept. of Angiology

  Case 09 – LEI 05: male, 72 years (D-W)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Severe claudication right calf, walking capacity 40 meters
  - ABI right 0.47, Rutherford class 3
  - PTA/ stenting left SFA 12/2017
  - CAD, MI 8/2016, PTCA
  - Ischaemic cardiomyopathy, EF 47%
  - Pace-maker 5/2016
  
  RISK FACTORS
  - Art. hypertension, former smoker
  
  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 (ABBOOTT)
  - 7F 55 cm 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)
  - 6.0/80 mm iLuminor DCB (iVASCULAR)
  

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• Wednesday, January 31st: 8:00 - 8:15, Room 5 - Global Expert Exchange

  Case 53 – Calcified CTO of the right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 53 – LEI 18: male, 70 years (M-N)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 50 m right, ABI right 0.6, left 0.8
  - PTA/stent of the left SFA 01/2018, of the left CIA 11/2011
  - CEA left 2008, AMI 1998, CABG 02/2017
  
  RISK FACTORS
  Arterial hypertension, former smoker, hyperlipidemia, renal impairment
  
  ANGIOGRAPHY
  During PTA left: severely calcifed occlusion of the right SFA
  
  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 (ABBOOTT)
  - 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" CXC support catheter, 135 cm (COOK)
  In case of failure guidewire passage from antegrade:
  3. Retrograde approach via distal SFA
  - 7 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F-10 cm Radiofocus introducer (TERUMO)
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  4. PTA and treatment with DCB
  - 6.0/40 mm Advance Enforcer balloon (COOK)
  - Luminor DCB 6.0/120 mm (iVASCULAR)
  5. Stenting on indication
  - 7/150 mm iVolution Self-Expanding stent (iVASCULAR)
  

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• Wednesday, January 31st: 8:24 - 8:51, Room 1 - Main Arena 1

  Case 30 – Calcified BTK-CTOs left, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 30 – LEI 11: male, 71 yeras (T-K)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 5, D3-ulcerations and rest pain at night, walking capacity 10 m
  - PTA of the left popliteal artery 01/18
  
  RISK FACTORS
  - Diabetes mellitus type 2, arterial hypertension, former smoker
  - ABI right 0.7, left 0.5
  
  ANGIOGRAPHY
  During PTA 01/18: occlusion of ATP and ATA
  
  PROCEDURAL STEPS
  1. Left groin antegrade approach
  - 6F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
  2. Guidewire passage of the occlusion PTA with DCBs
  - 0.014" Command ES guidewire, 300 cm (ABBOTT)
  - 0.018" 90 cm Seeker support catheter (BARD)
  - 0.014" Ultraverse balloon (BARD)
  - Lutonix-BTK DCB (BARD)
  3. In case of dissections after DCB, provisional placement of nitinol "tacks"
  - Tack Endovascular System (Intact Vascular)
  

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• Wednesday, January 31st: 9:47 - 10:07, Room 1 - Main Arena 1

  Case 31 – Occlusion of the right popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 31 – LEI 12: male, 68 years (H-A)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 10–15 m, ABI right 0.55, left 0,8
  - PTA/stenting of left SFA and BTK 12/2107
  
  RISK FACTORS
  - Arterial hypertension, hyperlipidemia, diabetes mellitus type 2 with neuro- and angiopathy
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 6F–40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the occlusion
  - 0.035" Halfstiff Terumo 260 cm (TERUMO)
  - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
  3. PTA with scoring ballon
  - 4/40 mm AngioSculpt PTA scoring balloon (SPECTRANETICS-PHILIPS)
  4. PTA with DCBs
  - Stellarex 5.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
  

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• Wednesday, January 31st: 10:10 - 10:40, Room 2 - Main Arena 2

  Case 39 – Progressive infrarenal AAA

  Center:

  Leipzig, Dept. of Angiology

  Case 39 – LEI 16: male, 63 years (M-B)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  - Progressive asymptomatic AAA, diameter max. 59 mm
  - Coiling of 3 lumbar arteries L2-L3 1/2018
  - PAOD Rutherford 3, PTA left EIA 11/2007 and left SFA 2010
  
  RISK FACTORS
  Artrial hypertension, hyperlipidemia, nicotine abuse (30Y) and renal impairment
  
  PROCEDURAL STEPS
  1. Bifemoral percutaneous approach in local anaesthesia
  - Preclosing with 2 Proglide closure devices both sides (ABBOTT)
  2. Guidewire positioning
  - Lunderquist GW 180 cm (COOK)
  3. Implantation of a bifurcational stentgraft
  - Ovation Stentgraft (ENDOLOGIX)
  Cannulation of the contralateral limb:
  - 5F Amplatz Left diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0.035" soft angled short Radiofocus glidewire (TERUMO)
  4. PTA
  - Proximal seal: Reliant balloon (MEDTRONIC)
  - Graft-bifurcation: 12/40 mm Admiral balloon (MEDTRONIC)
  

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• Wednesday, January 31st: 10:21 - 10:41, Room 1 - Main Arena 1

  Case 32 – Instent reoclusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 32 – LEI 13: male, 69 years (C-D)

  Operators:

  • Matthias Ulrich,
  • Sven Bräunlich

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 150 m, ABI left 0,6
  - PTA/stent right EIA 12/2017, PTA/stent left SFA 08/2016
  - CAD, PTCA 06/2016
  
  RISK FACTORS
  Hyperlipidemia, nicotine abuse (20PY), arterial hypertension
  
  ANGIOGRAPHY
  During PTA right 12/2017: IRS left SFA
  
  PROCEDURAL STEPS
  1. Right groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 7F-40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the in-stent reocclusion
  - 0.035" Halfstiff Terumo 260 cm (TERUMO)
  - 0.035" QuickCross support catheter, 135 cm (SPECTRANETICS-PHILIPS)
  - Exchange to a 0.014" Floppy ES guidewire 300 cm (ABBOTT)
  3. Laser atherectomy
  - 7F Excimer laser with Turbo Elite 2.3 mm cathether (SPECTRANETICS-PHILIPS)
  4. PTA with DCBs
  - Stellarex 6.0/120 mm DCBs (SPECTRANETICS-PHILIPS)
  

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• Wednesday, January 31st: 10:55 - 11:30, Room 5 - Global Expert Exchange

  Case 54 – CTO of the distal SFA and Apop left

  Center:

  Leipzig, Dept. of Angiology

  Case 54 – LEI 19: male, 62 years (K-M)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - Severe claudication left calf, walking capacity 150 meters, ABI 0.5, Rutherford class 3
  - PTA / stenting right SFA 9/2017 elsewhere
  - CAD with MI and PTCA 2002, TIA 9/2017
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, nicotine abuse
  
  PROCEDURAL STEPS
  1. Right groin and cross-over access
  - IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
  - 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Guidewire passage
  - 5.0/100 mm Sterling OTW balloon, 90 cm (BOSTON SCIENTIFIC)
  - 0.018" Victory guidewire, 18 gramm, 300 cm (BOSTON SCIENTIFIC)
  3. Atherectomy for vessel-preparation
  - Diamondback 360 Peripheral Orbital Atherectomy system (CSI CARDIOVASCULAR SYSTEMS)
  - VANGUARD IEP peripheral balloon with integrated embolic protection (CONTeGO MEDICAL)
  4. Direct stenting
  - Eluvia drug-eluting stent (BOSTON SCIENTIFIC)
  

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• Wednesday, January 31st: 14:45 - 15:00, Room 1 - Main Arena 1

  Case 33 – Long SFA-occlusion left in a CLI-patient

  Center:

  Leipzig, Dept. of Angiology

  Case 33 – LEI 14: male, 63 years (AG-N)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  - Critical limb ischemia left, ulcerations dig 2/3 left, restpain
  - Previous femoro-popliteal bypass surgery left (in-situ) 2007 with bypass-thrombectomy 2017
  - Congestive heartfailure, NYHA III
  - Paroxysmal atrial fibrillation
  - COPD
  
  RISK FACTORS
  Art. hypertension, nicotine abuse
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 6F-40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - 0.035" stiff, angled glidewire, 260 cm (TERUMO)
  - 0.035" Seeker support catheter, 135 cm (BARD)
  3. Angioplasty
  - VascuTrak 5.0/300 mm balloon (BARD)
  - Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)
  4. Stenting on indication
  - LifeStent (BARD)
  

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• Wednesday, January 31st: 16:42 - 17:09, Room 3 - Technical Forum

  Case 51 – Aorto-iliac occlusion, Leriche-syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 51 – LEI 17: male, 64 years (K-F)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt,
  • Yvonne Bausback

  CLINICAL DATA
  - Critical limb ischemia, ulcerations left foot
  - Congestive heart-failure, EF 35%, NYHA II
  
  RISK FACTORS
  Diabetes mellitus type 2, art. hypertension, current smoker
  
  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 from below
  4. PTA via the groin access bilateral
  - SupraCore 300 cm 0,035" guidewire (ABBOTT)
  - Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
  5. Implantation of covered stents
  - Viabahn 8.0/150 mm in kissing-technique (GORE)
  - Reinforcement with balloon-expandable stents at the aortic bifurcation:
  - Palmaz Genesis 8.0/79 mm balloon-expandable stents in kissing-technique (CORDIS)
  - Bigraft covered stent for the medial sacral artery (BENTLEY)
  
  

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• Wednesday, January 31st: 17:25 - 17:50, Room 1 - Main Arena 1

  Case 37 – Calcified stenosis left CFA

  Center:

  Leipzig, Dept. of Angiology

  Case 37 – LEI 15: male, 65 years (W-W)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  - Severe claudication left leg, walking capacity 200 meters
  - ABI left 0.53, Rutherford class 3, CAD
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, current smoker
  
  PROCEDURAL STEPS
  1. Right groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
  - 0,035" SupraCore guidewire 30 cm (ABBOTT)
  - 7F-40 cm Balkin Up&Over sheath (COOK)
  2. PTA of the CFA left
  - Admiral balloon 7.0; 8.0/20 mm (MEDTRONIC)
  3. Stenting
  - 7.0/40 or 8.0/40 mm Supera Interwoven Nitinol stent (ABBOTT)
  
  

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• Thursday, February 1st: 8:00 - 8:20, Room 1 - Main Arena 1

  Case 55 – Severely calcified occlusion of right popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 55 – LEI 20: male, 65 years (R-B)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - PAD Rutherford 4 right, rest pain at night, walking capacity 10 m
  - Femoro-popliteal bypass right 2008 and recurrent reocclusion 2017 (11/17)
  - Failed recanalization attempt of the right popliteal 01/18
  
  RISK FACTORS
  Former smoker, arterial hypertension, renal impairement, atrial fibrillation
  
  ANGIOGRAPHY
  Occluded femoro-popliteal bypass right and severly calcified popliteal occlusion right
  
  PROCEDURAL STEPS
  1. Antegrade access right groin
  - 6F 90 cm Check-Flow Performer (COOK MEDICAL)
  2. Antegrade guidewire passage
  in casse of failure retrograde approach via the anterior 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)
  3. PTA of the popliteal artery occlusion
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  4. Stenting
  - 5.0/100 mm Supera Interwoven Self-expanding Nitinol stent (ABBOTT)
  
  

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• Thursday, February 1st: 8:00 - 9:30, Room 3 - Technical Forum

  Case 75 – CTO of the right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 75 – LEI 29: male, 59 years (S-K)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 10 m
  - CAD; CABG MV-Reconstruction, 2010
  - NSTEMI 11/2107 with CPR, PTCA 11/17, ICM (LV-EF 40%)
  
  RISK FACTORS
  Diabetes mellitus type 2, arterial hypertension, hyperlipidemia
  
  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 (ABBOOTT)
  - 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" CXC support catheter, 135 cm (COOK)
  - Exchange to 0.018" SteelCore guidewire (ABBOTT)
  3. PTA and stenting on indication
  - Legflow drug-coated balloon (CARDIONOVUM)
  - VascuFlex Multi-LOC (B.BRAUN)
  

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• Thursday, February 1st: 9:02 - 9:29, Room 2 - Main Arena 2

  Case 68 – Progressive descending thoracic aortic aneurysm

  Center:

  Leipzig, Dept. of Angiology

  Case 68 – LEI 27: male, 72 years (L-J)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan,
  • Chang Shu

  CLINICAL DATA
  - Progressive thoracic AAA (max. diameter 67mm)
  - Coiling of intercostal arteries to reduce the risk of spinal cord ischemia during TEVAR in two sessions (3 arteries)
  - CAD
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia
  
  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 (LIFE TECH)
  - Stengraft from left subclavian artery to the celiac trunk
  

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• Thursday, February 1st: 9:40 - 10:00, Room 1 - Main Arena 1

  Case 57 – Reocclusion of right SFA, in-stent-reocclusion

  Center:

  Leipzig, Dept. of Angiology

  Case 57 – LEI 21: male, 62 years (J-W)

  Operators:

  • Matthias Ulrich,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 3, painfree walking distance 50 m
  - Stent-PTA right SFA 03/2017
  - ABI right: 0,5, left: 1,0
  
  RISK FACTORS
  Smoker, arterial hypertension, diabetes mellitus type 2
  
  DUPLEX
  ISR-occlusion of the right SFA
  
  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 (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Guidewire passage and thrombectomy
  - Rotarex 6F (STRAUB MEDICAL)
  3. Filter placement
  - 6 mm Spiderfilter (MEDTRONIC) in PIII segment
  4. PTA with DCBs
  - Ranger DCB 5.0/120 mm (BOSTON SCIENTIFIC)
  
  

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• Thursday, February 1st: 10:07 - 10:27, Room 1 - Main Arena 1

  Case 58 – Thrombotic occlusion of the right CIA

  Center:

  Leipzig, Dept. of Angiology

  Case 58 – LEI 22: male, 69 years (G-W)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  - POAD Rutherford 3, walking capacity 200 m
  - sudden deterioration of symptoms
  - ABI right 0.6
  
  RISK FACTORS
  Arterial hypertension, nicotine abuse (30PY)
  
  ANGIOGRAPHY
  Thrombotic iliac occlusion right
  
  PROCEDURAL STEPS
  1. Right femoral approach
  - 7F 25 cm sheath (TERUMO)
  2. Guidewire passage and thrombectomy
  - Rotarex 8F (STRAUB MEDICAL)
  3. Stenting
  - LifeStream covered stent for the common iliac artery (BARD)
  - Covera Plus self-expanding covered stent for the external iliac artery (BARD)
  
  

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• Thursday, February 1st: 11:00 - 12:30, Room 3 - Technical Forum

  Case 78 – Calcified CTO of the left SFA and popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 78 – LEI 30: male, 54 years (S-K)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3 left, painfree walking distance 150 m
  - PTA/ stent of the right SFA 11/2017
  - Pseudoxanthoma elasticum (vascular, ocular and cerebral affection)
  - ABI right: 0.8; left: 0.3
  - PTA/ stenting right SFA 11/2017
  
  RISK FACTORS
  Arterial hypertension, CAD, hyperlipidemia
  
  ANGIOGRAPHY
  During PTA right 11/17: occlusion of the left SFA and popliteal artery
  
  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 peroneal artery:
  - 7 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F-10 cm Radiofocus Introducer (TERUMO)
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  4. PTA and stenting
  - 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
  - 7.0/20 Conquest non-compliant high pressure balloon (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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• Thursday, February 1st: 11:00 - 12:30, Room 3 - Technical Forum

  Case 78b – Calcified CTO of the left SFA and popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 78b – LEI 30b: male, 54 years (S-K)

  CLINICAL DATA
  - PAOD Rutherford 3 left, painfree walking distance 150 m
  - PTA/ stent of the right SFA 11/2017
  - Pseudoxanthoma elasticum (vascular, ocular and cerebral affection)
  - ABI right: 0.8; left: 0.3
  - PTA/ stenting right SFA 11/2017
  
  RISK FACTORS
  Arterial hypertension, CAD, hyperlipidemia
  
  ANGIOGRAPHY
  During PTA right 11/17: occlusion of the left SFA and popliteal artery
  
  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 peroneal artery:
  - 7 cm 21 Gauge needle (COOK)
  - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F-10 cm Radiofocus Introducer (TERUMO)
  - Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC)
  4. PTA and stenting
  - 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
  - 7.0/20 Conquest non-compliant high pressure balloon (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)
  
  
  
• Thursday, February 1st: 11:17 - 11:43, Room 1 - Main Arena 1

  Case 59 – Long SFA-occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 59 – LEI 23: female, 65 years (N-G)

  Operators:

  • Sven Bräunlich,
  • Manuela Matschuck

  CLINICAL DATA
  - POAD Rutherford 3, walking capacity 200 m, ABI right 0.43
  - Asymptomatic high grade stenosis of brachiocephalic trunc
  
  RISK FACTORS
  Smoker (40PY), arterial hypertension, hyperlipidemia
  
  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 (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Passage of the occlusion right SFA
  - 0.018" Advantage guidewire (TERUMO)
  - 0.018" CXI support catheter (COOK)
  3. Vessel preparation right SFA
  - Sterling balloon (BOSTON SCIENTIFIC)
  4. Primary stenting
  - Eluvia DES (BOSTON SCIENTIFIC)
  5. Postdilatation left SFA
  - Mustang balloon (BOSTON SCIENTIFIC)
  

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• Thursday, February 1st: 12:30 - 13:25, Room 1 - Main Arena 1

  Case 61 – Left popliteal occlusion and BTK-CTO left, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 61 – LEI 24: female, 75 years (P-H)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  - PAOD Rutherford 5 left, forefeet ulcerations and infections, restpain at night, mediasclerosis
  - Failed recanalization attempt 01/18 elsewhere
  - CAD, AMI, PTCA 2012
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia
  
  ANGIOGRAPHY
  Popliteal and BTK occlusions left
  
  PROCEDURAL STEPS
  1. Left groin antegrade approach
  - 6F 55 cm Flexor Check-Flo Sheath, Raabe Modification (COOK)
  2. Guidewire passage, second attempt from antegarde
  - 0.014" CTO Approach 25 gramm 300 cm (COOK)
  - 0.018" CXI support catheter, 90 cm (COOK)
  In case of failure of guidewire passage from antegrade:
  3. Retrograde approach via the distal anterior tibial artery and PTA
  - 2.9F sheath (pedal puncture set) (COOK)
  - 0.014" Hydro-ST 300 cm guidewire (COOK)
  - 0.014" CTO-Approach 25 gramm guidewire, 300 cm (COOK)
  - 0.018" CXI support catheter 90 cm (COOK)
  - Advance 3.0/120 mm, 90 cm (COOK)
  4. PTA of the popliteal artery
  - Advance LP balloon 0.018" (3, 4, 5 mm) (COOK)
  

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• Thursday, February 1st: 13:30 - 17:00, Room 3 - Technical Forum

  Case 81 – Severely calcified BTK CTO left, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 81 – LEI 31: male, 64 years (B-A)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  - POAD Rutherford 5, Dig. I ulceration left, restpain at night, walking capacity 20 m, ABI left 0.4
  - PTA/stenting left SFA and left ATA 05/17
  - CAD, CABG 2013
  
  RISK FACTORS
  Arterial hypertension, diabetes mellitus type 2, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Left groin antegrade approach
  - 6F 55 cm Flexor Check-Flo Introducer, Raabe Modifcation (COOK)
  2. Guidewire-passage from antegrade
  In case of failure retrograde approach via dorsal pedal artery:
  - 2.9F sheath (pedal puncture set) (COOK)
  - 0.014" CTO-Approach Hydro guidewire, 300 cm (COOK)
  - 0.018" CXI support catheter 90 cm (COOK)
  - Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
  3. In case of failure antegrade approach via posterior tibial artery
  - 0.018" Command 18 guidewire, 300 cm (ABBOTT)
  - 0.018" Quick-Cross support catheter (SPECTRANETICS-PHILIPS)
  4. PTA
  - 2.5/100 m Amphirion Deep ballon catheter (MEDTRONIC)
  
  
  

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• Thursday, February 1st: 13:40 - 14:00, Room 1 - Main Arena 1

  Case 62 – ATA recanalization and dexamethason injection with a Bullfrog-device

  Center:

  Leipzig, Dept. of Angiology

  Case 62 – LEI 25: male, 63 years (B-F)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  - PAOD Rutherford 6 left, forefeet ulcerations, ABI 0.3 left
  - Renal imparement, kidney transplantation 2001, CAD
  
  RISK FACTORS
  Diabetes mellitus type 2 with neuro- and angiopathy, arterial hypertension, hyperlipidemia, former smoker
  
  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)
  

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• Thursday, February 1st: 16:28 - 17:02, Room 2 - Main Arena 2

  Case 73 – Coiling of segmental arteries to reduce the risk of paraplegia in FEVAR

  Center:

  Leipzig, Dept. of Angiology

  Case 73 – LEI 28: male, 57 years (W-F)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  CLINICAL DATA
  - Progressive throraco-abdominal aneurysm after Type B-dissection (diameter max. 61mm)
  - Adipositas, congestive heart failure, NYHA II-III
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, adipositas
  
  PROCEDURAL STEPS
  1. Right groin access
  - 6F 25 cm sheath (TERUMO)
  - 6F MACH 1 LIMA guiding catheter (BOSTON SCIENTIFIC)
  - 5F SOS diagnostic catheter (MERIT MEDICAL)
  2. Cannulation and embolisation of segmental arteries
  - 0.014 PT2, 300 cm guidewire (BOSTON SCIENTIFIC)
  - 2.7F Progreat Microcatheter, 130 cm (TERUMO)
  - 0.018" pushable microcoils (COOK)
  

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• Thursday, February 1st: 17:26 - 17:55, Room 1 - Main Arena 1

  Case 67 – Occlusion right SFA after CEA right groin, flush-occlusion

  Center:

  Leipzig, Dept. of Angiology

  Case 67 – LEI 26: male, 64 years (N-M)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  - Chronic critical limb ischemia right forefoot, severe claudication right calf
  - Rutherford class 5, ABI right 0.46
  - PTA/stent of left SFA 12/2017, failed antegrade recanalisation attempt 01/2018 right
  - TEA right groin 8/2017 and left 11/2017
  - CAD, PTCA 2004
  
  RISK FACTORS
  Diabetes mellitus type 2, art. hypertension, hyperlipidemia, former smoker
  
  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
  - 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 (philips)
  - 0.014" Floppy ES guidewire, 300 cm (ABBOTT)
  - Snaring of the retrograde guidewire into the the cross-over sheath
  4. PTA/stenting
  - Armada 35 5.0/100 mm balloon (ABBOTT)
  - Distal and proximal: Zilver PTX-DES (COOK)
  - SFA-ostium: Viabahn 7.0/250 mm (GORE)
  

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• Friday, February 2nd: 9:05 - 9:45, Room 3 - Technical Forum

  Case 87 – High grade stenosis of an arteria lusoria

  Center:

  Leipzig, Dept. of Angiology

  Case 87 – LEI 33: female, 56 years (C-L)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - Pain and paresthesia right hand during elevation followed by dizziness and headache
  - RR right: 110/ 60 mmHg ; RR left 140/80 mmHg
  
  RISK FACTORS
  Arterial hypertension, former smoker (40 py), hyperlipidema , diabetes mellitus Typ II
  
  PRESENT STATE
  - Subclavian-steal syndrome with retrograde flow in the vertebral artery
  - No dysphagia
  
  PROCEDURAL STEPS
  1. Right brachial approach
  - 5F 25 cm sheath (TERUMO)
  2. Right femoral approach
  - 7F 90 sheath, Flexor Check-Flo Introducer (COOK)
  3. Passage of the lesion
  - Snaring of the guide wire from femoral acces
  4. Predilation
  - 8 mm Admiral balloon (MEDTRONIC)
  5. Implantation of a self-expanding nitinol stent from femoral
  - Smart 10–12/60 mm stent (CORDIS)
  

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• Friday, February 2nd: 10:06 - 10:53, Room 3 - Technical Forum

  Case 88 – Chronic occlusion iliac arteries TASC D and long SFA occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 88 – LEI 34: female, 76 years (C-H)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3, walking capacity 10 m left
  - ABI left 0.53
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus type 2, hyperlipidemia
  - Chronic renal failure, GFR 40 ml/min/1.73 m2
  - CAD: NSTEMI and CABG 2009
  - Cerebral ischemia 1994
  - COPD
  
  PROCEDURAL STEPS
  1. Brachial approach
  - 6F 90 cm Check-Flo Performer (COOK)
  2. Left femoral approach
  - 7 25 cm sheath (TERUMO)
  3. Guidewire passage
  - 0.035" stiff angled Glidewire, 260 cm (TERUMO)
  - Pacific 5.0/120 0mm-Ballon (MEDTRONIC)
  4. Stenting
  - LifeStream covered stent (common iliac artery) (BARD)
  - Cover Plus covered stent (external iliac artery) (BARD)
  

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• Friday, February 2nd: 10:15 - 10:55, Room 1 - Main Arena 1

  Case 85 – Juxtarenal aortic aneurysm

  Center:

  Leipzig, Dept. of Angiology

  Case 85 – LEI 32: female, 78 years (R-R)

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  b>CLINICAL DATA
  - Incidental finding of a juxtarenal aortic aneurysm with progression to 75 mm max. diameter
  - Coiling of intercostal and lumbar arteries before FEVAR to reduce the risk of spinal ischemia and prevent type II endoleak, coiling performed during production period of the custommade device
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus Type 2
  - chronic renal impairment, GFR 60 ml/min/1.73 m2
  
  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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• Friday, February 2nd: 11:07 - 12:30, Room 3 - Technical Forum

  Case 89 – Occlusion of the tibial trifurcation left

  Center:

  Leipzig, Dept. of Angiology

  Case 89 – LEI 35: male, 71 years (M-P)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  - PAOD Rutherford 3, claudication, walking capacity 100 m left
  - ABI left 0,68
  - Stenting SFA left (Supera) 2017, DEB angioplasty SFA right 2017
  - Angioplasty BTK arteries + stenting popliteal artery right 2014
  
  RISK FACTORS
  - Arterial hypertension, diabetes mellitus Type 2
  - Chronic renal impairment, GFR 60 ml/ min/ 1.73 m2
  
  PROCEDURAL STEPS
  1. Left femoral retrograde and cross-over approach
  - 7 F 55 cm Check-Flo Performer, Raab Modification (COOK)
  2. Guidewire passage and filter positioning in the peroneal artery
  - PT2 0.014" guidewire, 300 cm (BOSTON SCIENTIFIC)
  3. Atherectomy and PTA with DCBs
  - Jetstream SC (BOSTON SCIENTIFIC)
  4. PTA with drug eluting balloons
  - Lutonix drug-coated balloon (BARD)
  

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