LINC 2018 live case guide

Münster

• Wednesday, January 31st: 11:35 - 12:03, Room 2 - Main Arena 2

  Case 40 – Double-Chimney-EVAR for abdominal aortic aneurysm with a PAU at the level of the renal arteries

  Center:

  Münster

  Case 40 – MUN 01: male, 77 years (W-A)

  Operators:

  • Martin Austermann,
  • Marc Bosiers,
  • Konstantinos Stavroulakis

  CLINICAL DATA
  - Art. hypertension
  - PAD
  - COPD
  
  PRESENT STATE
  Growing aneurysm from 35 mm to >50 mm in 3 years
  
  PROCEDURAL STEPS
  1. Cut down left axillary artery and double puncture
  2. Placement of two 7 F Shuttle sheath from above
  3. Percutanous approach both groins Prostar XL 10F (ABBOTT) Placement of 14 F sheaths (COOK)
  4. Cannulation of both renal arteries from above
  5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
  6. Placement of the Chimney stent-grafts in both renal arteries
  - Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group) or Viabahn VBX balloon expandable endoprosthesis (GORE)
  7. Closure of the accesses
  

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• Wednesday, January 31st: 16:50 - 17:18, Room 2 - Main Arena 2

  Case 42 – Preloaded FEVAR for a rapid growing juxtarenal aneurysm 61 mm diameter

  Center:

  Münster

  Case 42 – MUN 02: male, 77 years (B-H)

  Operators:

  • Martin Austermann,
  • Marc Bosiers

  CLINICAL DATA
  Art. hypertension, CAD, PAD
  
  PRESENT STATE
  Rapid growing of a juxtarenal abdominal aortic aneurysm from 45 mm up to 61 mm in 6 month.
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins (Prostar XL, ABBOTT); 14F sheats (COOK) both groins
  2. Change for the Lunderquist-wire (COOK) on the right side and pig-tail-cath on the left side
  3. Angiography to locate CT, SMA and RAs and use of the fusion-technology
  4. Placement of the 3-fenestrated Zenith-endograft (COOK) via the right groin
  5. Cannulation of the renal arteries through the introducer sheath and the fenestrations by using the preloaded wire
  6. Cannulation of the SMA through the left access
  7. Implantation of the bridging stentgrafts (Atrium Advanta V 12 balloon-expandable covered stent (Maquet Gettinge-Group)) after deployment of the Top-Stent and removal of the preloaded wire
  8. Removal of the introducer sheath
  9. Implantation of the bifurcated endograft and the iliac limbs
  10. Closure of the accesses
  

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• Thursday, February 1st: 10:15 - 10:39, Room 2 - Main Arena 2

  Case 70 – EVAR for a AAA with a hostile neck using endoanchors and chimney for the RRA

  Center:

  Münster

  Case 70 – MUN 04: male, 77 years (S-L)

  Operators:

  • Martin Austermann,
  • Marc Bosiers,
  • Konstantinos Stavroulakis

  CLINICAL DATA
  - Art. hypertension
  - Diab. mell. II
  - CAD - PTCA 1998 and 2015
  - SAS
  
  RISK FACTORS
  - Hostile abdomen, obesity
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins
  - Prostar XL (ABBOTT)
  - Placement of 14F sheath (COOK)
  2. Cut down left axillary artery and cannulation of the right renal artery; Placement of a 7F sheath in the RRA
  3. Placement of Endurant bifurcated endograft (MEDTRONIC) just below the left RA
  4. Implantation of the Chimneygraft in the RRA from above
  5. Additional fixation of the proximal sealing zone with Heli-FX Endoanchors (MEDTRONIC)
  6. Closure of the groin
  - Prostar XL (ABBOTT)
  7. Closure of the axillary access
  

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• Thursday, February 1st: 11:15 - 11:35, Room 2 - Main Arena 2

  Case 71 – TEVAR with the new GORE TAG Conformable Stent Graft with active control system for a 62 mm TAA

  Center:

  Münster

  Case 71 – MUN 05: male, 78 years, (K-G)

  Operators:

  • Martin Austermann,
  • Michel Bosiers

  CLINICAL DATA
  Art. hypertension, PAD
  
  PRESENT STATE
  62 mm thoracic aneuysm with a penetrating ulcer and a small AAA 41 mm in diameter
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins
  - 5F sheath left groin
  - Prostar XL (ABBOTT) right groin
  - Placement of 14F later 24F Dry-Seal-sheath (GORE) through the right groin
  2. Implantation of the GORE C-TAG endograft with the active control system step by step
  3. Positioning of the graft and deploiment up to 50% diameter
  4. Agiography, correction of the graftposition and the C-arm angulation, if necessary angulation of the graft
  5. Complete deploiment of the graft and possibly some more angulation in order to achieve ideal wall apposition
  6. Final angiography, if needed post-dilation
  7. Closure of the groin
  - Right groin: Prostar XL (ABBOTT)
  - Left groin: Angioseal (ST. JUDE)
  

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• Thursday, February 1st: 14:18 - 14:40, Room 1 - Main Arena 1

  Case 63 – OCT-guided atherectomy of Tosaka III ISR right SFA and distal popliteal stenosis

  Center:

  Münster

  Case 63 – MUN 03: female, 65 years, (F-D)

  Operators:

  • Arne Schwindt,
  • N. Abu-Bakr

  CLINICAL DATA
  - Rutherford III right leg, painfree wd 50 m
  - ABI right leg 0,3
  - 2012 nitinol stent right SFA
  
  RISK FACTORS
  CVRF: hypertension, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Left femoral access
  - 7F 45 cm Destination x-over sheath (TERUMO) to right CFA
  2. Wire passage
  - 0,018" V18 wire (BOSTON SCIENTIFIC) and 0,035" Quick-cross (SPECTRANETICS) support catheter
  3. Filter placement
  - 4 mm Spiderfilter (MEDTRONIC) to peroneal artery
  4. OCT-guided atherectomy
  - Pantheris 3.0 7F directional atherectomy catheter (AVINGER) of SFA ISR and popliteal artery
  5. Post PTA
  - 5 x 120 mm paclitaxel eluting balloons, passeo lux (BIOTRONIK)
  6. Filter removal
  - 0,035" Quickcross
  7. Closure of access site
  - Proglide VCD (ABBOTT)
  

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• Friday, February 2nd: 9:00 - 9:40, Room 1 - Main Arena 1

  Case 84 – Double chimney EVAR for a juxtarenal abdominal aortic aneurysm

  Center:

  Münster

  Case 84 – MUN 06: male, 71 years, (M-D)

  Operators:

  • Arne Schwindt,
  • Konstantinos Stavroulakis

  CLINICAL DATA
  - Art. hypertension
  - CAD - PTCA Riva 2001
  - Occlusion RCA
  - Occlusion right ICA and CAS left ICA some years ago
  - Bleeding from a gastric ulcer after NSAR 2016
  
  PRESENT STATE
  Progression of the aneurysm from 4.5 up to 61
  
  PROCEDURAL STEPS
  1. Cut down left axillary artery and double puncture
  2. Placement of two 7F Shuttle sheaths from above
  3. Percutanous approach both groins Prostar XL 10F (ABBOTT), placement of 14F sheaths (COOK)
  4. Cannulation of both renal arteries from above
  5. Placement of Endurant bifurcated endograft just below the SMA (MEDTRONIC)
  6. Placement of the Chimney stent-grafts in both renal arteries
  7. Closure of the accesses
  

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• Friday, February 2nd: 11:37 - 12:17, Room 1 - Main Arena 1

  Case 86 – CMD-5-BEVAR for a thoracoabdominal aneurysm

  Center:

  Münster

  Case 86 – MUN 07: female, 65 years (H-W)

  Operators:

  • Martin Austermann,
  • Marc Bosiers,
  • S. Mühlenhöfer

  CLINICAL DATA
  - Cardiac fibrillation-anticoagulation,
  - art. hypertension,
  - ventilation disorders due to scoliosis of the spine-O2 therapy
  
  PRESENT STATE
  Growing TAAA, turned down for OR
  
  PROCEDURAL STEPS
  1. Percutanous approach both groins
  - (Prostar XL, ABBOTT) 14 F (COOK) both groins
  2. Left axillary access 5F sheath via cut down
  3. Pull through wire between right femoral and axillary access. Pig tail catheter through the left groin for imaging. Registration of the Fusion technology
  4. Placement of the CMD-branched-endograft (COOK) with 5 branches with help of the Fusion system
  5. Placement othe the 12F Flexor sheath from above over the pull through wire
  6. Closure of the groins in order to avoid SCI
  7. Bridging of all the branches from the axillary access
  - Advanta, VBX, Viabahn
  8. Closure of the axillary access
  

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