LINC 2018 live case guide

Paris

• Wednesday, January 31st: 8:24 - 9:05, Room 2 - Main Arena 2

  Case 38 – Aorto iliac aneurysm - EVAR + Iliac branch device

  Center:

  Paris

  Case 38 – PAR 01: male, 86-years (G-J)

  Operators:

  • Stéphan Haulon

  CLINICAL DATA
  Right nephrectomy, pneumothorax, chronic renal insuffisency MDRD 46 ml/min
  
  RISK FACTORS
  Smoking
  
  PARACLINICS
  - Echocardiography: normal
  - Supra aortic trunks US: normal
  
  PROCEDURAL STEPS
  1. R: ZBIS (COOK) advanced into distal aorta, unsheath until tip of prelaoded catheter is released; advance 260 cm Terumo
  2. L: advance 12F sheath + snare
  3. L: snare 260 Terumo, through-and-through wire, advance 12F dilatator tip to tip of preloaded catheter – secure both ends of Terumo wire with clamps
  4. L: unsheath ZBIS to release internal branch – advance 12F sheath into ZBIS (pull and push), access hypogastric with parallel wire, advance 7F sheath-55 cm and bridging stent
  5. Release through and through wire, pull down ZBIS to position the branch at the IIA origin + bridging stent deployment
  6. Selective angiogram + ZBIS final deployment
  7. L: insert and deploy bifurcated component
  8. R: catheterize contro limb and deploy bridging ZSLE 16 limb
  9. Coda balloon, completion angiogram, CBCT
  

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• Wednesday, January 31st: 13:54 - 14:20, Room 2 - Main Arena 2

  Case 41 – Chronic aortic dissection – false lumen thoraco abdominal aneurysm evolution – 4-vessel FEVAR

  Center:

  Paris

  Case 41 – PAR 02: male, 70 years (J-L-C)

  Operators:

  • Stéphan Haulon

  CLINICAL DATA
  - Acute type A aortic dissection open repair in 2014
  - Aortic arch aneurysm 09/2015: left common carotid subclavian by pass + 2 branches arch endograft
  
  RISK FACTORS
  - Smoking, hypertension, dyslipidemia, BMI >30
  - Obstructive sleep apnea syndrome, transient stroke
  
  PARACLINICS
  - PFT: restrictive syndrome
  - CTscan: thoraco abdominal aneurysm, 70 mm maximal diameter
  - Cardiac stress test: negative
  - Supra aortic trunks US: no significative lesion
  
  PROCEDURAL STEPS
  1. Percutaneous access R and L CFA with Proglide systems; 100ULkg Heparin (Target ACT>250)
  2. R: Dilatators up to 20F, insertion of TEVAR
  3. L: 16F introducer + Pigtail angiocatheter
  4. Aortic angiogram / TEVAR deployment
  5. Insertion of FEVAR delivery system (COOK)
  6. Aortic angiogram / fusion regsitration + FEVAR deployment + access target vessels through fenestrations / bridging stents
  7. ZBIS deployment (COOK)
  6. Bifurcated component deployment
  7. Completion angiogram + non injected CBCT
  

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• Thursday, February 1st: 9:29 - 9:52, Room 2 - Main Arena 2

  Case 69 – Arch aneurysm – 3-branch arch endograft

  Center:

  Paris

  Case 69 – PAR 03: female, 78 years (E-V)

  Operators:

  • Stéphan Haulon,
  • P. Amabile

  CLINICAL DATA
  - Appendicectomy/ pulmonary lobectomy
  - Present state: asymptomatic
  
  RISK FACTORS
  Hypertension, smoking, dyslipidemia
  
  PARACLINICS
  - Echocardiography: LVEF 65% stress test negative
  - PTF: COPD
  
  PROCEDURAL STEPS
  1. Bilateral cervicotomy
  2. Percutaneous access R and L CFA with Proglide systems; 100UI/kg Heparin (Target ACT>300)
  3. L: Dilatators up to 22F + advance branched endograft to the arch
  4. Aortography + fusion fine tuning
  5. Branched endograft deployment under rapid pacing (COOK)
  6. From RCCA, access to the Inominate branch + deployment of the bridging stent
  7. From LCCA, access to the carotid branch + deployment of the bridging stent
  8. From the groin, access to the LSCA branch + artery + deployment of the bridging stent
  9. Completion angiography + non injected CBCT
  10. Close access sites
  

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• Thursday, February 1st: 15:06 - 15:40, Room 2 - Main Arena 2

  Case 72 – Type IV thoraco abdominal aneurysm – 5-vessel FEVAR

  Center:

  Paris

  Case 72 – PAR 04: male, 71 years (J-P-H)

  Operators:

  • Stéphan Haulon

  CLINICAL DATA
  No medical history
  
  RISK FACTORS
  Smoking, hypertension
  
  CT-SCAN
  Type IV abdominal aneurysm/ 2 right renal arteries/ inferior mesenteric artery > 4 mm
  
  PROCEDURAL STEPS
  1. Percutaneous access R and L CFA with Proglide systems
  2. Inferior mesenteric artery embolization with 6 mm Amplatzer; 100UI/kg Heparin (Target ACT>250)
  3. L: 20F 25cm sheath in the LCFA over Lunderquist –Valve puncture with 6F and 7F 55cm + Pigtail angio catheter
  4. R: Dilatators up to 20F + insertion of fenestrated endograft
  5. Aortic angiogram/ Fusion registration/ FEVAR deployment (COOK)
  6. Access target vessels through fenestrations
  7. Bridging stents deployment
  8. Bifurcated component deployment
  9. Coda inflation at overlap
  10. Completion aortography + non injected CBCT
  

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