LINC 2018 live case guide

Conference day 3

• 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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• 8:00 - 9:30, Room 3 - Technical Forum

  Case 74 – Recanalisation of a chronic CIA CTO and stenting of bilateral IIA stenoses

  Center:

  Bad Krozingen

  Case 74 – BK 03: male, 62 years (FG)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IIb, Rutherford 3
  - Recanalisation right SFA and proximal popliteal artery 12/2017
  - Recanalisation right popliteal and posterior tibial arteries 06/2014
  - Persistant CTO left CIA and bilateral IIA stenoses
  
  RISK FACTORS
  Smoking, hypertension, diabetes mellitus, hypercholesterolemia
  
  PRESENT STATE
  - Buttock, thigh and calf claudicatio left side
  - ABI: 0.8 / 0.4
  - MRA 2014: CTO of left CIA, high grade stenosis of bilateral IIA
  
  PROCEDURAL STEPS
  1. Bilateral retrograde femoral access
  - Right side 45 cm, left side 11 cm
  2. First crossing approach from contralateral side
  - 6F IMA- or 5 F SOS-catheter
  3. Additional retrograde crossing attempt in order to avoid impacting the left IIA origin (CART technique)
  4. Predilatation of left CIA
  5. Stent implantation left CIA
  6. Stent implantation left IIA (right side on indication)
  - Promus Stent (BOSTON SCIENTIFIC)
  

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• 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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• 8:48 - 9:09, Room 1 - Main Arena 1

  Case 56 – BTK and BTA recanalization

  Center:

  Abano Terme

  Case 56 – ABT 01: male, 75 years (B-P)

  Operators:

  • Marco Manzi,
  • Luis Mariano Palena,
  • Cesare Brigato

  CLINICAL DATA
  DM, hypertension, hyperlipidemia
  
  PRESENT STATE
  Right foot: 3c TUC I°toe and 2c Tuc 2° and 3°
  
  PROCEDURAL STEPS
  1. US guided antegrade 6F 11 cm sheath
  2. CO2 angiography
  3. 4F Ber and V18 gw antegrade intraluminal recanalization attempt of pedal through AT
  4. Second 0,014" gw in PT and lateral plantar artery antegrade recanalization attempt; retrograde distal PT if failure
  5. POBA, Jetstream atherectomy (BOSTON SCIENTIFIC), Ranger DEB (BOSTON SCIENTIFIC) discussion
  6. US closure device deployment (6F Angio-Seal)
  
  

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• 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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• 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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• 9:30 - 11:00, Room 3 - Technical Forum

  Case 76 – Combined antegrade and retrograde recanalisation attempt of chronic calcified PTA & ATA occlusions left leg

  Center:

  Bad Krozingen

  Case 76 – BK 04: female, 81 years (G-E)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IV, Rutherford 5 left leg
  - Chronic bilateral venous insufficiency
  - Intermittant atrial fibrillation
  - Unsuccessful recanalisation attempt of left PTA and ATA 04/2017
  - Chronic kidney diseases NKF III - IV (GFR 23–35 ml/min)
  
  RISK FACTORS
  Diabetes mellitus, obesity
  
  PROCEDURAL STEPS
  1. Left antegrade femoral access, 6F
  2. 5F STR guiding catheter (CORDIS)
  3. Balloon guided antegrade crossing attempt
  - 0.014'' Advantage wire (TERUMO) or 0.014'' Victory 14 wire (BSC)
  4. Predilatation on indication
  5. Optional atherectomy
  - Rotablator (BSC)
  6. Drug coated balloon angioplasty
  - Lotus (Acotec)
  7. Stenting on indication
  

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• 9:30 - 11:00, Room 3 - Technical Forum

  Case 77 – Distal AT calcified occlusion and long PT/Lateral plantar occlusion

  Center:

  Abano Terme

  Case 77 – ABT 02: male, 60 years (C-N)

  Operators:

  • Marco Manzi,
  • Luis Mariano Palena,
  • Cesare Brigato

  CLINICAL DATA
  - DM, previous SFA stenting (2001)
  - re-treated with directional atherectomy for IS restenosis 2017
  
  PRESENT STATE
  Ulcerations in IV and V toes TUC 2C right foot
  
  PROCEDURAL STEPS
  1. Right US guided antegrade 6F 11 cm sheath deployment
  2. CO2 angiography
  3. AT antegrade 0,014" CTO gw intraluminal attempt, retrograde when failure; antegrade PT subintimal attempt
  4. AT Predilatation, Phoenix debulking atherectomy (Philips), Stellarex DEB (SPECTRANETICS-Philips); PT POBA
  5. US guided closure device deployment (Angio-Seal)
  
  

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• 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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• 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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• 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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• 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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• 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)
  
  
  
• 11:00 - 12:30, Room 3 - Technical Forum

  Case 79 – Critical limb ischemia left, complex BTK CTOs

  Center:

  Abano Terme

  Case 79 – ABT 03: male, 78 years (P-A)

  Operators:

  • Marco Manzi,
  • Luis Mariano Palena,
  • Cesare Brigato

  CLINICAL DATA
  DM, dyalisis, kidney transplant, ischemic heart disease
  
  PRESENT STATE
  Bilateral CLI with left toes gangrenes
  
  PROCEDURAL STEPS
  1. Retrograde access right CFA
  - 6F long sheath deployment and retrograde left P3 puncture + 6F 11 cm sheath
  2. Presto technique for SFA and popliteal artery
  - Balloon P3 aemosthasis
  3. Antegrade BTK and BTA reacanalization attempt
  4. Discussion for debulking and DEB
  5. Closure device
  

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• 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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• 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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• 11:59 - 12:24, Room 1 - Main Arena 1

  Case 60 – In-Stent reocclusion right SFA

  Center:

  Bad Krozingen

  Case 60 – BK 02: male, 53 years (M-P)

  Operators:

  • Elias Noory

  CLINICAL DATA
  - PAOD Rutherford 3
  - Severe claudication right calf, walking capacity 50 meters
  - Recanalisation, rtPA-thrombolysis and stent implantation right prox-dist SFA 04/2011
  - Recanalisation and stent implantation right distal SFA 11/2004
  - Fogarty thrombectomy right distal SFA 2004
  - Testicular cancer, semicastratio and radio-chemotherapy 2003-2004
  - ABI: right 0.6 after excercise test 0.4
  
  RISK FACTORS
  Nicotine abuse (25 PY) to 2006, hypercholertinemia
  
  DUPLEX
  Long instent reocclusion of right SFA
  
  PROCEDURAL STEPS
  1. Left femoral retrograde and cross over approach
  - 6F 45 cm sheath
  2. 0.035" or 0.018" Terumo GW, supported by vertebral catheter, 5F
  3. Rotarex thrombectomy
  - 6F (STRAUB MEDICAL)
  4. Predilatation on indication (Cutting balloon)
  5. Drug-coated balloon angioplasty
  

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• 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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• 13:30 - 17:00, Room 3 - Technical Forum

  Case 80 – Deep venous arterialization

  Center:

  Teaneck

  Case 80 – TEA 08: female, 83 years (F-G)

  Operators:

  • John Rundback,
  • Kevin Herman,
  • V. Gallo

  CLINICAL DATA
  Non-healing right hallux tip gangrene
  
  RISK FACTORS
  HTN, dyslipidemia, CAD, prior RLE revasc
  
  PROCEDURAL STEPS
  1. Antegrade RLE angio
  - 6F slender sheath (TERUMO)
  2. Retrograde pedal venous access (COOK)
  3. Retrograde snare placement in posterior tibial vein
  - EN Snare (MERIT)
  4. Outback (CORDIS) entry from posterior tibial artery to vein
  5. Placement of stent graft
  - Viabahn (GORE) or Graftmaster (ABBOTT)
  6. Flex angiotome or cutting balloon valvulotomy
  7. Selective embolization if needed
  

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• 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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• 13:30 - 17:00, Room 3 - Technical Forum

  Case 82 – AT and PT recanalization with BTA intervention

  Center:

  Abano Terme

  Case 82 – ABT 04: male, 65 years (L-G)

  Operators:

  • Marco Manzi,
  • Luis Mariano Palena,
  • Cesare Brigato

  CLINICAL DATA
  DM, hypertension
  
  PRESENT STATE
  - Right CLI in previous 2°-3°-4°-5° amputation
  - plantar 2CTUC
  
  PROCEDURAL STEPS
  1. US guided antegrade Right CFA puncture and 6F 11 cm sheath deployment
  2. CO2 angiography
  3. Antegrade AT recanalization (V18 cw + 4F BER2) antegrade lateral plantar and arch recanalization (0,014 Command)
  4. Discussion for DEB/POBA
  5. US guided closure device deployment (Angio-Seal)
  
  

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• 13:30 - 17:00, Room 3 - Technical Forum

  Case 83 – Combined antegrade and retrograde recanalisation left CIA, EIA, CFA and SFA

  Center:

  Bad Krozingen

  Case 83 – BK 05: male, 71 years (S-W)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IIb/ Rutherford 3
  - Recanalisation right EIA, CFA & DFA with persistant SFA occlusion 11/2017
  - Infrarenal AAA
  - ABI: 0.6/ 0.4
  
  RISK FACTORS
  Hypertension, ex-smoker, hypercholesterolemia
  
  MRA
  Occlusion of left CIA, EIA, CFA and SFA
  
  PROCEDURAL STEPS
  1. Retrograde right femoral access (45 cm sheath)
  2. Retrograde puncture distal left SFA
  3. Primarily retrograde recanalisation attempt
  - 0.018'' or 0.035'' Glidewire (TERUMO)
  4. Stenting of iliac vessels
  5. DCB angioplasty of femoral arteries with stenting on indication
  - BioMimics (Veryan) or Supera (ABBOTT VASCULAR)
  
  

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• 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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• 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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• 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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• 15:14 - 15:42, Room 1 - Main Arena 1

  Case 64 – Transradial radiocephalic hemodialysis fistulogram and DCB

  Center:

  Teaneck

  Case 64 – TEA 06: male, 66 years (O-S)

  Operators:

  • V. Gallo,
  • John Rundback,
  • Kevin Herman

  RISK FACTORS
  - HTN, dyslipidemia, hypertension, former 2pk/day smoker stopped 2012
  - Type 1 diabetes mellitus
  - End stage renal disease on maintance hemodialysis via left radiocephalic AV fistula
  - Atrial fibrillation, prior forced maturation, recurrent juxta-anastamotic stenosis
  
  DUPLEX
  - 1/3/18 mild right iliac in-stent restenosis and high grade distal right
  - Superficial femoral above knee popliteal artery stenosis
  
  PROCEDURAL STEPS
  1. US guided radial artery access (COOK)
  2. 5F Slender sheath insertion (TERUMO)
  3. POBA
  4. POBA for additional vessel prep
  - Conquest high pressure balloon (BARD)
  5. Bard Lutonix DCB
  6. Any necessary additional procedures
  

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• 16:09 - 16:19, Room 1 - Main Arena 1

  Case 65 – Pelvic venogram and superficial venous ablation

  Center:

  Teaneck

  Case 65 – TEA 07: male, 70 years (D-R)

  Operators:

  • Kevin Herman,
  • John Rundback,
  • V. Gallo

  CLINICAL DATA
  Chronic LLE swelling, prior LLE fem-pop bypass
  
  PROCEDURAL STEPS
  1. US guided access into L GSV
  - 10F sheath (BOSTON SCIENTIFIC)
  2. Pelvic venogram
  3. IVUS
  - VOLCANO (PHILIPS)
  4. Iliac vein stent
  - Wallstent (BOSTON SCIENTIFIC)
  5. Post stent venogram and IVUS
  6. GSV Ablation via one access site
  - Venoseal (MEDTRONIC)
  

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• 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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• 16:44 - 17:12, Room 1 - Main Arena 1

  Case 66 – Combined antegrade and retrograde recanalisation right popliteal artery

  Center:

  Bad Krozingen

  Case 66 – BK 06: male, 64 years (T-B)

  Operators:

  • Aljoscha Rastan

  CLINICAL DATA
  - Claudication Rutherford-Becker 3
  - Unsuccessful recanalisation right popliteal artery with perforation 12/2017
  
  RISK FACTORS
  Hypertension, tobacco use, hypercholesterolemia
  
  PRESENT STATE
  - ABI: 0.3
  - Duplex ultrasound/ angiography: Occlusion of the right popliteal artery
  
  PROCEDURAL STEPS
  1. Femoral access (cross-over)
  - 0.035" wire (TERUMO)
  - 6F 45 cm sheath (COOK)
  2. Retrograde puncture ATA vs. ATP
  3. Recanalisation attempt
  - 0.018" wire (BOSTON SCIENTIFIC, TERUMO)
  - 3 x 40 mm balloon (BOSTON SCIENTIFIC)
  4. Pre-dilatation
  - DCB vs. POBA (MEDTRONIC, BOSTON SCIENTIFIC)
  5. Stenting on indication
  - Supera (ABBOTT)
  

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• 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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