LINC 2019 live case guide

CLINICAL DATA
Severe claudication right calf, walking capacity 100 meters,
ABI right 0.54, Rutherford class 3
PTA both EIA 10/2014 and left SFA 12/2014
CAD, AMI 02/2014
Mild renal impairment

RISK FACTORS
Arterial hypertension, hyperlipidemia, former smoker

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
- Command 18 and Armada 18 balloon (ABBOTT) or
- 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO)
3. In case of failure to pass the CTO
- GoBackTM Crossing Catheter (Upstream Peripheral)
4. PTA
- 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
- Conquest high pressure balloon on indication (BARD)
5. Stenting
- 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

CLINICAL DATA
Severe post-thrombotic syndrome right leg
History of provoked deep venous thrombosis left leg 2009

PRESENT STATE
Villalta score: 12 points
Hetercygote Faktor-V Leiden mutation

DUPLEX
Right leg: chronic thrombosis of common femoral and femoral vein
Patent iliac veins

PROCEDURAL STEPS
1. Analgosedation propofol, fentanyl; ultrasound-guided access: of the size and location of metastases.
2. Lesion examination with selective venography in two orthogonal views, deep femoral vein imaging using balloon occlusion venography of common femoral vein, provisional IVUS
3. Passage of femoral vein occlusion using stiff angled glidewire 0.035“, Astato 0.018“ 30 g tip load, angled 0.035“ CXI support catheter
4. Balloon angioplasty up to 12 mm high pressure of common femoral vein, provisional cutting ballon up to 8 mm
5. Placement of Blueflow stent (14 x 100 mm or 14 x 150 mm) likely from the jugular approach
6. Postdilatation high pressure of Blueflow up to 14 mm (ATLAS GOLD, BARD)
7. Final venograms and assessment of peak flow velocity in common femoral vein by Duplex sonography

CLINICAL DATA
PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0,5
CAD, ICM (EF 32%), AMI 2014 and 12/2018, CABG 2014, PTCA 12/18
Renal impairment

RISK FACTORS
Arterial hypertension, diabetes mellitus type 2 with angio- and neuropathy, hyperlipidemia

PROCEDURAL STEPS
1. Right 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)
- 5.0/40 mm Armada 35 balloon (ABBOTT)
3. Stenting
- 5.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
High grade bilateral ICA stenosis (left>right)
Diabetic foot syndrom left
Bilateral total SFA occlusions (PTA with DEB and Ultrascore 08/2018)
Bilateral high grade CIA&EIA steosis (PTA and Stenting 08/2018
Coronary disease (2 vessel, symptomatic)
High grade left renal stenosis
Left Subclavian artery high grade stenosis

RISK FACTORS
Smoker, diabetes mellitus, art. hypertension

CT
Aortic Arch Type 1, left ostial subtotal carotid artery stenosis

DUPLEX
High grade stenosis, not much calcium, straight vessel, soft plaques, high grade stenosis

PROCEDURAL STEPS
1. Transfemoral access
- Short 8F sheath (TERUMO)
2. Sheath placement
- 8F MP-shape guiding catheter sheath into the left CCA (VISTA BRITE IG, CORDIS)
3. Distal Protection
- Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
4. Predilatation
- 3 x 40 mm Maverick balloon (BOSTON SCIENTIFIC)
5. Secondary protection/ stenting/ postdilatation
- Neuroguard IEP stent 9 mm (CONTEGO MEDICAL) filter, Nitinol stent and postdilation balloon in one system
6. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
7. Control angiography extra – and intracranial DSA
8. Access care
- Angioseal 8F (TERUMO)

CLINICAL DATA
Severe claudication right, walking-capacity 50-100 meters
Rutherford class 3, ABI right 0.46
COPD

RISK FACTORS
Arterial hypertension, hyperlipidemia, strong smoker (50PY)

PROCEDURAL STEPS
1. Right femoral access
- 7F 25 cm Radiofocus Introducer (TERUMO)
- 0.035“ SupraCore guidewire 300 cm (ABBOTT)
Left brachial approach:
- 6F 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 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
- Covera Plus vascular covered stent for the external iliac artery (BARD)

CLINICAL DATA
PAOD Rutherford 3, walking capacity 100 m, ABI right 0.55, left 0.6
Failed recanalisation attempt of the right SFA 08/12 elsewhere
Renal impairment grade 2

RISK FACTORS
Aterial hypertension, former nicotine abuse (20PY), hyperlipidemia

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 (PHILIPS)
3. PTA with scoring ballon
- 4/40 mm AngioSculpt PTA scoring balloon (PHILIPS)
4. PTA with DCBs
- Stellarex 5.0/120 mm DCBs (PHILIPS)

CLINICAL DATA
Stable angina during the last 12 months, 1 hospital admission for TIA (transient dysartria) 1 month ago

RISK FACTORS
Hypertension, hypercholesterolemia

DUPLEX
Critical LICA stenosis with evidence of a ‚soft‘ plaque

PROCEDURAL STEPS
1. Femoral access
2. Selective angiography
3. Cerebral protection
- MOMA 9F (MEDTRONIC) positioning
4. Stenting
- C-Guard (Inspire MD)
5. Postdilatation
- 5,0/20 mm balloon (BOSTON SCIENTIFIC )
6. Femoral access haemostasis

CLINICAL DATA
Massive descending bilateral iliofemoral DVT in September 2018 including the infrarenal IVC diagnosed late
and treated conservatively, ongoing shortness of breath, ongoing severe spinal and biliateral leg claudication,
limited physical performance since childhood

PRESENT STATE
Villata score: 6 points;
Spiroergometry: limited oxygen uptake during exercise due to impaired venous return

CT VENOGRAPHY
Obtained 4 weeks after onset of symptoms:
- chronic total occlusion of perirenal inferior vena cava with descending DVT into both iliac and common femoral veins
- acygos collaterals

DUPLEX
Preserved leg inflow veins

PROCEDURAL STEPS
1. General anaesthesia, ultrasound-guided access bilateral femoral veins (below occlusion) and possibly right jugular vein (10F)
2. Passage of occlusion of vena cava and iliac veins stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load
3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
4. High pressure balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
5. Stenting of IVC with 20 mm Venovo stent (BARD) with high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
6. Y-reconstruction of iliac confluens using Venovo (BARD) 14 mm kissing stents
7. Kissing balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
8. Stent extension to both common femoral veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Limited physical performance
History of acute venous thrombosis right common iliac vein (2013)
Several catheterizations as newborn

IMPORTANT ITEMS
MR-venography: atresia of entire inferior vena cava starting from the liver veins, bilateral common iliac vein occlusion, prominent collateral veins (vena azygos and lumbar veins)
Spiroergometry: limited oxygen uptake during exercise due to impaired venous return (60% of norm)
Villalta score: 9 points

DUPLEX
patent common femoral veins

PROCEDURAL STEPS
1. General anaesthesia, Ultrasound-guided access:
right and left common femoral veins and possibly right jugular veins (10F)
2. Passage of occlusion of vena cava and iliac veins using stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load, angled CXI 0.035“ support catheter
3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
4. High pressure Balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
5. Stenting of IVC with two overlapping 20 mm Venovo (BARD) stents and high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
6. Y-reconstruction of iliac confluens using Venovo 14 mm kissing stents (BARD)
7. Kissing Balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
8. Possibly stent extensions to both external iliac veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography

CLINICAL DATA
Recanalisation of the rigt popliteal artery CTO in 11/2018,
PTA with Sequent Please OTW and 4 Multiloc 5 x 13 mm stents.
Deep vein thrombosis in 02/2018 with DOAK for 6 months

PRESENT STATE
ABI left 0.7, walking distance <50 mm, calf claudication,
Duplex and Angio showed popliteal segment I CTO

RISK FACTORS
Smoking, art. hypertension

PROCEDURAL STEPS
1. Cross-over access
- 6F Fortress 45 cm sheath (BIOTRONIK) right to left
2. Catheter for lesion crossing
- Navicross 0.035“ support catheter 90 cm (TERUMO)
3. Guidewire for lesion crossing
- Angled stiff glidewire, 260 cm (TERUMO)
4. Lesion crossing
5. Backup retrograde access
- 0.018“ approach, sheathless with CXI 0.018“ support catheter (COOK)
6. Predilation
- 3 x 120 mm Passeo 35 balloon (BIOTRONIK)
7. PTA
- 5 x 120 mm Sequent Please OTW DEB (B. BRAUN)
8. Spot Stenting
- Multi-Loc 5 x 13 mm if needed (B. BRAUN)
9. Postdilation if stent was necessary
- 5 mm POBA (BIOTRONIK)
10. Sheath removal and vessel closure

CLINICAL DATA
Severe claudication left calf, walking capacity 50 meters, ABI left 0.62
Femoro-popliteal bypass right 2012, thrombendatherectomy left groin 01/2019
CEA left 11/2012 and right 12/16, CAD, AMI 1997

RISK FACTORS
Art. hypertension, diabetes mellitus type 2, nicotine abuse (80PY), hyperlipidemia

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 (ABBOTT)
- 7F Balkin Up&Over sheath, 40 cm (COOK)
2. Antegrade guidewire-passage
In case of failure from antegrade:
Retrograde GW-passage via proximal ATA
- 21 Gauge 9cm needle (B.BRAUN)
- 0.018” V-18 Control GW, 300cm (BOSTON SCIENTIFIC)
- 0.018” CXC Support-Catheter, 90cm (COOK)
3. In case of failure to pass the guidewire
- retrograde approach via distal SFA or GoBackTM Crossing Catheter (Upstream Peripheral) from antegrade
4. Tumescent anesthesia of the SFA
- Bullfrog-Device (MERCATOR)
5. PTA/ vessel preparation
- Sterling 5/100 mm balloon (BOSTON SCIENTIFIC)
- Conquest High pressure balloon on indication (BARD)
6. Differential stenting
- Eluvia DES in case of minor recoil (BOSTON SCIENTIFIC)
- Supera Interwoven Nitinol-Stent in case of severe recoil (ABBOTT)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Severe claudication both calves, walking capacity 20 meters
Obesitiy, renal impairment G3, ICM, mycardial infarction 2009
ABI right: 0.53 and left: 0.64

RISK FACTORS
Arterial hypertension, former smoker

ANGIOGRAPHY
11/2018: long SFA-occlusions both sides, moderate calcification

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 of the right SFA
- 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
- 0.035“ TrailBlazer support catheter, 135 cm (MEDTRONIC)
- Exchange to 0.018“ SteelCore guidewire (ABBOTT)
3. PTA with DCBs
- 5.0 mm Chocolate balloon (MEDTRONIC)
- 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)
4. Stenting on indication
- Complete Selfexpanding Nitinol stent (MEDTRONIC)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Left leg claudication x 6 months (< 3 blocks)
Failed exercise therapy and a trial of Cilostazol
ABI (R/L) 0.92/0.71

RISK FACTORS
Type 2 DM, HTN, dyslipidemia

DUPLEX
Suggestive of distal left SFA occlusion

PROCEDURAL STEPS
1. Right CFA access
- Micropuncture sheath (COOK)
2. Access sheath
- 6F 45 cm crossover Destination sheath (TERUMO)
3. Antegrade lesion crossing
- 0.035“ stiff angled glidewire (TERUMO)
4. Embolic protection
- Emboshield Nav 6 (4-7) filter deployment (ABBOTT)
5. Ultrasound
- Vision PV 0.14 intravascular ultrasound (PHILIPS)
6. Atherectomy
- Directional atherectomy, Hawk M (MEDTRONIC)
7. Angioplasty
- Drug coated balloon angioplasty IN.PACT Admiral balloon (MEDTRONIC)
8. Stenting
- Stent scaffold for severe flow limiting dissection

CLINICAL DATA
PAOD Rutherford 3 bilateral, ABI bilateral 0.5
Absolute walking-capacity 100 meters, weakness both thighs/calves

RISK FACTORS
Art. hypertension, nicotine abuse (30PY)

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 from above into the groin-sheath or
- Into 6F-Judkins-Right guiding catheter (CORDIS) inserted from below
4. PTA/thrombectomy via the groin access bilateral
- Rotarex 10F thrombectomy (STRAUB MEDICAL)
- SupraCore 300 cm 0,035“ guidewire (ABBOTT)
- Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
5. Implantation of covered stents
- VBX covered stents for both renal arteries (GORE)
- VBX covered stents bilateral in kissing technique (GORE)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Gangrene Dig. ped. II right, persistend occlusion of right tibioperoneal trunc
Diabetes mellitus
Minor amputation of right foot Dig ped I ex-articulation of end-phalanx
PTA and Supera stenting right SFA & popliteal artery 01/2019
Impaired renal function
TEA and Patch bilateral common femoral artery (2015)

RISK FACTORS
Hyperlipidemia (Lipidapharesis since 2016), art. hypertension
CHD (post-MI), recanalisation of inflow was done by cross-over approach,
wound is only slowly improving

PROCEDURAL STEPS
1. Antegrade access
- Destination 5F sheath (45 cm) right CFA (TERUMO)
2. Recanalisation
- supported by CXI Supportcatheter 0.018“ (COOK) and Advantage Glidewire 0.018“ (TERUMO)
3. PTA
- 2 x 40 mm ballon Passeo 18 (BIOTRONIK)
4. Recanalisation of the tibioperoneal trunc & distal ATP to the pedal arch and PTA
5. Stenting of the tibioperoneal trunc
- 3.0 x 31 mm Cre8 BTK dedicated DES (ALVIMEDICA)
6. BACK-UP: transpedal-loop recanalisation of the ATP via the ATA
- 0.014“ Corsair Microcatheter (ASAHI) and 0.014“ Advantage Wire (TERUMO)

CLINICAL DATA
CVRFs: hypertension, hypercholesterolemia
Unstable angina treated with PCI to LAD (DES) in December 2018 (need for 12-month double antiplatelet therapy)

DUPLEX
Critical RICA stenosis (NASCET 80%) with evidence of a ‚soft‘ fast-growing plaque (40% at Duplex scan performed in January 2018)

PROCEDURAL STEPS
1. Femoral access
2. Selective angiography
3. Cerebral protection
- MOMA 9F (MEDTRONIC) positioning
4. Stenting
- Roadsaver (TERUMO) stent
5. Postdilatation
- 5,0/20 mm balloon (BOSTON SCIENTIFIC)
6. Femoral access haemostasis

CLINICAL DATA
Radiation and open surgery due to parotid cancer (years ago)
Renal insufficiency (last Creatinin level 2.3 mg/dl)

DUPLEX
High grade RICA, PSV 364 cm/sec, EDV >100 cm/sec, MDV 100 cm/sec

RISK FACTORS
Ex-nicotine, art. hypertension

PRESENT STATE
CTA and MRA not available due to impaired renal function

PROCEDURAL STEPS
1. Transfemoral access
- Short 8F sheath (TERUMO)
2. Placement of the guiding catheter
- 8F MP-shape guiding catheter sheath into the right CCA (VISTA BRITE IG, CORDIS)
3. Distal Protection
- Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
4. Predilatation
- 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
5. Stenting
- Roadsaver 8 x 25 mm Micromesh-stent (TERUMO)
6. Postdilatation
- 5 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
7. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
8. Control angiography extra – and intracranial DSA
9. Access care
- Angioseal 8F (TERUMO)

CLINICAL DATA
History of acute iliac vein thrombosis (left) during complicated gemini-pregnancy in 23rd week of gestation
treated with enoxaparin 1 mg/kg twice daily (in August 2018), caeserian section for twins in October 2018;
currently breastfeeding and still treated with enoxaparin but severe venous claudication with leg swelling and venous claudication.

DUPLEX
Postthrombotic changes of common femoral veins, May Thurner anatomy with compressed left common
ilica vein, preserved leg inflow veins

ULTRASOUND
Post-thrombotic changes left iliac and common femoral veins
Linear flow pattern left external iliac vein
Left common iliac vein compressed down to 2 mm (May-Thurner anatomy)

PROCEDURAL STEPS
1. Ultrasound-assisted access left femoral vein (10F), analogosedation propofol, fentanyl
2. Passage of iliac veins with stiff angeld glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load,
4F Berenstein catheter or angled CXI 0.035“ support catheter
3. Selective venograpy two planes, intra-occlusion venography, deep femoral vein imaging using
balloon occlusion venography of common femoral vein and provisional IVUS
4. Balloon angioplasty up to 14 mm (ATLAS GOLD, BARD)
5. Left iliac vein stenting (SINUS obliquus 14 x 150 mm, OPTIMED)
6. Provisional stent extension to common femoral vein (SINUS XL Flex 14 mm, OPTIMED)
7. Postdilation high pressure up to 14 mm (ATLAS GOLD, BARD)
8. Postdilation high pressure up to 14 mm (ATLAS GOLD, BARD)
9. Final venograms and assessment of peak flow velocity in common femoral vein by Duplex sonography

Information will follow in due time. Thank you for your understanding.

PRESENT STATE
During the last 3 months she referred effort left arm pain (while doing homework).
One week ago 1 episode of marked dizziness while climbing stairs.
Duplex showed critical left subclavian artery stenosis (then confirmed by angio)

RISK FACTORS
Hypertension, hypercholesterolemia
Known history of CAD (previous PCI to LM-LAD and RCA)

PROCEDURAL STEPS
1. Femoral access
2. Left radial access
3. Lesion crossing
- 0.018‘‘ wire
4. Lesion predilation
- cutting balloon (WOLVERINE, BOSTON SCIENTIFIC) and drug-coated balloon (RANGER, BOSTON SCIENTIFIC)
5. Stenting
- Innova self-expanding stent (BOSTON SCIENTIFIC)
6. Postdilatation

CLINICAL DATA
Asymptomatic highgrade stenosis of the the common carotid artery left, dizziness
M. Hodgkin 1984 with cervical radiation
CEA right 09/16 and CEA of left common carotid artery 05/17

RISK FACTORS
Art. hypertension, hyperlipidemia, former smoker

DUPLEX
4.8 m/sec. Left distal common carotid artery

PROCEDURAL STEPS
1. Right groin access
- 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0.015“ SupraCore guidewire (ABBOTT)
- 7F 90cm Check Flo Performer sheath (COOK)
2. Cerebral protection
- Filter-wire EZ (BOSTON SCIENTIFIC)
3. Predilatation and Stenting
- 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
- 8/30 mm CGuard stent (InspireMD)

CLINICAL DATA
Critical limb ischemia left, ulceration dig 4, Rutherford class 5
Severe claudication left calf, walking capacity 50–100 meters,
PTA/stenting left EIA 11/2018
ABI left: 0.45

RISK FACTORS
Diabetes mellitus type 2, arterial hypertension, former smoker

PROCEDURAL STEPS
1. Right femoral access and cross-over approach
- 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
2. Passage of the occlusion left 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
- 9 cm 20 Gauge spinal needle (BD)
- 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
- 4F 10 cm Radiofocus introducer (TERUMO)
- Passeo 18 4.0/40 mm balloon, 90 cm (BIOTRONIK)
4. PTA
- Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
- 5 mm Passeo 18 Lux DCB (BIOTRONIK)
5. Stenting on indication, spot-stenting
- Pulsar 18-T3 stent (BIOTRONIK)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford class 4, claudication right calf, walking capacity 50 m, restpain during night, ABI right 0.52, EVAR and stenting right renal artery 11/2018, chronic pancreatitis
Failed recanalization attempt right popliteal 12/18 elsewhere

RISK FACTORS
Arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Antegrade approach right groin
- 7F 55 cm Flexor sheath (COOK)
2. Antegrade guidewire passage
in case of failure retrograde approach via the proximal 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. Atherectomy of the popliteal artery
- JetStream atherectomy device (BOSTON SCIENTIFIC)
4. Angioplasty
- VascuTrak 4.0/120 mm balloon (BARD)
- Luminor DCB (iVascular)
5. Stenting on indication
- Spot-stenting with Multi Lock (B.BRAUN)

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Critical limb ischemia both lower legs with chronic ulcerations, Rutherford class 5
ABI left 0.34, ABI right 0.45
Recanalization right peroneal artery 01/07/2018
PTA SFA/popliteal artery left and PTA anterior tibial right 11/2018
Amputation forefoot left
Amputation D1 right

RISK FACTORS
Diabetes mellitus type 2 with diabetic neuropathy, arterial hypertension, chronic renal impairment

PROCEDURAL STEPS
1. Antegrade approach left groin
- 6F 55 cm sheath (COOK)
2. Guidewire-passage anterior/posterior tibial
- 0.014“ Command (ABBOTT)
- 0.014“ PT2 Guidewire 300 cm (BOSTON SCIENTIFIC)
- In case of failure: retrograde approach
3. PTA
- Vessel preparation – scoring balloon (VascuTrak, BARD)
- Lutonix BTK DCB (BARD)
4. In case of dissections after DCB, provisional placement of nitinol „tacks“
- Tack Endovascular System (Intact Vascular)

CLINICAL DATA
HCC Stage IIIa (pT3 Nx M0) 6/18
Atypical segmentectomy segment III 6/18
cTACE performed in referring hospital
Multifocal HCC in both liver lobes
Primary outside MILAN
Universal liver tumor board waived sequential SIRT, starting right
Evaluation showed a 2.5% shunt to the lung and estimated dose of 2.5GBq for Therasphere (BTG)
No extrahepatic deposition of radioactivity in test-dose

RISK FACTORS
Liver cirrhosis CHILD A, MELD 6
Diabetis mellitus, arterial hypertonia

PROCEDURAL STEPS
1. Right groin retrograde access
- 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
- 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
2. Placement of diagnostic catheter in main hepatic artery
- 0.035‘‘Radiofocus angled guidewire, 180 cm (TERUMO)
- Diagnostic catheter SIM 1, 4F 0.035‘‘, 100 cm (CORDIS)
3. Placement of microcatheter in right hepatic artery
- Progreat 2.7F (TERUMO)
- alternative wire: Cirrus 14‘ (COOK)
4. Radioembolisation
- SIRT with TheraSphereR yttrium-90 glass microspheres (BTG)
5. Puncture site occlusion
- Vascularclosure Device Exoseal (CORDIS)

CLINICAL DATA
Asymptomatic infrarenal AAA, diameter max. 58 mm
Coiling of lumbar arteries 12/2018

RISK FACTORS
Art. hypertension, chronic renal impairment, hyperlipidemia

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)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford 3, claudication left calf, walking capacity 30 m
ABI left 0.3
Hypotyhreosis

RISK FACTORS
Arterial hypertension, current smoker, hypelipidemia

PROCEDURAL STEPS
1. Right groin cross-over approach
- Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0,035“ SupraCore guidewire 30 cm (ABBOTT)
- 6F 55 cm Balkin Up&Over sheath (COOK)
2. Guidewire passage of the occlusion and 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)

CLINICAL DATA
Differentiated hepatocellular carcinoma (G1)

RISK FACTORS
Liver cirrhosis CHILD A
Chronische hepatitis

PROCEDURAL STEPS
1. Right groin retrograde access
- 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
- 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
2. Placement of diagnostic catheter in main hepatic artery
- 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
- Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
3. Placement of microcatheter in right hepatic artery
- Progreat 2.7F (TERUMO)
- alternative wire: Cirrus 14‘ (COOK)
4. Superselective placement of microcatheter in feeding artery
5. Embolization
- 40μm Embozene-Tandem (BOSTON SCIENTIFIC) loaded with 150 mg Doxorubicin till stasis
6. If still perfusion after administration of the whole 3ml Embozene Tandem 40μm then additional embolization with blande microparticals Embozene 400μm till stasis is reached
7. Control angiography
8. Puncture site occlusion
- Vascular closure device Exoseal (CORDIS) and pressure dressing

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
CAD, PTCA 2015, art. hypertension, PAD, COPD, calf claudication on the left side after 50 m with progress

PRESENT STATE
Subtotal occlusion with calcification of the popliteal artery

PROCEDURAL STEPS
1. Percutaneous approach from the contralateral femoral artery
2. Use of 6F 45 cm long sheath with placement in the external iliac artery
3. Recanalisation of the subtotal occlusion of the popliteal artery
4. Use of the orbital atherectomy system (360°, Stealth) CSI as lithoplasty option of the severe calcified lesion to prepare the vessel
5. Use of a DCB balloon
6. Closure of the groin with Angioseal 6F system

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford 5, non-healing forefoot gangrene, mediasclerosis, ABI > 1.4
PTA left peroneal artery 07/18 and left TPA 08/18
Terminal kidney disease
Paroxysmal atrial fibrilation, pacemaker 12/17

RISK FACTORS
Arterial hypertension, hyperlipdemia, dialysis

PROCEDURAL STEPS
1. Left groin antegrade access
- 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
Left distal venous tibial retrograde access
- 5F sheath Introducer 2R (TERUMO)
Arteriography and phlebography to define the optimal level for arterio-venous crossing
2. Crossing from artery to vein
- LimFlow Arterial Catheter 7F (LIMFLOW)
- LimFlow Venous Catheter 5F (LIMFLOW)
- LimFLow Ultrasound System (LIMFLOW)
- PT2 0.014“ Guidewire to pass from artery into vein (BOSTON SCIENTIFIC)
- Predilatation with MiniTrek 3.5/20 mm OTW Coronary Balloon (ABBOTT)
3. Guidewire passage through vein and vein preparation
- PT2 0.014“ guidewire (BOSTON SCIENTIFIC) or
- Command 18 guidewire (ABBOTT)
- Push Valvulotome 4F (LIMFLOW)
- 4.0/120 mm Pacific ballon (MEDTRONIC)
4. Implantation of covered stentgrafts
- LimFlow Extension stentgrafts 7F 5.5 mm x 150 mm (LIMFLOW) for vein coverage
- LimFLow Crossing Stentgraft 7F 3.5 x 60 mm (LIMFLOW) for connection artery to vein

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford 3, walking capacity of 40 m, claucation left calf
ABI left 0.6

RISK FACTORS
Arterial hypertension, hyperlipidemia, strong smoker (50PY)

PROCEDURAL STEPS
1. Right groin cross-over approach
- Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0,035“ SupraCore guidewire 30 cm (ABBOTT)
- 6F-55 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)
In-case of inability to reenter distal:
- either retrograde approach via distal SFA or GoBack Crossing Catheter (UPSTREAM PERIPHERAL)
3. Angioplasty
- ULTRASCORE Balloon 5.0/100 mm (BARD)
- Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD)

CLINICAL DATA
Art. hypertension, CAD, deep vein thrombosis and LE 10/2018, prostate carcinoma 2014 healed

IMPORTANT ITEMS
Incidental finding of the aneurysm during therapy of the LE

PROCEDURAL STEPS
1. Left axillary access 5F sheath via cut down
2. Percutanous approach both groins (Prostar XL, ABBOTT)
14F (COOK) both groins
3. Lunderquist wire through the right groin
Pig tail catheter through the left groin for imaging
Registration of the Fusion technology
4. Placement of the CMD-branched-endograft (COOK) with 4 branches by using the Fusion system
5. Placement of the bifurcated graft: Unibody (COOK) and the iliac extensions
Then closure of the groins to avoid paraplegia
6. Connection of all targetvessels through the corresponding branches using Viabahn BX (GORE) from above
7. Closure of the axillary access

CLINICAL DATA
Yearly carotid artery surveillance given diffuse vascular disease.
Asymptomatic patient with progressive LICA disease over past year.
On optimal medical therapy (ASA, clopidogrel, atorvastatin 80 mg, losartan 100 mg).
Pt unwilling to undergo carotid surgery

RISK FACTORS
CAD s/p 4vCABG 2000, prior subsequent PCI, HTN, HLD,
ischemic cardiomyopathy (EF 40%), stable angina

PRESENT STATE
Asymptomatic, denies TIA/CVA/amarosis fugax

DUPLEX
Carotid duplex Nov 2018 – RICA 157/21 cm/s ratio 2.0, LICA 290/104, ratio 5.2;
CT neck: 70-80% LICA stenosis, no significant LCCA stenosis

ANGIOGRAM
Carotid angiogram: 80% LICA bifurcation stenosis by NASCET

PROCEDURAL STEPS
1. Micropuncture femoral artery access
2. Sheath placement
- 6F 90 cm braided sheath delivery into LCCA
3. Distal embolic protection
- Nav6 Emboshield wire (ABBOTT)
4. Stenting
- Xact 10-8 x 40 mm (ABBOTT)
5. Predilatation
- 4x20 mm NC balloon (ABBOTT)
4. Postdilatation
- 5 x 30 mm NC balloon (ABBOTT)(if necessary)

CLINICAL DATA
Prostatic volume 80 ml
Negative TRUST-guided systematic biopsy due to increased PSA 6.0
IPSS: 19 (0-35), QoL: 3 (0-6), Qmax: 13.0 ml/s with voided volume of 160 ml
IIEF-5: 15 (1-25)

RISK FACTORS
Arterial hypertension

DUPLEX
Post void residual urine of 100ml

PRESENT STATE
Lower urinary tract symptoms due to BPH (confirmed by urology department)
No successful medication therapy for more than 6 month, refusing operative therapy

PROCEDURAL STEPS
1. Right groin access
- ST. JUDE (ABBOTT)
2. Placement of coaxial catheter in distal aorta
- RIM 4F (CORDIS) or alternative (MERRIT Medical)
- Alternative wire: Cirrus 14“ (COOK)
3. Large-FOV-dyna CT for determination of anatomy and origins of the prostatic arteries
4. Placement of microcatheter in the left prostatic artery for embolization
- Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT Medical)
- Embozene 250 μm (BOSTON SCIENTIFIC), alternative: 400 μm (BOSTON SCIENTIFIC)
5. Placement of the microcatheter in the right prostatic artery for embolization
- Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT Medical)
- Embozene 250 μm (BOSTON SCIENTIFIC)

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
CAD, MI and PTCA 2007, art. hypertension

PRESENT STATE
Previous Onyx Embolization of type2 EL‘s
Still growing aneurysm
Degeneration of the aneurysm neck with loss of sealing

PROCEDURAL STEPS
1. Cut down left axillary artery and double puncture
2. Placement of two 7F Shuttle sheaths from above
3. Percutanous approach right groin Prostar XL 10F (ABBOTT)
Placement of 14F sheaths (COOK)
Puncture of the left groin for imaging through a 5F sheath
4. Cannulation of both renal arteries from above
5. Placement of the Endurant aortic extension ETCF 36 36 C 49 (MEDTRONIC)
6. Placement of the Chimney stent-grafts in both renal arteries: Advanta V12 (Getinge)
7. Closure of the accesses

CLINICAL DATA
16 mm neurysm of the lienal artery with growth tendency

RISK FACTORS
Arterial hypertension, rheumatoid arthritis

PROCEDURAL STEPS
1. Right groin retrograde access
- 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
- 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
2. Placement of diagnostic catheter in main hepatic artery
- 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
- Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
3. Placement of microcatheter in splenic artery
- Progreat 2.7F (TERUMO)
- alternative wire: Cirrus 14‘ (COOK)
4. Embolization
- PENUMBRA Coils system
5. Control angiography
6. Puncture site occlusion
- Vascular Closure System Exoseal (CORDIS) and pressure dressing

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Pt with 4 year history of PAD, s/p multiple interventions of the iliac, femoropopliteal and tibial vessels for claudication and previous critical limb Ischemia. Originally treated multilevel for left foot ulceration in 2015, restenosis of iliacs treated wtih stent grafts, SFA occlusion attempted to be treated with cilostazol but no effect at 3 months. Now s/p Super stent in 2015 that occluded, treated with DCB and proximal DES extension in 2017. Now with recurrent RC II claudication and duplex scan with restenosis
ABI R: .96 and L: .88

RISK FACTORS
DM II, CAD, HTN, hyperlipidemia, past smoker

DUPLEX
Peak velocity of 343 within the stent

PROCEDURAL STEPS
1. Contralateral femoral access
2. Placement of 7F or 8F braided sheath
3. Excimer Laser debulking
4. Hig pressure PTA
5. If good result DCB, if poor result consider DES
6. Suture based sheath removal

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford class 3, severe claudication both calves, walking capacity 50 m,
ABI left 0.3, ABI right 0.6
COPD, biliar carcinoma 12/17

RISK FACTORS
Arterial hypertension, hyperlipidemia, nicotine abuse (40PY)

ANGIOGRAPHY
Occlusion of left CIA and EIA and of both SFA

PROCEDURAL STEPS
1. Left femoral access
- 7F 25 cm Radiofocus Introducer (TERUMO)
- 0.035“ SupraCore guidewire 300 cm (ABBOTT)
Left brachial approach:
- 6F 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 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
- Covera Plus vascular covered stent for the external iliac artery (BARD)

CLINICAL DATA
POAD Fontaine IIb / Rutherford 3 right leg, walking distance < 100 m
Unsuccesful recanalisation attempt December 2018 in referring clinic
ABI: 0.6/1.0

RISK FACTORS
Smoker, hypercholesterinemia

ANGIOGRAM
80% ostial DFA stenosis, flush occlusion of SFA origin, reconstitution distal SFA

PROCEDURAL STEPS
1. Access
- 7F cross-over Sheath (TERUMO)
2. Directional atherectomy of DFA origin
- SilverHawk (MEDTRONIC)
3. Recanalisation of SFA
- Woodpecker (Upstream Medical)
4. Placement of a filter protection device into the popliteal artery
- Spider (MEDTRONIC)
5. DA of SFA
- SilverHawk (MEDTRONIC)
6. DCB angioplasty
- IN.PACT Pacific (MEDTRONIC)
7. Stent on indication
- BioMimics (Veryan/Otsuka)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Critical limb ischemia, minor gangrene dig 1 left,
restpain and severe claudication left, ABI left 0.2
Multiple interventions both legs, D4-Amputation right 11/2018

RISK FACTORS
Art. Hypertension, diabetes mellitus type 2 with multiple complications

PROCEDURAL STEPS
1. Antegrade approach left groin
- 6F 55 cm sheath (COOK)
2. Guidewire passage antegrade into posterior tibial artery
- 0.014“ Command (ABBOTT)
- 0.014“ PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
- In case of failure: retrograde approach
3. PTA
- Vessel preparation – scoring balloon (VascuTrak, BARD)
- Lutonix BTK DCB (BARD)
4. In case of dissections after DCB, provisional placement of nitinol „tacks“
- Tack Endovascular System (Intact Vascular)

CLINICAL DATA
Critical limb ischemia bilateral, ulcerations both feet (right forefoot, left lateral foot)
ABI left 0.54, Rutherford class 5
PTA right SFA 12/2018
Iliac stenting 2013/2014
CAD with PTCA 2018
CEA right internal carotid artery 2015
Renal transplantation 2006

RISK FACTORS
Art. hypertension, diabetes mellitus type 2

PROCEDURAL STEPS
1. Right femoral retrograde and cross-over approach
- 8F Balkin Up&Over 40 cm sheath (COOK)
2. Guidewire passage
- 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
3. Rotarex-thrombectomy
- 8F (STRAUB MEDICAL)
4. PTA/stenting on indication
- Pacific 5/120 mm balloon (MEDTRONIC)
- Eluvia DES 6.0/120 mm stent (BOSTON SCIENTIFIC) or Zilver PTX (COOK)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Severe claudication left calf, walking capacity 200 meters
ABI left 0.68, Rutherford class 3
PTA/stenting left SFA 2015 (Zilver-PTX)
PTA right SFA, DCB-treatment 12/2018
Dilatative cardiomyopathy, EF 35%

RISK FACTORS
Arterial hypertension, former smoker

ANGIO
Complete in-stent reocclusion left SFA

PROCEDURAL STEPS
1. Right groin retrograde and cross-over approach
- 8F Balkin Up&Over sheath (COOK)
2. Guidewire passage
- 0.018“ Command 18, 300 cm (ABBOTT)
- 0.018“ Quick-Cross support catheter, 135 cm (PHILIPS)
3. Thrombectomy
- Rotarex 8F (STRAUB MEDICAL)
4. PTA
- Luminor 5.0/200 mm DCB (iVASCULAR)
- potentially with filter protection Spider-filter 6 mm (MEDTRONIC)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford Class 3, severe claudication left, walking capacity 50m, ABI left 0.45
PTA both CIA 2012, multiple interventions right,
failed recanalization attempt left SFA 12/2018
CAD, CABG 2012, atrial fibrillation, renal impairment

RISK FACTORS
Arterial hypertension, hyperlipdemia, former smoker (30PY)

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)
- GoBack Crossing-Catheter (UPSTREAM-PERIPHERAL)
3. Retrograde guidewire passage
Access via the proximal anterior tibial artery:
- 9 cm 20 Gauge Spinal Needle (BD)
- 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
- 6.0/20mm 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 6.0/150 mm (GORE)
- Relining with Supera Interwoven Nitinol stent (ABBOTT)

CLINICAL DATA
Multiple skleroses since 2015, plasmapheresis via central venous catheter since 2016, central venous catheter
removal 06/2018 due to thrombosis of right anonymous vein

PRESENT STATE
Chronic swelling of right arm and neck due to venous CTO of right anonymous vein

PROCEDURAL STEPS
1. Duplex guided puncture and access via right common femoral vein and right subclavian vein
- Insertion of 5F 90 cm shuttle sheath femoral (COOK) and 8F 45 cm destination sheath via subclavian vein
2. Recanalization of anonymous vein occlusion
- Command 18 wire (ABBOTT) and 0,018“ Quickcross caheter (PHILIPS)
3. Predilatation
- 4 mm ULTRAVERSE balloon (BARD)
4. Stent implantation
- 10 mm COVERA covered stent (BARD)
5. Postdilatation
- 10 mm CONQUEST high pressure balloon
6. Access managment by manual compression and pressure dressing

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Thoracoabdominal aneurysm (max. diameter 61mm), progressive (41mm 2014)
Open repair of an infrarenal aortic aneurysm 10/2014
CAD, PTCA 2014

RISK FACTORS
Arterial hypertension

CT
Progressive aneurysm, max. diameter 61 mm

IMPORTANT ITEMS
Endovascular repair planned (CMD, COOK)
Staged segmental artery coilembolisation
for prevention of spinal-cord-ischemia planned

PROCEDURAL STEPS
1. Right femoral approach
- 6F 25 cm sheath (TERUMO)
2. Angiography
of the segmental arteries Th 12 - Th 10 bilateral
Selection of the arteries to be embolized during the first session
3. Coilembolisation
- IMA 6F guiding catheter (MEDTRONIC)
- SIM-I 5F diagnostic catheter (CORDIS-CARDINAL HEALTH)
- 0.014“ PT2 guidewire (BOSTON SCIENTIFIC)
- Progreat Micro Catheter System 2.7F 130 cm (TERUMO)
- Micro-Coils (COOK)

CLINICAL DATA
Gangrene of III and ulceration of IV toes
Previous twice occluded fem-pop by-pass
Failed attempts of endovascular recanalization

PRESENT STATE
DM, ischemic cardiac disease
Popliteal occlusion and BTK/BTA occlusion

PROCEDURAL STEPS
1. Antegrade US puncture
- 6F 11 cm sheath deployment (TERUMO)
2. Retrograde distal leg vein (posterior tibial vein) US puncture
- 6F 11 cm sheath deployment (TERUMO)
3. Guidewires
- Retrograde 0.018 vein wiring
- Antegrade 0.014 arterial wiring
4. AVF level identification
5. Retrograde in-vein balloon inflation and antegrade arterial Outback deployment and balloon puncture
6. Antegrade vein wiring and valves penetration to foot
Venous anatomy evaluation
7. Dilatation
- Venous non compliant Dorado (BARD) POBA dilatation and valves rupture
8. Stenting
- Proximal Covered BARD Fluency SES deployment
9. US guided closure
- 6F Angio-Seal

CLINICAL DATA
Restpain right, ABI 0.23; walking capacity 20 meters
Rutherford class 4
CAD, NYHA II
PTA left BTK-arteries 12/2018

RISK FACTORS
Arterial hypertension, former smoker

MRA
Aneurysm of the left popliteal artery (35 mm), popliteal occlusion right

PROCEDURAL STEPS
1. Right antegrade access
- 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
2. Guidewire passage from antegrade
- 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
- GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
3. Atherectomy and PTA of the distal SFA-lesions
- JetStream atherectomy device (BOSTON SCIENTIFIC)
- RANGER DCB 6 mm (BOSTON SCIENTIFIC)
4. Guidewire passage of the tibioperoneal-trunk occlusion
- 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
5. In case of failure: retrograde approach via peroneal artery
- 7cm 21 Gauge needle (COOK)
- Pedal access-kit (COOK)
- Connect 250T guidewire (ABBOTT)
- CXI 0.018“ Support catheter (COOK)
6. PTA + Stenting of the TPT
- MiniTrek 4.0/20 mm OTW-balloon (ABBOTT)
- Xience Prime 4.0/38 mm DES (ABBOTT)

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Fontaine IV / Rutherford 5 both legs
Stent angioplasty distal infrarenal aorta & DCB SFA left leg 12.12.2018
Recanalisation & stentimplantation both CIA & EIA and SFA recanalisation left leg 2011
ABI non-diagnostic due to mediacalcification

RISK FACTORS
Hypertension, hyperlipidemia

DUPLEX
Moderate stenosis of right CFA & SFA origin, high grade stenosis of popliteal artery

PROCEDURAL STEPS
1. 7F cross-over sheath
2. Lesion crossing
- 0.035“ Glidewire (TERUMO) guided by a 5F vertebral catheter (CORDIS)
3. Embolic protection
- Introduction of a Spider embolic protection system (MEDTRONIC)
4. Atherectomy
- Directional atherectomy (HawkOne, MEDTRONIC) of CFA, SFA origin, and popliteal artery
5. Angioplasty
- Drug coated balloon angioplasty (IN.PACT Pacific, MEDTRONIC or Tulip, ACOTEC)
6. Sheath removal with closure device
- Femoseal (TERUMO)

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
PAOD Rutherford class 3, claudication left calf, walking capacity 150 m, ABI left 0.65
Failed recanalization attempt (thrombectomy) 07/18 elsewere

RISK FACTORS
Arterial hypertension, hyperlipidemia, current smoker

PROCEDURAL STEPS
1. Right femoral access and cross-over approach
- 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
2. Passage of the occlusion left 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 ATA
- 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 with DCBs
- Passeo 18 balloon 5 x 150 mm (BIOTRONIK)
- 5 mm Passeo 18 Lux DCB (BIOTRONIK)
5. Stenting on indication
- Pulsar 18-T3 stent (BIOTRONIK)

CLINICAL DATA
Type 2 diabetes, HTA, obesity (BMI >30)
Incisional hernia, splenectomy

PROCEDURAL STEPS
1. L: Advance 16F 30cm GORE Dryseal sheath in the LCFA over Lunderquist
- 2 x 6F 55 cm COOK Ansel sheaths
- 100 U/kg Heparin (Target ACT≥250)
- L (through one of the 6F): advance long pigtail catheter
- R: 10F sheath
- Lunderquist (dilators up to 20)
2. Fluoroscopy to locate fenestrations gold markers
- R: Advanced fenestrated endograft
- Aortic angiogram
- Fenestrated endograft deployment
3. R: Rosen wire advanced through preloaded catheter
- Exchange preloaded catheter for a 6F 90 cm COOK Ansel sheath
- Exchange Rosen for a V18 300 cm wire
- Retrieve 6F to the level of the fenestration
- Retrieve the 6F dilator
- Puncture valve
- DAV + TERUMO Roadrunner through 6F for renal artery catheterisation
- Renal angiogram
- Exchange TERUMO for Rosen
- Retrieve V18 wire
- Advance 6F into the renal artery
- Advance BENTLEY Begraft bridging stent to parking position
4. Same for controlateral renal artery
5. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen
- Advance 6F below the fenestration (SMA/CT)
- USL + TERUMO Roadrunner through 6F sheath to catheterise target vessel (SMA/CT)
- Vessel angiogram
- Exchange TERUMO for Rosen wire
- Advance 6F into target vessel
- Advance BENTLEY Begraft bridging stent to parking position
6. R: Release diameter-reducing ties
- Proximal and distal attachments
- Nose retrieval under fluoroscopy
7. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval
- Flare the aortic portion of stent with 9-20 mm balloon
- Advance 6F back into the renal stent
- Angiogram
- same for left renal artery
8. L: SMA/CT stent deployment (3-4cmm protruding in the aortic lumen) after 6F retrieval
- Flare the aortic portion of stent with 10-20 mm balloon
- Advance 6F in the SMA
- CT stent
- Angiogram (SMA: exchange Rosen for TERUMO wire)
9. R : Remove nose under fluoroscopy
- Remove fenestrated device delivery system
L: Withdraw 6F sheath in 16F
- insert and deploy bifurcated device and iliac limbs
10. CODA balloon to mold overlaps and distal sealing zones
- Pigtail catheter
- Angiogram + non-contrast CBCT

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
CAD, PTCA 2006 and 2012, artrial fibrillation, art. hypertension, PAD, COPD, left hemicolectomy due to cancer 9/2018

IMPORTANT ITEMS
Stent-PTA left CIA 2001, very narrow iliac arteries

PROCEDURAL STEPS
1. Percutaneous approach both groins with 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 12 F 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.

Information will follow in due time. Thank you for your understanding.

Information will follow in due time. Thank you for your understanding.

CLINICAL DATA
Severe claudication and weakness both legs and buttocks, progressive,
Walking capacity 50 meters, Rutherford class 3
CAD, PTCA 2010, chronic heart failure, EF 40%

RISK FACTORS
Art. hypertension, nicotine abuse

CT
Severely calcified occlusion of the infrarenal aorta and iliac arteries

PROCEDURAL STEPS
1. Transbrachial bilateral approach
- 7F 90 cm Check-Flo-Performer sheath (COOK)
2. Transfemoral retrograde approach
- 8F 25 cm sheath (TERUMO)
3. Transbrachial guidewire passage
- 0.035“ Stiff angled glidewire, 260 cm (TERUMO)
- 6F 100 cm Multipurpose guiding catheter (MEDTRONIC)
- 5F 125 cm Judkins Right diagnostic catheter (CORDIS-CARDINAL HEALTH)
4. Snaring of the gudewire-tip from antegrade into the retrograde femoral sheaths
- 6F Judkins Right guiding catheter
5. Renal protection
- Implantation of 2 covered stents (LifeStream 7/26 mm, BARD)
6. PTA of the infrarenal occlusion from retrogade
- 6.0/120 mm Admiral balloons (MEDTRONIC)
7. Implantation of covered stents
- BeGraft covered stent (BENTLEY)

CLINICAL DATA
Dizziness, syncope 12/2018
Recurrent minor strokes 2017,
Attempt to recanalize the subclavian artery via a femoral approach 12/2018
CAD, PTCA 2012
PAOD, stenting iliac arteries right
Nicotine abuse

DUPLEX
Occlusion right vertebral artery, high-grade stenosis right internal carotid artery,
Occlusion left subclavian artery

PROCEDURAL STEPS
1. Left transbrachial approach
- 6F 55 cm Flexor Check-Flo Introducer Raabe-configuration (COOK)
2. Transfemoral retrograde approach
- 8F 25 cm sheath (TERUMO)
- 8F Judkins-Right guiding catheter (MEDTRONIC)
3. Transbrachial and transfemoral guidewire-passage
- 0.018“ Connect Flex guidewire (ABBOTT)
4. Snaring of the gudewire-tip from antegrade or retrograde and pull-through-wire
5. PTA and stenting
- Pacific 5.0/40 mm balloon (MEDTRONIC)
- BeGraft covered peripheral stent (BENTLEY)

CLINICAL DATA
Severe claudication right calf, ABI 0.67; walking-capacity 150 meters
Rutherford class 3
PTA/Stenting ot the infrarenal aorta and iliac arteries 2015
PTA stenting both SFA 2016
PTA of a reocclusion left SFA 12/2018

RISK FACTORS
Art. Hypertension, heavy smoker

PRESENT STATE
Reocclusion right SFA since 2 months, slow onset of symptoms

PROCEDURAL STEPS
1. Left retrograde and cross-over approach
- 7F 40 cm Up&Over sheath (COOK)
2. Guidewire passage from antegrade
- 0.018“ Command 18 guidewire, 300 cm (ABBOTT)
- GoBack Crossing-Catheter (UPSTREAM PERIPHERAL) in case of failure to pass with a GW
3. Potentially retrograde stent puncture
4. Guidewire passage of the tibioperoneal trunk occlusion
- 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
5. Pre-treatment
- Rotarex 6F Thrombectomy (STRAUB MEDICAL)
6. PTA + Stenting
- RANGER DCB within the stents (BOSTON SCIENTIFIC)
- Evaluation of the stentfracture and potentially relinining with Supera stents (ABBOTT)
- Eluvia DES for the proximal SFA (BOSTON SCIENTIFIC)