LINC 2019 live case guide

Paris

• Thursday, January 24th: 9:54 - 10:18, Room 2 - Main Arena 2

  Case 67 – Live case from Paris

  Center:

  Paris

  Case 67 – Live case from Paris

  Information will follow in due time. Thank you for your understanding.
• Thursday, January 24th: 16:18 - 16:53, Room 2 - Main Arena 2

  Case 71 – FEVAR for type 4 thoraco abdominal aortic aneurysm

  Center:

  Paris

  Case 71 – PAR 02: female, 72 years (V-M)

  Operators:

  • Stéphan Haulon,
  • Dominique Fabre,
  • J. Mougin,
  • L. Freycon,
  • B. Pochulu

  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

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