CLINICAL DATA
PAOD Rutherford 3, severe claudication right calf,
walking capacity 150m, ABI right 0.65
PTA with DCBs 10/18
Osteoporosis

RISK FACTORS
Arterial hypertension, hyperlipidemia, current smoker (40PY)

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
PAOD Rutherford III left, painfree walking distance 10 m, ABI left: 0.3
CAD, CABG 2017, terminal kidney disease (dialysis)

RISK FACTORS
Arterial hypertension, 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
– 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
– Retrograde approach via left peroneal artery
4. Vessel preparation/ PTA
– 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
– Conquest high pressure balloon on indication (BARD/ BD)
5. Stenting
– 5.5/120 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

CLINICAL DATA
PAOD Rutherford 5 left, ulceration Dig. 5 left, ABI right 0.22, left 0.33
Severe claudication both calves, absolute walking capacity 30–50 meters

RISK FACTORS
Art. hypertension, diabetes mellitus type 2, nicotine abuse (35PY)

CT
Chronic, thrombus-containing occlusion of the infrarenal aorta and severe stenosis both iliac arteries

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
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)

CLINICAL DATA
PAOD Rutherford 3, walking capacity 100 m, ABI right 0.49
PTA/stent left SFA 12/2019

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

PROCEDURAL STEPS
1. Left groin and cross-over approach
– Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
– 0.035'' SupraCore guidewire 30 cm (ABBOTT)
– 7F - 40 cm Balkin Up&Over sheath (COOK)
2. Guidewire passage of the occlusion
– 0.018'' Command 18 300 cm (ABBOTT)
– 0.035'' QuickCross support catheter, 135 cm (PHILIPS)
– Exchange to a 0.014'' Floppy ES guidewire 300 cm (ABBOTT)
– Confirm intraluminal position with Vision PV 0.14 IVUS (PHILIPS)
3. Laser atherectomy
– 7F Turbo Power Laser with Turbo Elite 2.3 mm catheter (PHILIPS)
4. PTA with DCBs
– Stellarex 5.0/120 mm or 6.0/120 mm DCBs (PHILIPS)
5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 3 right, walking capacity 150m
DCB-PTA right 11/2017, ABI right 0.66
Multiple interventions left SFA (stent, PTA, DCB) COPD

RISK FACTORS
Arterial hypertension, hyperlipidemia, nicotin abuse (50PY)

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. Passage of the occlusion right 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
– 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. Vessel preparation
– Pacific 2.0/120 mm balloon (MEDTRONIC)
– VascuTrak 5.0/120 mm balloon (BARD/BD)
5. Stenting on indication
– 5 mm or 6 mm Biomimics 3D stent (VERYAN MEDICAL)

CLINICAL DATA
Critical limb ischemia right, rest-pain right forefoot
Walking capacity 50 meters, ABI right 0.49

Imaging
Duplex: occlusion of all BTK-arteries
DSA: TPT-occlusion, long occlusions of the ATA and PTA

PROCEDURAL STEPS
1. Antegrade access right
– 6F 55 cm sheath Flexor Check-Flo Introducer Raabe Modification (COOK)
2. Guidewire passage of the TPT
– 0.014'' Command ES (ABBOTT) or
– 0.014'' Winn 200 T (ABBOTT)
3. Atherectomy of the TPT
– TurboHawk SX-C (MEDTRONIC)
potentially also atherectomy of the ATA-origin
4. Balloon dilatation of the TPT and ATA
– Amphirion Deep (MEDTRONIC)
5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 3, claudication left calf, walking capacitiy 50m, ABI left 0.45

RISK FACTORS
Arterial hypertension, hyperlipidemia, nicotine abuse (35PY)

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:
v5F 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/BD)
– LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD/BD)
– Covera Plus vascular covered stent for the external iliac artery (BARD/BD)

CLINICAL DATA
PAOD Rutherford 5, ulceration dig. 1 right, severe claudication right calf, walking capacity 20 m, ABI right 0.45
Amputation Dig. 5 right 2015

RISK FACTORS
Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

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
– 0.035'' stiff, angled glidewire, 260 cm (TERUMO)
– 0.035'' Seeker support catheter, 135 cm (BARD/ BD)
3. Angioplasty
– UltraScore 5.0/300 mm balloon (BARD/BD)
– Lutonix GEOALIGN marking system DCB 6.0/120 mm (BARD/ BD)
4. Stenting on indication
– LifeStent (BARD/ BD)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford class 3, severe claudication left, walking capacity 50 m, ABI 0.5
Multiple interventions both SFA

RISK FACTORS
Arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Right femoral retrograde and cross-over approach
– 7F 55 cm Check-Flo Performer, Raab Modification (COOK)
2. Passage of the occlusion left SFA
– 0.018'' V-18 or Victory guidewire (BOSTON SCIENTIFIC)
– 0.018'' Rubicon support catheter (BOSTON SCIENTIFIC)
3. Guidewire passage and filter placement
– 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
4. Atherectomy
– 2.4/3.4 mm JetStream atherectomy device (BOSTON SCIENTIFIC)
5. PTA with DCBs and/or stenting
– Ranger DCB balloon (BOSTON SCIENTIFIC)
– Eluvia drug-eluting stent (BOSTON SCIENTIFIC)

CLINICAL DATA
Symptomatic infarenal aortic aneurysm (max. diam. 47 mm)
Occasionally back-pain and abdominal pain

RISK FACTORS
Arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Bilateral femoral percutaneous access
– Preloading of Proglide-Systems (ABBOTT)
2. Coilembolisation of lumbar segmental arteries before EVAR
– 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)
– Microvascular Plugs (MEDTRONIC) and Amplatzer Plug for the IMA (ABBOTT)
3. Implantation of stentgraft system
– Altura Ultra Low Profile stentgraft system (LOMBARD MEDICAL)

CLINICAL DATA
PAOD Rutherford 3, severe claudication left > right, walking capacity 20 m, ABI left 0.45, ABI right 0.7
Aorto-bifemoral bypass (on CFA) 2007, failled recanalization attempt left elsewere

RISK FACTORS
Arterial hypertension, hyperlipidemia, former smoker, diabetes mellitus type 2

IMAGING
Angiography 01/20: midgrade infrarenal aortic stenosis, high grade stenosis of distal bypass-anastomosis and DFA left, SFA-occlusions both sides

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 placement of an embolic protection
– Command 18 guidewire, 300 cm (ABBOTT)
– Placement of a SpiderFX 6 mm Embolic Protection System (MEDTRONIC)
3. Atherectomy
– Directional atherectomy with HawkOne (MEDTRONIC) of CFA and DFA origin
4. PTA with DCB
– 5 or 6 mm IN.PACT Admiral balloon (MEDTRONIC)
5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)

CLINICAL DATA
Asymptomatic highgrade stenosis of the internal carotid artery left, dizziness
Mamarian carcinoma 2016 (surgery and radiation)
CEA left 09/18, stroke 2013

RISK FACTORS
Arterial hypertension, hyperlipidemia, renal impairment G3

DUPLEX
4.2 m/sec, left distal internal carotid artery

PROCEDURAL STEPS
1. Right groin access
– 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
– 0.035'' SupraCore guidewire (ABBOTT)
– 7F 90 cmTuohy-Borst sheath (COOK)
2. Cerebral protection
– Filter-wire EZ (BOSTON SCIENTIFIC)
3. Predilatation and stenting
– 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
– 8/20 mm Roadsaver Carotid stent (TERUMO)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 5, non-healing forefoot ulcerations, severe claudication left, walking capacity 20 m, ABI left 0.2
PTA left peronal artery 12/19 with no clinical improvement

RISK FACTORS
Arterial hypertension, hyperlipidemia, diabetes mellitus

PROCEDURAL STEPS
1. Antegrade access left groin
– 6F 55 cm Check-Flow Performer (COOK MEDICAL)
2. Guidewire passage anterior tibial artery
– 0.014'' Command (ABBOTT)
– 0.014'' PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
In case of failure: retrograde approach
3. Vessel preparation
– 2.5/100 m Amphirion Deep ballon catheter (MEDTRONIC)
4. PTA with Sirolimus coated balloon
– 3.0/40 mm MagicTouch SCB balloon (CONCEPT MEDICAL)
5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)

CLINICAL DATA
Critical limb ischemia, minor gangrene dig 1 - 4 right, restpain and severe claudication right, ABI right 0.3
PTA right EIA and CFA 12/19
CAD, stroke 10/2019, COPD, MGUS

RISK FACTORS
Heavy smoker (50PY), arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Left femoral access and cross-over approach
– 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
2. Passage of the occlusion right SFA
– 0.018'' Command guidewire (ABBOTT)
– 0.018'' Carnelian support catheter, 135 cm (BIOTRONIK)
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
– Pulsar 18-T3 stent (BIOTRONIK)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 3, claudication left calf, walking capacity 150m, ABI left 0.63

RISK FACTORS
Hyperlipidemia, current smoker

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 (ABBOOTT)
– 6F Balkin Up&Over sheath, 40 cm (COOK)
2. Passage of the occlusion left SFA
– 0.018'' Advantage guidewire (TERUMO)
– 0.018'' CXI support catheter (COOK)
in case of failure:
– GoBack crossing catheter (UPSTREAM PERIPHERAL)
3. Vessel preparation left SFA with scoring balloon
– UltraScore 5.0/300 mm balloon (BARD/BD)
4. Primary stenting
– 6 mm Eluvia DES (BOSTON SCIENTIFIC)

CLINICAL DATA
Critical limb ischemia, ulceration dig 2 right,
restpain and severe claudication right, ABI right 0.2
PTA/stent right popliteal artery 12/19 with no clinical improvement
CAD, AMI 2010, CABG 2010

RISK FACTORS
Arterial hypertension, diabetes mellitus type 2, hyperlipidemia

PROCEDURAL STEPS
1. Antegrade approach right groin
– 6F 55 cm sheath (COOK)
2. Guidewire passage antegrade into anterior 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/ BD)
– Lutonix BTK DCB (BARD/ BD)
4. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)

CLINICAL DATA
Severe claudication left, ABI 0.65; walking capacity 100 meters
Rutherford class 3
PTA/stenting left CIA and left SFA 07/19
Stroke 1997

RISK FACTORS
Heavy smoker (50PY), arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Right groin retrograde and cross-over approach
– 8F Balkin Up&Over sheath (COOK)
2. Guidewire passage
– 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
– 0.018'' Quick-Cross support catheter, 135 cm (PHILIPS)
3. Thrombectomy
– Rotarex 8F (STRAUB MEDICAL)
4. PTA with DCBs
– Ranger DCB 5 mm (BOSTON SCIENTIFIC)

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 5, non-healing forefoot ulcerations, mediasclerosis, ABI > 1.4
PTA right popliteal artery 12/19 and proximal ATA
Cholangiocarcinoma with metastasis 02/18

RISK FACTORS
Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

PROCEDURAL STEPS
1. Right groin antegrade access
– 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
2. Right distal venous tibial retrograde access
– 5F sheath Introducer 2¨ (TERUMO)
3. Arteriography and phlebography to define the optimal level for arterio-venous crossing
4. 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)
5. 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)
6. 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

CLINICAL DATA
PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0.45
Multiple interventions right SFA and popliteal artery, D1-amputation right 10/19
CAD, ICM (EF 20%), AMI 2001, CABG 2001, ICA-occlusion left

RISK FACTORS
Arterial hypertension, current smoker, diabetes mellitus type 2, hyperlipidemia

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 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)
– GoBack crossing catheter (UPSTREAM PERIPHERAL)
4. PTA and Stenting
– 5.0/20 mm and 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
– 6.0/20 Conquest non-compliant high pressure balloon (BARD/BD)
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)

Detailed information will be shown in the video itself!

CLINICAL DATA
PAOD Rutherford 3 left, walking capacity 100 m, claudication left calf, ABI left 0.57
PTA of a 8 cm long profunda femoris occlusion right 10/2019 and right SFA 12/19
CAD, ICM (EF 35%), CABG and aortic valve replacement 09/19, atrial fibrillation, pacemaker 09/19

RISK FACTORS
Arterial hypertension, hyperlipidemia, current smoker (40PY)

PROCEDURAL STEPS
1. Right groin and cross-over approach
– Judkins Right 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
– 0,035'' SupraCore guidewire 30 cm (ABBOTT)
– 7F-40 cm Balkin Up&Over sheath (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 occluded SFA
– 7 cm 18 Gauge needle (COOK)
– 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
– 4F-10 cm Radiofocus Introducer (TERUMO)
– GoBack crossing catheter (UPSTREAM PERIPHERAL)
4. PTA with normal and high pressure balloons
– 6.0/ 20 mm Admiral Xtreme balloon (MEDTRONIC)
– 7.0/ 20 mm Conquest non-compliant high pressure balloon (BARD/ BD)
5. Stenting
– 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)
– Eluvia drug-eluting stent for proximal SFA (BOSTON SCIENTIFIC)

CLINICAL DATA
Subacute type-B-dissection, progressive dilatation of the descending thoracic aorta
EVAR 2019 elsewhere
Coilembolisation of segmental arteries to reduce the risk of spinal ischemia during Stabilise therapy
Implantation of a thoracic dissection stentgraft 1/2020

PROCEDURAL STEPS
1. Access right groin
– 16F sheath (COOK) right groin after preloading of Proglide systems (ABBOTT)
2. Confirmation of guidewire position in the true lumen by IVUS
– Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
3. Stent implantation
– Dissection Endovascular stent (COOK)
4. Postdilatation of the dissection stent
– Reliant balloon (MEDTRONIC)

CLINICAL DATA
PAOD Rutherford 4, restpain and severe claudication right calf, walking capacity 10 m, ABI right 0.2, failed recanalization attempt 09/19 elsewhere

RISK FACTORS
Arterial hypertension, hyperlipidemia, diabetes mellitus type 2

PROCEDURAL STEPS
1. Left groin and cross-over approach
– Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
– 0.035'' SupraCore guidewire 30 cm (ABBOTT)
– 7F-40 cm Balkin Up&Over sheath (COOK)
2. Second attempt of guidewire passage from antegrade
– 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
– GoBack crossing catheter (UPSTREAM PERIPHERAL) or retrograde approach via anterior tibial artery in case of failure to pass
3. Vessel preparation
– UltraScore 5.0/300 mm scoring balloon (BARD/ BD)
– 4.0 - 6.0 mm Armada 35 balloon (ABBOTT)
– Conquest high pressure balloon on indication (BARD/ BD)
4. Stenting
– Supera Interwoven Nitinol stent (ABBOTT)

CLINICAL DATA
PAOD Rutherford 4, severe claudication left and rest-pain, walking capacity 20 m, ABI left 0.43
Failed recanalization attempt left, elsewhere

RISK FACTORS
Arterial hypertension, hyperlipidemia, nicotine abuse

PROCEDURAL STEPS
1. Right groin and cross-over approach
– Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
– 0.035'' SupraCore guidewire 30 cm (ABBOTT)
– 7F-40 cm Balkin Up&Over sheath (COOK)
2. Second attempt of guidewire passage of the occlusion from antegrade
– Visions PV 0.035'' Digital IVUS catheter (VOLCANO-PHILIPS)
3. In case of failure to pass with a GW from antegrade
– GoBack crossing catheter (UPSTREAM PERIPHERAL)
or retrograde approach via peroneal artery:
– 21 Gauge 9 cm needle (B. Braun)
– 0.018Ó V-18 Control GW, 300 cm (BOSTON SCIENTIFIC)
– 0.018Ó CXC support catheter, 90 cm (COOK)
4. Laser atherectomy
– 7F Turbo Power Laser with Turbo Elite 2.3 mm cathether (PHILIPS)
5. PTA with DCBs
– 5.0/80 mm and 6.0/80 mm iLuminor DCB (iVASCULAR)
6. Stenting
– Supera Interwoven Nitinol stent in case of severe recoil (ABBOTT)

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

CLINICAL DATA
No relevant prior vascular history
One month ago transient ischemic attack with left-sided hemyparesis

RISK FACTORS
Hypertension, hypercholesterolemia

IMAGING
DUS: 85% RICA stenosis with significant flow acceleration
CT angio: sub-occlusive right ICA disease with presence of thrombus

PROCEDURAL STEPS
1. Right femoral access (9F)
2. Selective right carotid cannulation
– JR4 guiding cathether (CORDIS/CARDINAL HEALTH)
3. Proximal protection
– MOMA 9F (MEDTRONIC)
4. Lesion crossing
– 0.014‘‘ guidewire
5. Direct stenting
– C-Guard double mesh stent (Inspire MD)
6. Postdilatation
– 5.0 mm Ultrasoft balloon (BOSTON SCIENTIFIC)
7. Debris aspiration (if any)

CLINICAL DATA
No CV history
Previous right SFA PTA with plain balloon
During the last 3 months severe right leg claudication (walking distance 70 m)

RISK FACTORS
Hypertension, hypercholesterolemia, previous history of smoking

DUPLEX
Distal right SFA occlusion with flow demodulation in BTK vessels

PROCEDURAL STEPS
1. Femoral access (7F)
2. Lesion crossing
– 0.018‘‘ Control Wire + BerII 4F catheter
3. Wire exchange
– 0.018‘‘ wire with 0.014‘‘ wire Choice PT (BOSTON SCIENTIFIC)
4. Embolic protection
– Distal 6.0 mm Spider FX (MEDTRONIC)
5. Directional atherectomy
– HawkOne (MEDTRONIC)
6. Balloon dilatation
– 5.0 mm Inpact Admiral drug-coated balloon (MEDTRONIC)
7. Postdilatation if needed

CLINICAL DATA
Previous CABG (LIMA to LAD, VG to posterolateral branch) + ascending aorta repalcament (2015)
Previous multiple PCI (the last one in 2017 to LCx artery)
Currently asymptomatic for angina, negative stress echo in 2019
In December 2019 episode of left-sided hemiparesis with full neurological recovery

RISK FACTORS
Hypertension, hypercholesterolemia

IMAGING
DUS: severe right carotid artery stenosis with flow acceleration up to 473 cm/sec

PROCEDURAL STEPS
1. Radial access (6F)
2. Right carotid artery selective cannulation
– IM guiding catheter
3. Support guidewire
– 0.035‘‘ Supracore wire in ECA
4. Sheath placement
– Destination 6F long 90 cm sheath (TERUMO)
5. Filter placement
– Spider FX filter (MEDTRONIC) in RICA
6. Direct stenting
– Roadsaver double mesh stent (TERUMO)
7. Postdilatation
– 5.5 mm Ultraverse balloon (BOSTON SCIENTIFIC)

CLINICAL DATA
Previous coronary angiogram (abnormal stress test) showing unobstructed coronary arteries
Severe right leg claudication (90 m) much impairing quality of life
Quit smoking 1 year ago

RISK FACTORS
Mild hypertension, dyslipidemia

IMAGING
DUS: flow demodulation in right CFA compatible with iliac occlusion
Angio MRI: right distal common iliac occlusion

PROCEDURAL STEPS
1. Left femoral access (6F)
2. Cross-over approach
– 45 cm Destination sheath (TERUMO)
3. Right femoral access
– Back-up, 4F sheath
4. Lesion crossing from cross-over system
– 0.018‘‘ Control wire or hydrophilic 0.035‘‘ wire (TERUMO)
5. Predilatation
6. Stenting with self-expandable stent
– Everflex (MEDTRONIC)
7. Postdilatation

CLINICAL DATA
Stenting of the right carotid artery in 2007 without any restenosis
Known carotid artery stenosis on the left side with rapid progression within 6 months from 60 to 80%

RISK FACTORS
Art. hypertension, hypercholesterinemia

DUPLEX
PSVR >4 m/s left ICA, no restenosis in the right CAS

PROCEDURAL STEPS
1. Transfemoral access
– short 8F TERUMO sheath right
2. Selective engaging of the left CCA
– Weinberg Catheter (COOK)
3. Teleskoping of the left ECA
– Stiff glidewire 260 cm, angled tip (TERUMO)
– 8F Vista Brite TIP IG MP shape guiding catheter (CORDIS)
4. Distal protection
– Filterwire EZ (BOSTON SCIENTIFIC)
5. Predilatation
– Maverick 3.0 x 20 mm balloon (BOSTON SCIENTIFIC)
6. Stenting
– 8 x 25 mm Roadsaver Micromesh stent (TERUMO)
7. Postdilatation
– 5 x 20 mm Emerge balloon (BOSTON SCIENTIFIC)
8. Postprodecural DAS
9. Vessel closure
– Angioseal 8F (TERUMO)

CLINICAL DATA
Stenting of a left side, high-grade CIA stenosis in 2019
Still dramatically impaired walking distance due to popliteal occlusion
ABI: 0.5 left, ABI: 0.9 right

RISK FACTORS
Arterial hypertension, smoking, hyperlipidemia

IMAGING
Duplex and Angio show popliteal occlusion and SFA stenosis

PROCEDURAL STEPS
1. Antegrade access
– 6F short Prelude Introducer sheath (Merit medical)
2. Wire passage
– 0.018''Advantage wire (TERUMO)
– Backup: Halberd wire 0.018'' or 0.014'' (Asahi)
3. Support catheter
– Carnelian 0.018'' (BIOTRONIK)
4. Predilatation
– 3 x 150 mm PTA balloon (vessel preparation)
5. P TA in the SFA and popliteal
– Sequent OTW 5 x 150 mm balloon (B.Braun)
6. Focal/ spot stenting of SFA and Politeal artery
– Multi-LOC Stent as needed (6 stents maximum) (B.BRAUN)
or using the new 2-LOC
or 3-LOC in 30 or 40 mm length as a focal stent
7. Postdilation with a standard PTA balloon
8. Vessel closure
– Angioseal 6F (TERUMO)

Detailed information will be shown in the video itself!

CLINICAL DATA
Histologically confirmed HCC lesion in Segment 5
Highly differentiated HCC, no liver cirrhosis
Initial tumor stage: T3 Nx M0. Etiology NASH, no extrahepatic metastases
3 cycles of TACE were carried out for downsizing

PROCEDURAL STEPS
1. Revision of the previous images for confirmation of the size and location of the lesion
2. Non contrast enhanced CT of the liver for planning
3. Surface marking of the location of the lesion as well as the site of puncture on the skin
4. Sterile covering followed by infiltration of the local anesthetic
Conscious sedation would be given
5. Stepwise insertion of the Microwave antenna (COVIDIEN¨ SYSTEM) within the lesion
6. The energy required for ablation will be given to induce complete ablation of the lesion
Intermittent CT images to observe the changes during the ablation procedure
7. After applying the required energy for ablation, needle track ablation will be done followed by removal of the antenna
8. Transfer of the patient to the recovery room for clinical observation

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

CLINICAL DATA
54 year old lady, normally fit and well, acute onset left leg pain – actually started in the groin, moved inferiorly, went to see family doctor in am; immediately referred to radiology

IMAGING
US scan shows acute left leg DVT, CTPA clear, CTV images to follow

PROCEDURAL STEPS
1.Prone, 10F sheath
2.Initial very gentle venography – 10 cc of dilute contrast
3. IVUS, then stiff glide wire (Merit Medical) into IVC
4.Deploy VETEX (VETEX Medical) thrombectomy device, cranial to caudal action x 2
5.Aspiration – 8F 55 cm Hockey Stick (CORDIS) +/- 7F 90 cm desitination catheter (TERUMO)
6.IVUS to identify remaining thrombus v underlying lesion
7.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds
8.Stents 14 - 16 mm diameter (BARD/BD Venovo, or COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous)
9.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds
10.IVUS and one final venogram

CLINICAL DATA
DVT x 3; Factor V Leiden deficiency; venous claudication on hills at 50 m; weight gain 9 kg, no ulcers, minimal oedema when wearing stockings; fully anticoagulated

RISK FACTORS
Factor V Leiden

PROCEDURAL STEPS
1. 3 point access RIJV, L FV, R CFV
2. General anaesthetic, urethral catheter
3. Full anticoagulation
4. Cross lesion using multiple obliques – Cxi (COOK), Rubicon (BSCI); Roadrunner wire (COOK)
5. IVUS to confirm position and to confirm dominant inflow inferiorly
6. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum
7. Stents 14 – 16 mm diameter (COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous or Bard Venovo)
8. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum
9. IVUS to confirm full stent expansion
10. One final venogram to show rapid flow

Detailed information will be shown in the video itself!

CLINICAL DATA
iCCC, Grade II of the left lobe, not resectable due to advanced liver fibrosis

IMPORTANT ITEMS
ITB waived at first line therapy resection
Intra-operative advanced fibrosis
Liver surgeons stated this as not resectable
ITB reviewed the case and recommended SIRT (probably radio-segmentectomy if possible)

PROCEDURAL STEPS
1. Right groin puncture
– 5F sheath (TERUMO)
2. Access to liver
– 5F Cobra catheter (BOSTON SCIENTIFIC)
3. Access to tumor
– Microcatheter Progreat (TERUMO)
4. Application of estimated activity
– QuiremSpheres/Holmium 166 (TERUMO)
5. Vascular closure device of the right groin
– Exoseal (CORDIS)

CLINICAL DATA
22 mm HCC in the left lobe, bridging to transplant, liver cirrhosis Child-PUGH B7, in-side MILAN, no extrahepatic disease, no macrovascular invasion

IMAGING
Typical appearence in CT Scan, in-side Milan, no extrahepatic disease

PROCEDURAL STEPS
1. Right groin puncture
– 5F sheath (TERUMO)
2. Access to hepatic
– 5F Cobra catheter (BOSTON SCIENTIFIC)
3. Access to feeding vessel
– OccluSafe Micro-Catheter (TERUMO)
4. Inflation of Ballon on MicroCath to drop the arterial stump pressure
5. Embolization with doxorubicin loaded particels
– Embozene Tandem 40 μm (Varian Medical Systems)
– Doxorubicin load: 50 mg/ml
6. Embolization up to complete filling of tumor
7. Control angiography with proof of stasis
8. Vascular closure
– Exoseal 5F (CORDIS)

Detailed information will be shown in the video itself!

CLINICAL DATA
Lower urinary tract symptoms (LUTS)
IPSS 19, mainly obstructive symptoms (0-30)
QoL 5 (0-6), IIEF-5 25
Prostate volume 75 ml, PSA 2,4 ng/ml
Qmax 8,9ml/s
Residual urinary volume 30ml
Unsuccessful medication therapy for at least 6 mo
Counselling about urol. alternative treatments

PROCEDURAL STEPS
1. Cone beam CT
2. Identification of prostate arteries and their origin
3. Cannulation of prostate arteries (left side first)
4. Guiding catheter: 4F RIM 65 cm (Merit Medical)
alternative 4F SIM1 65 cm (Merit Medical)
5. Microcatheter: Progreat 2.7F 130 cm (TERUMO)
alternative Progreat 2.0F 130 cm (TERUMO)
6. Embolic agent: Embozene 400 μm (Boston Scienfic)
7. Microcoils for embolization of possible accessory and collateral arteries: Azur18 helica 2 mm x 2 cm (TERUMO)

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

CLINICAL DATA
October 2016 emergency EVAR (Endurant MEDTRONIC) for ruptured AAA with overstenting of left hypogastric artery aneurysm, surgigal graft interposition for left CFA aneurysm

PRESENT STATE
Growing of left hypogastric from 5.5 cm 2016 to 70 mm January 2020, CT angiograms show type II EL via left inferior hypogastic artery

PROCEDURAL STEPS
1. Duplex guided antegrade puncture of proximal left CFA insertion of 5F 10 cm sheath (TERUMO) into profunda artery
2. Cannulation of left internal circumflex artery with 4F Glidecath (TERUMO)
3. Angiography and cannulation of pelvic collaterals to hypogastric aneurysm with 0,014'' wire (CONNECT, ABBOTT) and 0,014'' Microcatheter (ECHELON, MEDTRONIC)
4. Catheter flush with DMSO and embolization of EL with alcohol coplymer (ONYX, MEDTRONIC)

Detailed information will be shown in the video itself!

Detailed information will be shown in the video itself!

CLINICAL DATA
1990 Luxation trauma of right knee with emergency distal origin saphenous vein bypass, knee TEP Oct/2018, Sept 2019 Rutherford IV right leg, advanced ante- & retrograde recanalization of chronic occluded popliteal bypass and stent PTA with three 5.5 mm Supera stents

PRESENT STATE
After symptom free interval recurrent claudication and restpain right leg, CCDuplex shows TOSAKA II ISR of the popliteal vein graft with vmax of 350 cm/sec, drop of ABI from >1 in September to 0.4 right leg January 2020

PROCEDURAL STEPS
1. Duplex guided antegrade puncture of right CFA, insertion of 5F 10 cm sheath (TERUMO) angiogram of right leg
2. Change to 7F 40 cm sheath (Destination, TERUMO), placement of 4 mm filter in TP trunc (Spider, MEDTRONIC)
3. OCT-guided directional atherectomy of ISR with 7F Pantheris (Avinger)
4. Antirestenotic therapy with Passeo Lux DCB (Biotronik)
5. Filter recovery and closure of access site with Angioseal VCD (TERUMO) - 10 mm CONQUEST high pressure balloon

Detailed information will be shown in the video itself!

CLINICAL DATA
CAD-stent-PTCA 1/12, arterial hypertension

CLINICAL HISTORY
2003: Open repair of a AAA by replacement with a monoiliac graft
Preexisting occlusion of the left iliac artery
2014: BEVAR for a proximal anastomitic aneurysm and a TAAA type 4 in combination with a cross-over bypass

PRESENT STATE
New aneurysm of the thoracic aorta above the graft and growing Iliac aneurysm below the graft
Stenosis of the proximal SFA

PROCEDURAL STEPS
1. Left axillary access 5 F sheath via cut down
2. Cut down right groin below the cross over bypass
Placement of a 14F sheath (COOK)
Cannulation of the aorta up to the aortic valve and change for a Lunderquist wire (COOK)
3. Implantation of the thoracic endograft TGM 37 37 15 E (GORE)
4. Implantation of the IBD ZBIS 12 62 41 (COOK)
5. Closure of the groins in order to avoid SCI
6. Placement of the the 12F Flexor sheath from above
7. Bridging of the hypogastric branch (Advanta GETINGE, VBX or Viabahn GORE)
8. Endovascular treatment of the SFA stenosis through the bypass
9. Closure of the axillary access

Detailed information will be shown in the video itself!

CLINICAL DATA
Previous EVAR for AAA

PRESENT STATE
71 mm AAA

PROCEDURAL STEPS
1. L: Advance 18F 33cm GORE Dryseal sheath in the LCFA over Lunderquist – 1 x 6F 55 cm and 1 x 7F 55 COOK Ansel sheaths
100 U/kg Heparin (Target ACT³250)
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 – fusion mask registration – fenestrated endograft deployment
3. R: Rosen wire advanced through preloaded catheter – Exchange preloaded catheter for a 6F-90cm COOK Ansel Shuttle sheath – Exchange Rosen for a Stealcore 0.018 - 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 Stealcore
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 steps (cont.): – 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. L: SMA/CT stent deployment (3-4 mm protruding in the aortic lumen) after sheath retrieval – Flare the aortic portion of stent with 10-20 mm balloon – Advance the sheath in the SMA/CT stent/angiogram (SMA: exchange Rosen for TERUMO wire)
8. 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
9. R: Remove nose under fluoroscopy / Remove fenestrated device delivery system
L: Withdraw sheaths in 18F – insert and deploy bifurcated device and iliac limbs
10. CODA balloon to mold overlaps and distal sealing zones
Pigtail catheter – Angiogram + non-contrast CBCT

Detailed information will be shown in the video itself!

CLINICAL DATA
Lumbar spine surgery for herniated disc (1993)
Aorto bi-femoral bypass for an infrarenal AAA (1998)
Bilateral femoral arteries angioplasty and stenting, L CFA endarterectomy (2012)
Urothelial cancer resected in 2011, colon polypectomy in 2003
Chronic kidney disease (GFR 48 ml/min), hypertension, dyslipidemia

PRESENT STATE
ASA 3, ECG: sinus, TTE: LVEF: 65%, normal

PROCEDURAL STEPS
1. L: Advance 16F 30 cm GORE Dryseal sheath in the LCFA over Lunderquist – 2x 6F-55 cm COOK Ansel sheaths
100 U/kg Heparin (Target ACT³250)
L (through one of the 6F): advance long pigtail catheter
R: 10F sheath/Lunderquist/ dilators up to 20
2. R: Deployment of proximal TEVAR, just above the celiac trunk
3. Fluoroscopy to locate fenestrations gold markers
R: Advanced fenestrated endograft – Aortic angiogram – fenestrated endograft deployment
4. R: Rosen wire advanced through preloaded catheter – Exchange preloaded catheter for a 6F-90 cm COOK Ansel Shuttle sheath – Exchange Rosen for a Stealcore 0.018- 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 Stealcore wire – Advance 6F into the renal artery – Advance BENTLEY Begraft bridging stent to parking position
5. Same for controlateral renal artery
6. 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
7. R: Release diameter-reducing ties – proximal and distal attachments – Nose retrieval under fluoroscopy
8. L: SMA/CT stent deployment (3-4 mm 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: 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
10. R: Remove nose under fluoroscopy / Remove fenestrated device delivery system
L: Withdraw 6F sheath in 16F – Insert and deploy bifurcated device and iliac limbs
11. CODA balloon to mold overlaps and distal sealing zones
Pigtail catheter – Angiogram + non-contrast CBCT

CLINICAL DATA
Left lower abdominal pain radiating to left proximal thigh; aggravated by menstrual cycle
Painful varicose veins vulva and left thigh
Left-sided venous claudication

IMAGING
Ultrasound & MR findings:
- May-Thurner compression
- Retrograde flow left internal iliac vein
- No evidence for nutcracker anatomy
- Left pudendal vein feeding varicose thigh veins

PROCEDURAL STEPS
1. Local anesthesia left groin, supine position
2. Ultrasound-assisted venous access (common femoral vein), insertion 10F sheath
3. Phlebography / IVUS
4. Sinus obliquus stent (OPTIMED)

CLINICAL DATA
High-risk PE requiring CPR and systemic thrombolysis following hernioplasty, 03/2019
Complications: active retroperitoneal bleeding, sepsis, renal failure, IVC Optease filter thrombosis with massive bilateral DVT of entire deep veins below the IVC filter
Current medical condition: Dyspnea NYHA II-III, post-thrombotic syndrome with permanent leg swelling and venous claudication (particularly left side)

IMAGING
Echocardiography 11/2019: Normal LV function, normalized RV size and function, no indirect signs of pulmonary hypertension
Ultrasound 11/2019 and Chest-CT 07/2019: Patent common femoral veins, patent external iliac veins, post-thrombotic common iliac veins, occluded infrarenal IVC, patent suprarenal IVC

PROCEDURAL STEPS
Cardiopulmonary exercise test 11/2019: Max VO2: 53%

PROCEDURAL STEPS
1. General anesthesia, urinary catheter, supine position
2. Ultrasound-assisted access from:
bifemoral
– common femoral vein: left 10F sheath, right 16F sheath
right jugular vein
– 10F sheath
3. Angioplasty of iliac veins and infrarenal IVC
4. Extraction Optease Filter
5. Reconstruction IVC and iliac veins
– Venovo stents (BARD/ BD)

CLINICAL DATA
Pregnancy-induced right-sided iliofemoral DVT 01/2018
Conservative treatment with LMWH and compression stockings
Persistant venous claudication and leg swelling as well as lower abdominal pain with aggravation during menstruation cycle
Endovascular reconstruction of right ilio-femoral veins 11/2019 using Venovo & BlueFlow stents

PRESENT STATE
Follow-up in outpatient clinic 12/2019:
Leg symptoms completely resolved
Lower abdominal pain unchanged

IMAGING
Duplex: confirmed patency of venous stents
MR-imaging: enlarged ovarian veins

PROCEDURAL STEPS
1. Local anesthesia right jugular vein, supine position
2. Ultrasound-assisted access
– 5F sheath
3. Venography of ilio-femoral stents
4. Selective Valsalva venography left ovarian and parauterine veins
– 5F Kobra catheter (COOK)
5. Selective injection of Aethoxysclerol (3%) foam to parauterine veins during Valsalva
6. Coil embolization of left ovarian vein
– Nester 12 mm coils (COOK)
7. Final venogram to confirm ovarian vein occlusion